|
BEARINGS PSN MC VE 13MM 12/J
|
Facility
|
IP
|
$8,165.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.52 |
| Max. Negotiated Rate |
$7,838.88 |
| Rate for Payer: Aetna Commercial |
$6,287.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,369.09
|
| Rate for Payer: Cash Price |
$4,082.75
|
| Rate for Payer: Cigna Commercial |
$6,777.36
|
| Rate for Payer: First Health Commercial |
$7,757.22
|
| Rate for Payer: Humana Commercial |
$6,940.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,695.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,026.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,449.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,185.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,124.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,531.30
|
| Rate for Payer: PHCS Commercial |
$7,838.88
|
| Rate for Payer: United Healthcare All Payer |
$7,185.64
|
|
|
BEARINGS PSN MC VE 13MM 12/J
|
Facility
|
OP
|
$8,165.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.52 |
| Max. Negotiated Rate |
$7,838.88 |
| Rate for Payer: Aetna Commercial |
$6,287.44
|
| Rate for Payer: Anthem Medicaid |
$2,808.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,369.09
|
| Rate for Payer: Cash Price |
$4,082.75
|
| Rate for Payer: Cigna Commercial |
$6,777.36
|
| Rate for Payer: First Health Commercial |
$7,757.22
|
| Rate for Payer: Humana Commercial |
$6,940.68
|
| Rate for Payer: Humana KY Medicaid |
$2,808.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,836.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,695.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,026.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,449.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,864.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,185.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,124.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,531.30
|
| Rate for Payer: PHCS Commercial |
$7,838.88
|
| Rate for Payer: United Healthcare All Payer |
$7,185.64
|
|
|
BEARINGS PSN MC VE 14MM 12/GH
|
Facility
|
IP
|
$8,165.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.52 |
| Max. Negotiated Rate |
$7,838.88 |
| Rate for Payer: Aetna Commercial |
$6,287.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,369.09
|
| Rate for Payer: Cash Price |
$4,082.75
|
| Rate for Payer: Cigna Commercial |
$6,777.36
|
| Rate for Payer: First Health Commercial |
$7,757.22
|
| Rate for Payer: Humana Commercial |
$6,940.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,695.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,026.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,449.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,185.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,124.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,531.30
|
| Rate for Payer: PHCS Commercial |
$7,838.88
|
| Rate for Payer: United Healthcare All Payer |
$7,185.64
|
|
|
BEARINGS PSN MC VE 14MM 12/GH
|
Facility
|
OP
|
$8,165.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.52 |
| Max. Negotiated Rate |
$7,838.88 |
| Rate for Payer: Aetna Commercial |
$6,287.44
|
| Rate for Payer: Anthem Medicaid |
$2,808.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,369.09
|
| Rate for Payer: Cash Price |
$4,082.75
|
| Rate for Payer: Cigna Commercial |
$6,777.36
|
| Rate for Payer: First Health Commercial |
$7,757.22
|
| Rate for Payer: Humana Commercial |
$6,940.68
|
| Rate for Payer: Humana KY Medicaid |
$2,808.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,836.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,695.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,026.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,449.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,864.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,185.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,124.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,531.30
|
| Rate for Payer: PHCS Commercial |
$7,838.88
|
| Rate for Payer: United Healthcare All Payer |
$7,185.64
|
|
|
BEARINGS PSN MC VE 14MM 12/J
|
Facility
|
IP
|
$8,165.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.52 |
| Max. Negotiated Rate |
$7,838.88 |
| Rate for Payer: Aetna Commercial |
$6,287.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,369.09
|
| Rate for Payer: Cash Price |
$4,082.75
|
| Rate for Payer: Cigna Commercial |
$6,777.36
|
| Rate for Payer: First Health Commercial |
$7,757.22
|
| Rate for Payer: Humana Commercial |
$6,940.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,695.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,026.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,449.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,185.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,124.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,531.30
|
| Rate for Payer: PHCS Commercial |
$7,838.88
|
| Rate for Payer: United Healthcare All Payer |
$7,185.64
|
|
|
BEARINGS PSN MC VE 14MM 12/J
|
Facility
|
OP
|
$8,165.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.52 |
| Max. Negotiated Rate |
$7,838.88 |
| Rate for Payer: Aetna Commercial |
$6,287.44
|
| Rate for Payer: Anthem Medicaid |
$2,808.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,369.09
|
| Rate for Payer: Cash Price |
$4,082.75
|
| Rate for Payer: Cigna Commercial |
$6,777.36
|
| Rate for Payer: First Health Commercial |
$7,757.22
|
| Rate for Payer: Humana Commercial |
$6,940.68
|
| Rate for Payer: Humana KY Medicaid |
$2,808.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,836.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,695.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,026.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,449.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,864.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,185.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,124.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,531.30
|
| Rate for Payer: PHCS Commercial |
$7,838.88
|
| Rate for Payer: United Healthcare All Payer |
$7,185.64
|
|
|
BEARINGS PSN MC VE 16MM 12/GH
|
Facility
|
IP
|
$8,165.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.52 |
| Max. Negotiated Rate |
$7,838.88 |
| Rate for Payer: Aetna Commercial |
$6,287.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,369.09
|
| Rate for Payer: Cash Price |
$4,082.75
|
| Rate for Payer: Cigna Commercial |
$6,777.36
|
| Rate for Payer: First Health Commercial |
$7,757.22
|
| Rate for Payer: Humana Commercial |
$6,940.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,695.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,026.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,449.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,185.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,124.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,531.30
|
| Rate for Payer: PHCS Commercial |
$7,838.88
|
| Rate for Payer: United Healthcare All Payer |
$7,185.64
|
|
|
BEARINGS PSN MC VE 16MM 12/GH
|
Facility
|
OP
|
$8,165.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.52 |
| Max. Negotiated Rate |
$7,838.88 |
| Rate for Payer: Aetna Commercial |
$6,287.44
|
| Rate for Payer: Anthem Medicaid |
$2,808.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,369.09
|
| Rate for Payer: Cash Price |
$4,082.75
|
| Rate for Payer: Cigna Commercial |
$6,777.36
|
| Rate for Payer: First Health Commercial |
$7,757.22
|
| Rate for Payer: Humana Commercial |
$6,940.68
|
| Rate for Payer: Humana KY Medicaid |
$2,808.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,836.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,695.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,026.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,449.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,864.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,185.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,124.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,531.30
|
| Rate for Payer: PHCS Commercial |
$7,838.88
|
| Rate for Payer: United Healthcare All Payer |
$7,185.64
|
|
|
BEARINGS PSN MC VE 16MM 12/J
|
Facility
|
OP
|
$8,165.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.52 |
| Max. Negotiated Rate |
$7,838.88 |
| Rate for Payer: Aetna Commercial |
$6,287.44
|
| Rate for Payer: Anthem Medicaid |
$2,808.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,369.09
|
| Rate for Payer: Cash Price |
$4,082.75
|
| Rate for Payer: Cigna Commercial |
$6,777.36
|
| Rate for Payer: First Health Commercial |
$7,757.22
|
| Rate for Payer: Humana Commercial |
$6,940.68
|
| Rate for Payer: Humana KY Medicaid |
$2,808.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,836.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,695.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,026.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,449.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,864.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,185.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,124.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,531.30
|
| Rate for Payer: PHCS Commercial |
$7,838.88
|
| Rate for Payer: United Healthcare All Payer |
$7,185.64
|
|
|
BEARINGS PSN MC VE 16MM 12/J
|
Facility
|
IP
|
$8,165.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.52 |
| Max. Negotiated Rate |
$7,838.88 |
| Rate for Payer: Aetna Commercial |
$6,287.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,369.09
|
| Rate for Payer: Cash Price |
$4,082.75
|
| Rate for Payer: Cigna Commercial |
$6,777.36
|
| Rate for Payer: First Health Commercial |
$7,757.22
|
| Rate for Payer: Humana Commercial |
$6,940.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,695.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,026.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,449.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,185.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,124.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,531.30
|
| Rate for Payer: PHCS Commercial |
$7,838.88
|
| Rate for Payer: United Healthcare All Payer |
$7,185.64
|
|
|
BEARINGS PSN MC VE 18MM 12/GH
|
Facility
|
IP
|
$8,165.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.52 |
| Max. Negotiated Rate |
$7,838.88 |
| Rate for Payer: Aetna Commercial |
$6,287.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,369.09
|
| Rate for Payer: Cash Price |
$4,082.75
|
| Rate for Payer: Cigna Commercial |
$6,777.36
|
| Rate for Payer: First Health Commercial |
$7,757.22
|
| Rate for Payer: Humana Commercial |
$6,940.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,695.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,026.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,449.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,185.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,124.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,531.30
|
| Rate for Payer: PHCS Commercial |
$7,838.88
|
| Rate for Payer: United Healthcare All Payer |
$7,185.64
|
|
|
BEARINGS PSN MC VE 18MM 12/GH
|
Facility
|
OP
|
$8,165.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.52 |
| Max. Negotiated Rate |
$7,838.88 |
| Rate for Payer: Aetna Commercial |
$6,287.44
|
| Rate for Payer: Anthem Medicaid |
$2,808.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,369.09
|
| Rate for Payer: Cash Price |
$4,082.75
|
| Rate for Payer: Cigna Commercial |
$6,777.36
|
| Rate for Payer: First Health Commercial |
$7,757.22
|
| Rate for Payer: Humana Commercial |
$6,940.68
|
| Rate for Payer: Humana KY Medicaid |
$2,808.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,836.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,695.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,026.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,449.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,864.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,185.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,124.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,531.30
|
| Rate for Payer: PHCS Commercial |
$7,838.88
|
| Rate for Payer: United Healthcare All Payer |
$7,185.64
|
|
|
BEARINGS PSN MC VE 18MM 12/J
|
Facility
|
IP
|
$8,165.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.52 |
| Max. Negotiated Rate |
$7,838.88 |
| Rate for Payer: Aetna Commercial |
$6,287.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,369.09
|
| Rate for Payer: Cash Price |
$4,082.75
|
| Rate for Payer: Cigna Commercial |
$6,777.36
|
| Rate for Payer: First Health Commercial |
$7,757.22
|
| Rate for Payer: Humana Commercial |
$6,940.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,695.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,026.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,449.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,185.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,124.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,531.30
|
| Rate for Payer: PHCS Commercial |
$7,838.88
|
| Rate for Payer: United Healthcare All Payer |
$7,185.64
|
|
|
BEARINGS PSN MC VE 18MM 12/J
|
Facility
|
OP
|
$8,165.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.52 |
| Max. Negotiated Rate |
$7,838.88 |
| Rate for Payer: Aetna Commercial |
$6,287.44
|
| Rate for Payer: Anthem Medicaid |
$2,808.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,369.09
|
| Rate for Payer: Cash Price |
$4,082.75
|
| Rate for Payer: Cigna Commercial |
$6,777.36
|
| Rate for Payer: First Health Commercial |
$7,757.22
|
| Rate for Payer: Humana Commercial |
$6,940.68
|
| Rate for Payer: Humana KY Medicaid |
$2,808.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,836.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,695.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,026.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,449.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,864.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,185.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,124.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,531.30
|
| Rate for Payer: PHCS Commercial |
$7,838.88
|
| Rate for Payer: United Healthcare All Payer |
$7,185.64
|
|
|
BEARINGS PSN MCVE18MM 4-5/EF L
|
Facility
|
IP
|
$8,165.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.52 |
| Max. Negotiated Rate |
$7,838.88 |
| Rate for Payer: Aetna Commercial |
$6,287.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,369.09
|
| Rate for Payer: Cash Price |
$4,082.75
|
| Rate for Payer: Cigna Commercial |
$6,777.36
|
| Rate for Payer: First Health Commercial |
$7,757.22
|
| Rate for Payer: Humana Commercial |
$6,940.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,695.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,026.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,449.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,185.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,124.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,531.30
|
| Rate for Payer: PHCS Commercial |
$7,838.88
|
| Rate for Payer: United Healthcare All Payer |
$7,185.64
|
|
|
BEARINGS PSN MCVE18MM 4-5/EF L
|
Facility
|
OP
|
$8,165.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.52 |
| Max. Negotiated Rate |
$7,838.88 |
| Rate for Payer: Aetna Commercial |
$6,287.44
|
| Rate for Payer: Anthem Medicaid |
$2,808.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,369.09
|
| Rate for Payer: Cash Price |
$4,082.75
|
| Rate for Payer: Cigna Commercial |
$6,777.36
|
| Rate for Payer: First Health Commercial |
$7,757.22
|
| Rate for Payer: Humana Commercial |
$6,940.68
|
| Rate for Payer: Humana KY Medicaid |
$2,808.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,836.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,695.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,026.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,449.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,864.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,185.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,124.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,531.30
|
| Rate for Payer: PHCS Commercial |
$7,838.88
|
| Rate for Payer: United Healthcare All Payer |
$7,185.64
|
|
|
BEARINGS PSN MC VE 20MM 12/GH
|
Facility
|
OP
|
$8,165.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.52 |
| Max. Negotiated Rate |
$7,838.88 |
| Rate for Payer: Aetna Commercial |
$6,287.44
|
| Rate for Payer: Anthem Medicaid |
$2,808.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,369.09
|
| Rate for Payer: Cash Price |
$4,082.75
|
| Rate for Payer: Cigna Commercial |
$6,777.36
|
| Rate for Payer: First Health Commercial |
$7,757.22
|
| Rate for Payer: Humana Commercial |
$6,940.68
|
| Rate for Payer: Humana KY Medicaid |
$2,808.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,836.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,695.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,026.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,449.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,864.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,185.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,124.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,531.30
|
| Rate for Payer: PHCS Commercial |
$7,838.88
|
| Rate for Payer: United Healthcare All Payer |
$7,185.64
|
|
|
BEARINGS PSN MC VE 20MM 12/GH
|
Facility
|
IP
|
$8,165.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.52 |
| Max. Negotiated Rate |
$7,838.88 |
| Rate for Payer: Aetna Commercial |
$6,287.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,369.09
|
| Rate for Payer: Cash Price |
$4,082.75
|
| Rate for Payer: Cigna Commercial |
$6,777.36
|
| Rate for Payer: First Health Commercial |
$7,757.22
|
| Rate for Payer: Humana Commercial |
$6,940.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,695.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,026.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,449.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,185.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,124.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,531.30
|
| Rate for Payer: PHCS Commercial |
$7,838.88
|
| Rate for Payer: United Healthcare All Payer |
$7,185.64
|
|
|
BEARINGS PSN MC VE 20MM 12/J
|
Facility
|
IP
|
$8,165.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.52 |
| Max. Negotiated Rate |
$7,838.88 |
| Rate for Payer: Aetna Commercial |
$6,287.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,369.09
|
| Rate for Payer: Cash Price |
$4,082.75
|
| Rate for Payer: Cigna Commercial |
$6,777.36
|
| Rate for Payer: First Health Commercial |
$7,757.22
|
| Rate for Payer: Humana Commercial |
$6,940.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,695.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,026.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,449.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,185.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,124.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,531.30
|
| Rate for Payer: PHCS Commercial |
$7,838.88
|
| Rate for Payer: United Healthcare All Payer |
$7,185.64
|
|
|
BEARINGS PSN MC VE 20MM 12/J
|
Facility
|
OP
|
$8,165.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.52 |
| Max. Negotiated Rate |
$7,838.88 |
| Rate for Payer: Aetna Commercial |
$6,287.44
|
| Rate for Payer: Anthem Medicaid |
$2,808.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,369.09
|
| Rate for Payer: Cash Price |
$4,082.75
|
| Rate for Payer: Cigna Commercial |
$6,777.36
|
| Rate for Payer: First Health Commercial |
$7,757.22
|
| Rate for Payer: Humana Commercial |
$6,940.68
|
| Rate for Payer: Humana KY Medicaid |
$2,808.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,836.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,695.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,026.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,449.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,864.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,185.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,124.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,531.30
|
| Rate for Payer: PHCS Commercial |
$7,838.88
|
| Rate for Payer: United Healthcare All Payer |
$7,185.64
|
|
|
BEARNG E1 ANTIOX INFSD 28*44MM
|
Facility
|
IP
|
$13,421.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,744.79 |
| Max. Negotiated Rate |
$12,884.59 |
| Rate for Payer: Aetna Commercial |
$10,334.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,468.73
|
| Rate for Payer: Cash Price |
$6,710.73
|
| Rate for Payer: Cigna Commercial |
$11,139.80
|
| Rate for Payer: First Health Commercial |
$12,750.38
|
| Rate for Payer: Humana Commercial |
$11,408.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,005.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,905.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,026.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,810.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,066.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,684.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,744.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,160.65
|
| Rate for Payer: PHCS Commercial |
$12,884.59
|
| Rate for Payer: United Healthcare All Payer |
$11,810.88
|
|
|
BEARNG E1 ANTIOX INFSD 28*44MM
|
Facility
|
OP
|
$13,421.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,744.79 |
| Max. Negotiated Rate |
$12,884.59 |
| Rate for Payer: Aetna Commercial |
$10,334.52
|
| Rate for Payer: Anthem Medicaid |
$4,615.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,468.73
|
| Rate for Payer: Cash Price |
$6,710.73
|
| Rate for Payer: Cigna Commercial |
$11,139.80
|
| Rate for Payer: First Health Commercial |
$12,750.38
|
| Rate for Payer: Humana Commercial |
$11,408.23
|
| Rate for Payer: Humana KY Medicaid |
$4,615.64
|
| Rate for Payer: Kentucky WC Medicaid |
$4,662.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,005.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,905.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,026.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,708.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,810.88
|
| Rate for Payer: Ohio Health Group HMO |
$10,066.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,684.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,744.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,160.65
|
| Rate for Payer: PHCS Commercial |
$12,884.59
|
| Rate for Payer: United Healthcare All Payer |
$11,810.88
|
|
|
BEARNGS PSN MCVE 10MM 4-5/CD L
|
Facility
|
IP
|
$8,165.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.52 |
| Max. Negotiated Rate |
$7,838.88 |
| Rate for Payer: Aetna Commercial |
$6,287.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,369.09
|
| Rate for Payer: Cash Price |
$4,082.75
|
| Rate for Payer: Cigna Commercial |
$6,777.36
|
| Rate for Payer: First Health Commercial |
$7,757.22
|
| Rate for Payer: Humana Commercial |
$6,940.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,695.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,026.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,449.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,185.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,124.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,531.30
|
| Rate for Payer: PHCS Commercial |
$7,838.88
|
| Rate for Payer: United Healthcare All Payer |
$7,185.64
|
|
|
BEARNGS PSN MCVE 10MM 4-5/CD L
|
Facility
|
OP
|
$8,165.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.52 |
| Max. Negotiated Rate |
$7,838.88 |
| Rate for Payer: Aetna Commercial |
$6,287.44
|
| Rate for Payer: Anthem Medicaid |
$2,808.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,369.09
|
| Rate for Payer: Cash Price |
$4,082.75
|
| Rate for Payer: Cigna Commercial |
$6,777.36
|
| Rate for Payer: First Health Commercial |
$7,757.22
|
| Rate for Payer: Humana Commercial |
$6,940.68
|
| Rate for Payer: Humana KY Medicaid |
$2,808.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,836.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,695.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,026.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,449.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,864.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,185.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,124.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,531.30
|
| Rate for Payer: PHCS Commercial |
$7,838.88
|
| Rate for Payer: United Healthcare All Payer |
$7,185.64
|
|
|
BEARNGS PSN MCVE 10MM 4-5/CD R
|
Facility
|
OP
|
$8,165.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.52 |
| Max. Negotiated Rate |
$7,838.88 |
| Rate for Payer: Aetna Commercial |
$6,287.44
|
| Rate for Payer: Anthem Medicaid |
$2,808.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,369.09
|
| Rate for Payer: Cash Price |
$4,082.75
|
| Rate for Payer: Cigna Commercial |
$6,777.36
|
| Rate for Payer: First Health Commercial |
$7,757.22
|
| Rate for Payer: Humana Commercial |
$6,940.68
|
| Rate for Payer: Humana KY Medicaid |
$2,808.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,836.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,695.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,026.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,449.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,864.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,185.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,124.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,531.30
|
| Rate for Payer: PHCS Commercial |
$7,838.88
|
| Rate for Payer: United Healthcare All Payer |
$7,185.64
|
|
