|
R3 20DEG 32ID DISP TRLLNR 58OD
|
Facility
|
OP
|
$1,542.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem Medicaid |
$530.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Humana KY Medicaid |
$530.29
|
| Rate for Payer: Kentucky WC Medicaid |
$535.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$540.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
R3 20DEG 32ID DISP TRLLNR 58OD
|
Facility
|
IP
|
$1,542.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
R3 20DEG 32ID DISP TRLLNR 60OD
|
Facility
|
IP
|
$1,542.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
R3 20DEG 32ID DISP TRLLNR 60OD
|
Facility
|
OP
|
$1,542.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem Medicaid |
$530.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Humana KY Medicaid |
$530.29
|
| Rate for Payer: Kentucky WC Medicaid |
$535.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$540.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
R3 20DEG 32ID DISP TRLLNR 62OD
|
Facility
|
IP
|
$1,542.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
R3 20DEG 32ID DISP TRLLNR 62OD
|
Facility
|
OP
|
$1,542.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem Medicaid |
$530.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Humana KY Medicaid |
$530.29
|
| Rate for Payer: Kentucky WC Medicaid |
$535.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$540.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
R3 20 DEG 32MM XLPE 50MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
R3 20 DEG 32MM XLPE 50MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
R3 20 DEG 32MM XLPE 52MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
R3 20 DEG 32MM XLPE 52MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
R3 20 DEG 32MM XLPE 54MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
R3 20 DEG 32MM XLPE 54MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
R3 20 DEG 32MM XLPE 56MM
|
Facility
|
OP
|
$11,195.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,358.80 |
| Max. Negotiated Rate |
$10,748.15 |
| Rate for Payer: Aetna Commercial |
$8,620.91
|
| Rate for Payer: Anthem Medicaid |
$3,850.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,732.87
|
| Rate for Payer: Cash Price |
$5,598.00
|
| Rate for Payer: Cigna Commercial |
$9,292.67
|
| Rate for Payer: First Health Commercial |
$10,636.19
|
| Rate for Payer: Humana Commercial |
$9,516.59
|
| Rate for Payer: Humana KY Medicaid |
$3,850.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,889.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,180.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,262.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,927.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,852.47
|
| Rate for Payer: Ohio Health Group HMO |
$8,396.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,956.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,740.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,725.23
|
| Rate for Payer: PHCS Commercial |
$10,748.15
|
| Rate for Payer: United Healthcare All Payer |
$9,852.47
|
|
|
R3 20 DEG 32MM XLPE 56MM
|
Facility
|
IP
|
$11,195.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,358.80 |
| Max. Negotiated Rate |
$10,748.15 |
| Rate for Payer: Aetna Commercial |
$8,620.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,732.87
|
| Rate for Payer: Cash Price |
$5,598.00
|
| Rate for Payer: Cigna Commercial |
$9,292.67
|
| Rate for Payer: First Health Commercial |
$10,636.19
|
| Rate for Payer: Humana Commercial |
$9,516.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,180.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,262.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,852.47
|
| Rate for Payer: Ohio Health Group HMO |
$8,396.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,956.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,740.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,725.23
|
| Rate for Payer: PHCS Commercial |
$10,748.15
|
| Rate for Payer: United Healthcare All Payer |
$9,852.47
|
|
|
R3 20 DEG 32MM XLPE 58MM
|
Facility
|
IP
|
$11,195.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,358.80 |
| Max. Negotiated Rate |
$10,748.15 |
| Rate for Payer: Aetna Commercial |
$8,620.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,732.87
|
| Rate for Payer: Cash Price |
$5,598.00
|
| Rate for Payer: Cigna Commercial |
$9,292.67
|
| Rate for Payer: First Health Commercial |
$10,636.19
|
| Rate for Payer: Humana Commercial |
$9,516.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,180.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,262.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,852.47
|
| Rate for Payer: Ohio Health Group HMO |
$8,396.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,956.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,740.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,725.23
|
| Rate for Payer: PHCS Commercial |
$10,748.15
|
| Rate for Payer: United Healthcare All Payer |
$9,852.47
|
|
|
R3 20 DEG 32MM XLPE 58MM
|
Facility
|
OP
|
$11,195.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,358.80 |
| Max. Negotiated Rate |
$10,748.15 |
| Rate for Payer: Aetna Commercial |
$8,620.91
|
| Rate for Payer: Anthem Medicaid |
$3,850.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,732.87
|
| Rate for Payer: Cash Price |
$5,598.00
|
| Rate for Payer: Cigna Commercial |
$9,292.67
|
| Rate for Payer: First Health Commercial |
$10,636.19
|
| Rate for Payer: Humana Commercial |
$9,516.59
|
| Rate for Payer: Humana KY Medicaid |
$3,850.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,889.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,180.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,262.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,927.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,852.47
|
| Rate for Payer: Ohio Health Group HMO |
$8,396.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,956.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,740.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,725.23
|
| Rate for Payer: PHCS Commercial |
$10,748.15
|
| Rate for Payer: United Healthcare All Payer |
$9,852.47
|
|
|
R3 20 DEG 32MM XLPE 60MM
|
Facility
|
IP
|
$11,195.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,358.80 |
| Max. Negotiated Rate |
$10,748.15 |
| Rate for Payer: Aetna Commercial |
$8,620.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,732.87
|
| Rate for Payer: Cash Price |
$5,598.00
|
| Rate for Payer: Cigna Commercial |
$9,292.67
|
| Rate for Payer: First Health Commercial |
$10,636.19
|
| Rate for Payer: Humana Commercial |
$9,516.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,180.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,262.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,852.47
|
| Rate for Payer: Ohio Health Group HMO |
$8,396.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,956.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,740.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,725.23
|
| Rate for Payer: PHCS Commercial |
$10,748.15
|
| Rate for Payer: United Healthcare All Payer |
$9,852.47
|
|
|
R3 20 DEG 32MM XLPE 60MM
|
Facility
|
OP
|
$11,195.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,358.80 |
| Max. Negotiated Rate |
$10,748.15 |
| Rate for Payer: Aetna Commercial |
$8,620.91
|
| Rate for Payer: Anthem Medicaid |
$3,850.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,732.87
|
| Rate for Payer: Cash Price |
$5,598.00
|
| Rate for Payer: Cigna Commercial |
$9,292.67
|
| Rate for Payer: First Health Commercial |
$10,636.19
|
| Rate for Payer: Humana Commercial |
$9,516.59
|
| Rate for Payer: Humana KY Medicaid |
$3,850.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,889.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,180.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,262.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,927.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,852.47
|
| Rate for Payer: Ohio Health Group HMO |
$8,396.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,956.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,740.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,725.23
|
| Rate for Payer: PHCS Commercial |
$10,748.15
|
| Rate for Payer: United Healthcare All Payer |
$9,852.47
|
|
|
R3 20DEG 36ID DISP TRLLNR 52OD
|
Facility
|
OP
|
$766.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.95 |
| Max. Negotiated Rate |
$735.84 |
| Rate for Payer: Aetna Commercial |
$590.21
|
| Rate for Payer: Anthem Medicaid |
$263.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$597.87
|
| Rate for Payer: Cash Price |
$383.25
|
| Rate for Payer: Cigna Commercial |
$636.20
|
| Rate for Payer: First Health Commercial |
$728.17
|
| Rate for Payer: Humana Commercial |
$651.52
|
| Rate for Payer: Humana KY Medicaid |
$263.60
|
| Rate for Payer: Kentucky WC Medicaid |
$266.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$628.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$565.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$229.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$268.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$674.52
|
| Rate for Payer: Ohio Health Group HMO |
$574.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$613.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$666.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$528.88
|
| Rate for Payer: PHCS Commercial |
$735.84
|
| Rate for Payer: United Healthcare All Payer |
$674.52
|
|
|
R3 20DEG 36ID DISP TRLLNR 52OD
|
Facility
|
IP
|
$766.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.95 |
| Max. Negotiated Rate |
$735.84 |
| Rate for Payer: Aetna Commercial |
$590.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$597.87
|
| Rate for Payer: Cash Price |
$383.25
|
| Rate for Payer: Cigna Commercial |
$636.20
|
| Rate for Payer: First Health Commercial |
$728.17
|
| Rate for Payer: Humana Commercial |
$651.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$628.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$565.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$229.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$674.52
|
| Rate for Payer: Ohio Health Group HMO |
$574.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$613.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$666.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$528.88
|
| Rate for Payer: PHCS Commercial |
$735.84
|
| Rate for Payer: United Healthcare All Payer |
$674.52
|
|
|
R3 20DEG 36ID DISP TRLLNR 54OD
|
Facility
|
IP
|
$1,542.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
R3 20DEG 36ID DISP TRLLNR 54OD
|
Facility
|
OP
|
$1,542.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem Medicaid |
$530.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Humana KY Medicaid |
$530.29
|
| Rate for Payer: Kentucky WC Medicaid |
$535.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$540.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
R3 20DEG 36ID DISP TRLLNR 56OD
|
Facility
|
OP
|
$1,542.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem Medicaid |
$530.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Humana KY Medicaid |
$530.29
|
| Rate for Payer: Kentucky WC Medicaid |
$535.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$540.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
R3 20DEG 36ID DISP TRLLNR 56OD
|
Facility
|
IP
|
$1,542.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
R3 20DEG 36ID DISP TRLLNR 58OD
|
Facility
|
IP
|
$1,542.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
