|
REMEDY MOD HUM HEAD LG RSHHLG
|
Facility
|
IP
|
$12,858.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,857.55 |
| Max. Negotiated Rate |
$12,344.16 |
| Rate for Payer: Aetna Commercial |
$9,901.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,029.63
|
| Rate for Payer: Cash Price |
$6,429.25
|
| Rate for Payer: Cigna Commercial |
$10,672.56
|
| Rate for Payer: First Health Commercial |
$12,215.58
|
| Rate for Payer: Humana Commercial |
$10,929.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,543.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,489.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,857.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,315.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,643.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,186.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,872.36
|
| Rate for Payer: PHCS Commercial |
$12,344.16
|
| Rate for Payer: United Healthcare All Payer |
$11,315.48
|
|
|
REMEDY MOD HUM HEAD LG RSHHLG
|
Facility
|
OP
|
$12,858.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,857.55 |
| Max. Negotiated Rate |
$12,344.16 |
| Rate for Payer: Aetna Commercial |
$9,901.05
|
| Rate for Payer: Anthem Medicaid |
$4,422.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,029.63
|
| Rate for Payer: Cash Price |
$6,429.25
|
| Rate for Payer: Cigna Commercial |
$10,672.56
|
| Rate for Payer: First Health Commercial |
$12,215.58
|
| Rate for Payer: Humana Commercial |
$10,929.73
|
| Rate for Payer: Humana KY Medicaid |
$4,422.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,467.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,543.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,489.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,857.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,510.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,315.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,643.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,186.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,872.36
|
| Rate for Payer: PHCS Commercial |
$12,344.16
|
| Rate for Payer: United Healthcare All Payer |
$11,315.48
|
|
|
REMEDY MOD HUM HEAD SM RSHHSM
|
Facility
|
OP
|
$15,870.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,761.00 |
| Max. Negotiated Rate |
$15,235.20 |
| Rate for Payer: Aetna Commercial |
$12,219.90
|
| Rate for Payer: Anthem Medicaid |
$5,457.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,378.60
|
| Rate for Payer: Cash Price |
$7,935.00
|
| Rate for Payer: Cigna Commercial |
$13,172.10
|
| Rate for Payer: First Health Commercial |
$15,076.50
|
| Rate for Payer: Humana Commercial |
$13,489.50
|
| Rate for Payer: Humana KY Medicaid |
$5,457.69
|
| Rate for Payer: Kentucky WC Medicaid |
$5,513.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,013.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,712.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,761.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,567.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,965.60
|
| Rate for Payer: Ohio Health Group HMO |
$11,902.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,696.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,806.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,950.30
|
| Rate for Payer: PHCS Commercial |
$15,235.20
|
| Rate for Payer: United Healthcare All Payer |
$13,965.60
|
|
|
REMEDY MOD HUM HEAD SM RSHHSM
|
Facility
|
IP
|
$15,870.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,761.00 |
| Max. Negotiated Rate |
$15,235.20 |
| Rate for Payer: Aetna Commercial |
$12,219.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,378.60
|
| Rate for Payer: Cash Price |
$7,935.00
|
| Rate for Payer: Cigna Commercial |
$13,172.10
|
| Rate for Payer: First Health Commercial |
$15,076.50
|
| Rate for Payer: Humana Commercial |
$13,489.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,013.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,712.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,761.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,965.60
|
| Rate for Payer: Ohio Health Group HMO |
$11,902.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,696.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,806.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,950.30
|
| Rate for Payer: PHCS Commercial |
$15,235.20
|
| Rate for Payer: United Healthcare All Payer |
$13,965.60
|
|
|
REMEDY MOD HUM STEM LG RSHSLG
|
Facility
|
IP
|
$12,858.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,857.55 |
| Max. Negotiated Rate |
$12,344.16 |
| Rate for Payer: Aetna Commercial |
$9,901.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,029.63
|
| Rate for Payer: Cash Price |
$6,429.25
|
| Rate for Payer: Cigna Commercial |
$10,672.56
|
| Rate for Payer: First Health Commercial |
$12,215.58
|
| Rate for Payer: Humana Commercial |
$10,929.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,543.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,489.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,857.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,315.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,643.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,186.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,872.36
|
| Rate for Payer: PHCS Commercial |
$12,344.16
|
| Rate for Payer: United Healthcare All Payer |
$11,315.48
|
|
|
REMEDY MOD HUM STEM LG RSHSLG
|
Facility
|
OP
|
$12,858.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,857.55 |
| Max. Negotiated Rate |
$12,344.16 |
| Rate for Payer: Aetna Commercial |
$9,901.05
|
| Rate for Payer: Anthem Medicaid |
$4,422.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,029.63
|
| Rate for Payer: Cash Price |
$6,429.25
|
| Rate for Payer: Cigna Commercial |
$10,672.56
|
| Rate for Payer: First Health Commercial |
$12,215.58
|
| Rate for Payer: Humana Commercial |
$10,929.73
|
| Rate for Payer: Humana KY Medicaid |
$4,422.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,467.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,543.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,489.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,857.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,510.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,315.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,643.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,186.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,872.36
|
| Rate for Payer: PHCS Commercial |
$12,344.16
|
| Rate for Payer: United Healthcare All Payer |
$11,315.48
|
|
|
REMEDY MOD HUM STEM MD RSHSMD
|
Facility
|
OP
|
$12,858.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,857.55 |
| Max. Negotiated Rate |
$12,344.16 |
| Rate for Payer: Aetna Commercial |
$9,901.05
|
| Rate for Payer: Anthem Medicaid |
$4,422.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,029.63
|
| Rate for Payer: Cash Price |
$6,429.25
|
| Rate for Payer: Cigna Commercial |
$10,672.56
|
| Rate for Payer: First Health Commercial |
$12,215.58
|
| Rate for Payer: Humana Commercial |
$10,929.73
|
| Rate for Payer: Humana KY Medicaid |
$4,422.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,467.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,543.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,489.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,857.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,510.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,315.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,643.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,186.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,872.36
|
| Rate for Payer: PHCS Commercial |
$12,344.16
|
| Rate for Payer: United Healthcare All Payer |
$11,315.48
|
|
|
REMEDY MOD HUM STEM MD RSHSMD
|
Facility
|
IP
|
$12,858.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,857.55 |
| Max. Negotiated Rate |
$12,344.16 |
| Rate for Payer: Aetna Commercial |
$9,901.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,029.63
|
| Rate for Payer: Cash Price |
$6,429.25
|
| Rate for Payer: Cigna Commercial |
$10,672.56
|
| Rate for Payer: First Health Commercial |
$12,215.58
|
| Rate for Payer: Humana Commercial |
$10,929.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,543.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,489.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,857.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,315.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,643.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,186.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,872.36
|
| Rate for Payer: PHCS Commercial |
$12,344.16
|
| Rate for Payer: United Healthcare All Payer |
$11,315.48
|
|
|
REMEDY MOD HUM STEM SM RSHSSM
|
Facility
|
IP
|
$12,858.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,857.55 |
| Max. Negotiated Rate |
$12,344.16 |
| Rate for Payer: Aetna Commercial |
$9,901.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,029.63
|
| Rate for Payer: Cash Price |
$6,429.25
|
| Rate for Payer: Cigna Commercial |
$10,672.56
|
| Rate for Payer: First Health Commercial |
$12,215.58
|
| Rate for Payer: Humana Commercial |
$10,929.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,543.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,489.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,857.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,315.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,643.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,186.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,872.36
|
| Rate for Payer: PHCS Commercial |
$12,344.16
|
| Rate for Payer: United Healthcare All Payer |
$11,315.48
|
|
|
REMEDY MOD HUM STEM SM RSHSSM
|
Facility
|
OP
|
$12,858.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,857.55 |
| Max. Negotiated Rate |
$12,344.16 |
| Rate for Payer: Aetna Commercial |
$9,901.05
|
| Rate for Payer: Anthem Medicaid |
$4,422.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,029.63
|
| Rate for Payer: Cash Price |
$6,429.25
|
| Rate for Payer: Cigna Commercial |
$10,672.56
|
| Rate for Payer: First Health Commercial |
$12,215.58
|
| Rate for Payer: Humana Commercial |
$10,929.73
|
| Rate for Payer: Humana KY Medicaid |
$4,422.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,467.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,543.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,489.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,857.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,510.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,315.48
|
| Rate for Payer: Ohio Health Group HMO |
$9,643.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,286.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,186.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,872.36
|
| Rate for Payer: PHCS Commercial |
$12,344.16
|
| Rate for Payer: United Healthcare All Payer |
$11,315.48
|
|
|
REMEDY MOD LONG STEM LG
|
Facility
|
IP
|
$9,570.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,871.00 |
| Max. Negotiated Rate |
$9,187.20 |
| Rate for Payer: Aetna Commercial |
$7,368.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,464.60
|
| Rate for Payer: Cash Price |
$4,785.00
|
| Rate for Payer: Cigna Commercial |
$7,943.10
|
| Rate for Payer: First Health Commercial |
$9,091.50
|
| Rate for Payer: Humana Commercial |
$8,134.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,847.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,062.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,871.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,421.60
|
| Rate for Payer: Ohio Health Group HMO |
$7,177.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,325.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,603.30
|
| Rate for Payer: PHCS Commercial |
$9,187.20
|
| Rate for Payer: United Healthcare All Payer |
$8,421.60
|
|
|
REMEDY MOD LONG STEM LG
|
Facility
|
OP
|
$9,570.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,871.00 |
| Max. Negotiated Rate |
$9,187.20 |
| Rate for Payer: Aetna Commercial |
$7,368.90
|
| Rate for Payer: Anthem Medicaid |
$3,291.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,464.60
|
| Rate for Payer: Cash Price |
$4,785.00
|
| Rate for Payer: Cigna Commercial |
$7,943.10
|
| Rate for Payer: First Health Commercial |
$9,091.50
|
| Rate for Payer: Humana Commercial |
$8,134.50
|
| Rate for Payer: Humana KY Medicaid |
$3,291.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,324.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,847.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,062.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,871.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,357.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,421.60
|
| Rate for Payer: Ohio Health Group HMO |
$7,177.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,325.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,603.30
|
| Rate for Payer: PHCS Commercial |
$9,187.20
|
| Rate for Payer: United Healthcare All Payer |
$8,421.60
|
|
|
REMEDY MOD LONG STEM MD
|
Facility
|
IP
|
$9,570.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,871.00 |
| Max. Negotiated Rate |
$9,187.20 |
| Rate for Payer: Aetna Commercial |
$7,368.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,464.60
|
| Rate for Payer: Cash Price |
$4,785.00
|
| Rate for Payer: Cigna Commercial |
$7,943.10
|
| Rate for Payer: First Health Commercial |
$9,091.50
|
| Rate for Payer: Humana Commercial |
$8,134.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,847.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,062.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,871.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,421.60
|
| Rate for Payer: Ohio Health Group HMO |
$7,177.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,325.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,603.30
|
| Rate for Payer: PHCS Commercial |
$9,187.20
|
| Rate for Payer: United Healthcare All Payer |
$8,421.60
|
|
|
REMEDY MOD LONG STEM MD
|
Facility
|
OP
|
$9,570.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,871.00 |
| Max. Negotiated Rate |
$9,187.20 |
| Rate for Payer: Aetna Commercial |
$7,368.90
|
| Rate for Payer: Anthem Medicaid |
$3,291.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,464.60
|
| Rate for Payer: Cash Price |
$4,785.00
|
| Rate for Payer: Cigna Commercial |
$7,943.10
|
| Rate for Payer: First Health Commercial |
$9,091.50
|
| Rate for Payer: Humana Commercial |
$8,134.50
|
| Rate for Payer: Humana KY Medicaid |
$3,291.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,324.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,847.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,062.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,871.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,357.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,421.60
|
| Rate for Payer: Ohio Health Group HMO |
$7,177.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,325.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,603.30
|
| Rate for Payer: PHCS Commercial |
$9,187.20
|
| Rate for Payer: United Healthcare All Payer |
$8,421.60
|
|
|
REMEDY MOD LONG STEM SMALL
|
Facility
|
OP
|
$9,570.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,871.00 |
| Max. Negotiated Rate |
$9,187.20 |
| Rate for Payer: Aetna Commercial |
$7,368.90
|
| Rate for Payer: Anthem Medicaid |
$3,291.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,464.60
|
| Rate for Payer: Cash Price |
$4,785.00
|
| Rate for Payer: Cigna Commercial |
$7,943.10
|
| Rate for Payer: First Health Commercial |
$9,091.50
|
| Rate for Payer: Humana Commercial |
$8,134.50
|
| Rate for Payer: Humana KY Medicaid |
$3,291.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,324.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,847.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,062.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,871.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,357.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,421.60
|
| Rate for Payer: Ohio Health Group HMO |
$7,177.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,325.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,603.30
|
| Rate for Payer: PHCS Commercial |
$9,187.20
|
| Rate for Payer: United Healthcare All Payer |
$8,421.60
|
|
|
REMEDY MOD LONG STEM SMALL
|
Facility
|
IP
|
$9,570.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,871.00 |
| Max. Negotiated Rate |
$9,187.20 |
| Rate for Payer: Aetna Commercial |
$7,368.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,464.60
|
| Rate for Payer: Cash Price |
$4,785.00
|
| Rate for Payer: Cigna Commercial |
$7,943.10
|
| Rate for Payer: First Health Commercial |
$9,091.50
|
| Rate for Payer: Humana Commercial |
$8,134.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,847.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,062.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,871.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,421.60
|
| Rate for Payer: Ohio Health Group HMO |
$7,177.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,325.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,603.30
|
| Rate for Payer: PHCS Commercial |
$9,187.20
|
| Rate for Payer: United Healthcare All Payer |
$8,421.60
|
|
|
REMEDY SPECGV FEM STEM LONG LG
|
Facility
|
IP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
REMEDY SPECGV FEM STEM LONG LG
|
Facility
|
OP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem Medicaid |
$4,106.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Humana KY Medicaid |
$4,106.51
|
| Rate for Payer: Kentucky WC Medicaid |
$4,148.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,188.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
REMEDY SPECGV FEM STEM LONG MD
|
Facility
|
IP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
REMEDY SPECGV FEM STEM LONG MD
|
Facility
|
OP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem Medicaid |
$4,106.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Humana KY Medicaid |
$4,106.51
|
| Rate for Payer: Kentucky WC Medicaid |
$4,148.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,188.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
REMEDY SPECGV FEM STEM LONG SM
|
Facility
|
IP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
REMEDY SPECGV FEM STEM LONG SM
|
Facility
|
OP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem Medicaid |
$4,106.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Humana KY Medicaid |
$4,106.51
|
| Rate for Payer: Kentucky WC Medicaid |
$4,148.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,188.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
REMEDY SPECTRUM GV FEM HEAD 46
|
Facility
|
IP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
REMEDY SPECTRUM GV FEM HEAD 46
|
Facility
|
OP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem Medicaid |
$4,106.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Humana KY Medicaid |
$4,106.51
|
| Rate for Payer: Kentucky WC Medicaid |
$4,148.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,188.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
REMEDY SPECTRUM GV FEM HEAD 54
|
Facility
|
OP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem Medicaid |
$4,106.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Humana KY Medicaid |
$4,106.51
|
| Rate for Payer: Kentucky WC Medicaid |
$4,148.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,188.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
