|
BHR 2MM ACE CUP HAP SZ 40/48
|
Facility
|
IP
|
$20,622.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,680.96 |
| Max. Negotiated Rate |
$19,797.84 |
| Rate for Payer: Aetna Commercial |
$15,879.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,085.74
|
| Rate for Payer: Cash Price |
$10,311.38
|
| Rate for Payer: Cigna Commercial |
$17,116.88
|
| Rate for Payer: First Health Commercial |
$19,591.61
|
| Rate for Payer: Humana Commercial |
$17,529.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,910.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,219.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,186.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,148.02
|
| Rate for Payer: Ohio Health Group HMO |
$15,467.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,124.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,680.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,393.05
|
| Rate for Payer: PHCS Commercial |
$19,797.84
|
| Rate for Payer: United Healthcare All Payer |
$18,148.02
|
|
|
BHR 2MM ACE CUP HAP SZ 44/50
|
Facility
|
IP
|
$20,622.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,680.96 |
| Max. Negotiated Rate |
$19,797.84 |
| Rate for Payer: Aetna Commercial |
$15,879.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,085.74
|
| Rate for Payer: Cash Price |
$10,311.38
|
| Rate for Payer: Cigna Commercial |
$17,116.88
|
| Rate for Payer: First Health Commercial |
$19,591.61
|
| Rate for Payer: Humana Commercial |
$17,529.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,910.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,219.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,186.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,148.02
|
| Rate for Payer: Ohio Health Group HMO |
$15,467.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,124.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,680.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,393.05
|
| Rate for Payer: PHCS Commercial |
$19,797.84
|
| Rate for Payer: United Healthcare All Payer |
$18,148.02
|
|
|
BHR 2MM ACE CUP HAP SZ 44/50
|
Facility
|
OP
|
$20,622.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,680.96 |
| Max. Negotiated Rate |
$19,797.84 |
| Rate for Payer: Aetna Commercial |
$15,879.52
|
| Rate for Payer: Anthem Medicaid |
$7,092.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,085.74
|
| Rate for Payer: Cash Price |
$10,311.38
|
| Rate for Payer: Cigna Commercial |
$17,116.88
|
| Rate for Payer: First Health Commercial |
$19,591.61
|
| Rate for Payer: Humana Commercial |
$17,529.34
|
| Rate for Payer: Humana KY Medicaid |
$7,092.16
|
| Rate for Payer: Kentucky WC Medicaid |
$7,164.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,910.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,219.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,186.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,234.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,148.02
|
| Rate for Payer: Ohio Health Group HMO |
$15,467.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,124.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,680.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,393.05
|
| Rate for Payer: PHCS Commercial |
$19,797.84
|
| Rate for Payer: United Healthcare All Payer |
$18,148.02
|
|
|
BHR 2MM ACE CUP HAP SZ 52/48
|
Facility
|
IP
|
$20,622.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,680.96 |
| Max. Negotiated Rate |
$19,797.84 |
| Rate for Payer: Aetna Commercial |
$15,879.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,085.74
|
| Rate for Payer: Cash Price |
$10,311.38
|
| Rate for Payer: Cigna Commercial |
$17,116.88
|
| Rate for Payer: First Health Commercial |
$19,591.61
|
| Rate for Payer: Humana Commercial |
$17,529.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,910.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,219.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,186.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,148.02
|
| Rate for Payer: Ohio Health Group HMO |
$15,467.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,124.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,680.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,393.05
|
| Rate for Payer: PHCS Commercial |
$19,797.84
|
| Rate for Payer: United Healthcare All Payer |
$18,148.02
|
|
|
BHR 2MM ACE CUP HAP SZ 52/48
|
Facility
|
OP
|
$20,622.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,680.96 |
| Max. Negotiated Rate |
$19,797.84 |
| Rate for Payer: Aetna Commercial |
$15,879.52
|
| Rate for Payer: Anthem Medicaid |
$7,092.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,085.74
|
| Rate for Payer: Cash Price |
$10,311.38
|
| Rate for Payer: Cigna Commercial |
$17,116.88
|
| Rate for Payer: First Health Commercial |
$19,591.61
|
| Rate for Payer: Humana Commercial |
$17,529.34
|
| Rate for Payer: Humana KY Medicaid |
$7,092.16
|
| Rate for Payer: Kentucky WC Medicaid |
$7,164.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,910.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,219.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,186.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,234.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,148.02
|
| Rate for Payer: Ohio Health Group HMO |
$15,467.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,124.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,680.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,393.05
|
| Rate for Payer: PHCS Commercial |
$19,797.84
|
| Rate for Payer: United Healthcare All Payer |
$18,148.02
|
|
|
BHR 2MM ACE CUP HAP SZ 52/60
|
Facility
|
IP
|
$20,622.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,680.96 |
| Max. Negotiated Rate |
$19,797.84 |
| Rate for Payer: Aetna Commercial |
$15,879.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,085.74
|
| Rate for Payer: Cash Price |
$10,311.38
|
| Rate for Payer: Cigna Commercial |
$17,116.88
|
| Rate for Payer: First Health Commercial |
$19,591.61
|
| Rate for Payer: Humana Commercial |
$17,529.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,910.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,219.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,186.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,148.02
|
| Rate for Payer: Ohio Health Group HMO |
$15,467.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,124.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,680.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,393.05
|
| Rate for Payer: PHCS Commercial |
$19,797.84
|
| Rate for Payer: United Healthcare All Payer |
$18,148.02
|
|
|
BHR 2MM ACE CUP HAP SZ 52/60
|
Facility
|
OP
|
$20,622.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,680.96 |
| Max. Negotiated Rate |
$19,797.84 |
| Rate for Payer: Aetna Commercial |
$15,879.52
|
| Rate for Payer: Anthem Medicaid |
$7,092.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,085.74
|
| Rate for Payer: Cash Price |
$10,311.38
|
| Rate for Payer: Cigna Commercial |
$17,116.88
|
| Rate for Payer: First Health Commercial |
$19,591.61
|
| Rate for Payer: Humana Commercial |
$17,529.34
|
| Rate for Payer: Humana KY Medicaid |
$7,092.16
|
| Rate for Payer: Kentucky WC Medicaid |
$7,164.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,910.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,219.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,186.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,234.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,148.02
|
| Rate for Payer: Ohio Health Group HMO |
$15,467.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,124.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,680.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,393.05
|
| Rate for Payer: PHCS Commercial |
$19,797.84
|
| Rate for Payer: United Healthcare All Payer |
$18,148.02
|
|
|
BHR 2MM ACE CUP HAP SZ 56/62
|
Facility
|
OP
|
$20,622.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,680.96 |
| Max. Negotiated Rate |
$19,797.84 |
| Rate for Payer: Aetna Commercial |
$15,879.52
|
| Rate for Payer: Anthem Medicaid |
$7,092.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,085.74
|
| Rate for Payer: Cash Price |
$10,311.38
|
| Rate for Payer: Cigna Commercial |
$17,116.88
|
| Rate for Payer: First Health Commercial |
$19,591.61
|
| Rate for Payer: Humana Commercial |
$17,529.34
|
| Rate for Payer: Humana KY Medicaid |
$7,092.16
|
| Rate for Payer: Kentucky WC Medicaid |
$7,164.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,910.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,219.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,186.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,234.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,148.02
|
| Rate for Payer: Ohio Health Group HMO |
$15,467.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,124.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,680.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,393.05
|
| Rate for Payer: PHCS Commercial |
$19,797.84
|
| Rate for Payer: United Healthcare All Payer |
$18,148.02
|
|
|
BHR 2MM ACE CUP HAP SZ 56/62
|
Facility
|
IP
|
$20,622.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,680.96 |
| Max. Negotiated Rate |
$19,797.84 |
| Rate for Payer: Aetna Commercial |
$15,879.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,085.74
|
| Rate for Payer: Cash Price |
$10,311.38
|
| Rate for Payer: Cigna Commercial |
$17,116.88
|
| Rate for Payer: First Health Commercial |
$19,591.61
|
| Rate for Payer: Humana Commercial |
$17,529.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,910.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,219.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,186.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,148.02
|
| Rate for Payer: Ohio Health Group HMO |
$15,467.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,124.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,680.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,393.05
|
| Rate for Payer: PHCS Commercial |
$19,797.84
|
| Rate for Payer: United Healthcare All Payer |
$18,148.02
|
|
|
BHR 2MM ACE CUP HAP SZ 56/64
|
Facility
|
OP
|
$20,622.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,680.96 |
| Max. Negotiated Rate |
$19,797.84 |
| Rate for Payer: Aetna Commercial |
$15,879.52
|
| Rate for Payer: Anthem Medicaid |
$7,092.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,085.74
|
| Rate for Payer: Cash Price |
$10,311.38
|
| Rate for Payer: Cigna Commercial |
$17,116.88
|
| Rate for Payer: First Health Commercial |
$19,591.61
|
| Rate for Payer: Humana Commercial |
$17,529.34
|
| Rate for Payer: Humana KY Medicaid |
$7,092.16
|
| Rate for Payer: Kentucky WC Medicaid |
$7,164.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,910.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,219.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,186.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,234.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,148.02
|
| Rate for Payer: Ohio Health Group HMO |
$15,467.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,124.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,680.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,393.05
|
| Rate for Payer: PHCS Commercial |
$19,797.84
|
| Rate for Payer: United Healthcare All Payer |
$18,148.02
|
|
|
BHR 2MM ACE CUP HAP SZ 56/64
|
Facility
|
IP
|
$20,622.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,680.96 |
| Max. Negotiated Rate |
$19,797.84 |
| Rate for Payer: Aetna Commercial |
$15,879.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,085.74
|
| Rate for Payer: Cash Price |
$10,311.38
|
| Rate for Payer: Cigna Commercial |
$17,116.88
|
| Rate for Payer: First Health Commercial |
$19,591.61
|
| Rate for Payer: Humana Commercial |
$17,529.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,910.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,219.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,186.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,148.02
|
| Rate for Payer: Ohio Health Group HMO |
$15,467.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,124.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,680.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,393.05
|
| Rate for Payer: PHCS Commercial |
$19,797.84
|
| Rate for Payer: United Healthcare All Payer |
$18,148.02
|
|
|
BHR 2MM FEMEROL HEAD 56MM
|
Facility
|
OP
|
$23,980.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,117.50 |
| Max. Negotiated Rate |
$23,021.52 |
| Rate for Payer: Aetna Commercial |
$18,465.18
|
| Rate for Payer: Anthem Medicaid |
$8,246.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,704.98
|
| Rate for Payer: Cash Price |
$11,990.38
|
| Rate for Payer: Cigna Commercial |
$19,904.02
|
| Rate for Payer: First Health Commercial |
$22,781.71
|
| Rate for Payer: Humana Commercial |
$20,383.64
|
| Rate for Payer: Humana KY Medicaid |
$8,246.98
|
| Rate for Payer: Kentucky WC Medicaid |
$8,330.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,664.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,697.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,194.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,412.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,103.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,985.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,796.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,117.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,434.03
|
| Rate for Payer: PHCS Commercial |
$23,021.52
|
| Rate for Payer: United Healthcare All Payer |
$21,103.06
|
|
|
BHR 2MM FEMEROL HEAD 56MM
|
Facility
|
IP
|
$23,980.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,117.50 |
| Max. Negotiated Rate |
$23,021.52 |
| Rate for Payer: Aetna Commercial |
$18,465.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,704.98
|
| Rate for Payer: Cash Price |
$11,990.38
|
| Rate for Payer: Cigna Commercial |
$19,904.02
|
| Rate for Payer: First Health Commercial |
$22,781.71
|
| Rate for Payer: Humana Commercial |
$20,383.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,664.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,697.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,194.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,103.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,985.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,796.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,117.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,434.03
|
| Rate for Payer: PHCS Commercial |
$23,021.52
|
| Rate for Payer: United Healthcare All Payer |
$21,103.06
|
|
|
BHR 2MM FEMOARL HD. 40MM
|
Facility
|
IP
|
$23,980.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,117.50 |
| Max. Negotiated Rate |
$23,021.52 |
| Rate for Payer: Aetna Commercial |
$18,465.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,704.98
|
| Rate for Payer: Cash Price |
$11,990.38
|
| Rate for Payer: Cigna Commercial |
$19,904.02
|
| Rate for Payer: First Health Commercial |
$22,781.71
|
| Rate for Payer: Humana Commercial |
$20,383.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,664.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,697.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,194.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,103.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,985.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,796.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,117.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,434.03
|
| Rate for Payer: PHCS Commercial |
$23,021.52
|
| Rate for Payer: United Healthcare All Payer |
$21,103.06
|
|
|
BHR 2MM FEMOARL HD. 40MM
|
Facility
|
OP
|
$23,980.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,117.50 |
| Max. Negotiated Rate |
$23,021.52 |
| Rate for Payer: Aetna Commercial |
$18,465.18
|
| Rate for Payer: Anthem Medicaid |
$8,246.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,704.98
|
| Rate for Payer: Cash Price |
$11,990.38
|
| Rate for Payer: Cigna Commercial |
$19,904.02
|
| Rate for Payer: First Health Commercial |
$22,781.71
|
| Rate for Payer: Humana Commercial |
$20,383.64
|
| Rate for Payer: Humana KY Medicaid |
$8,246.98
|
| Rate for Payer: Kentucky WC Medicaid |
$8,330.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,664.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,697.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,194.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,412.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,103.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,985.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,796.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,117.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,434.03
|
| Rate for Payer: PHCS Commercial |
$23,021.52
|
| Rate for Payer: United Healthcare All Payer |
$21,103.06
|
|
|
BHR 2MM FEMORAL HD. 48MM
|
Facility
|
IP
|
$23,980.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,117.50 |
| Max. Negotiated Rate |
$23,021.52 |
| Rate for Payer: Aetna Commercial |
$18,465.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,704.98
|
| Rate for Payer: Cash Price |
$11,990.38
|
| Rate for Payer: Cigna Commercial |
$19,904.02
|
| Rate for Payer: First Health Commercial |
$22,781.71
|
| Rate for Payer: Humana Commercial |
$20,383.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,664.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,697.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,194.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,103.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,985.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,796.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,117.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,434.03
|
| Rate for Payer: PHCS Commercial |
$23,021.52
|
| Rate for Payer: United Healthcare All Payer |
$21,103.06
|
|
|
BHR 2MM FEMORAL HD. 48MM
|
Facility
|
OP
|
$23,980.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,117.50 |
| Max. Negotiated Rate |
$23,021.52 |
| Rate for Payer: Aetna Commercial |
$18,465.18
|
| Rate for Payer: Anthem Medicaid |
$8,246.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,704.98
|
| Rate for Payer: Cash Price |
$11,990.38
|
| Rate for Payer: Cigna Commercial |
$19,904.02
|
| Rate for Payer: First Health Commercial |
$22,781.71
|
| Rate for Payer: Humana Commercial |
$20,383.64
|
| Rate for Payer: Humana KY Medicaid |
$8,246.98
|
| Rate for Payer: Kentucky WC Medicaid |
$8,330.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,664.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,697.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,194.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,412.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,103.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,985.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,796.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,117.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,434.03
|
| Rate for Payer: PHCS Commercial |
$23,021.52
|
| Rate for Payer: United Healthcare All Payer |
$21,103.06
|
|
|
BHR 2MM FEMORAL HD. 52MM
|
Facility
|
OP
|
$23,980.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,117.50 |
| Max. Negotiated Rate |
$23,021.52 |
| Rate for Payer: Aetna Commercial |
$18,465.18
|
| Rate for Payer: Anthem Medicaid |
$8,246.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,704.98
|
| Rate for Payer: Cash Price |
$11,990.38
|
| Rate for Payer: Cigna Commercial |
$19,904.02
|
| Rate for Payer: First Health Commercial |
$22,781.71
|
| Rate for Payer: Humana Commercial |
$20,383.64
|
| Rate for Payer: Humana KY Medicaid |
$8,246.98
|
| Rate for Payer: Kentucky WC Medicaid |
$8,330.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,664.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,697.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,194.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,412.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,103.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,985.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,796.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,117.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,434.03
|
| Rate for Payer: PHCS Commercial |
$23,021.52
|
| Rate for Payer: United Healthcare All Payer |
$21,103.06
|
|
|
BHR 2MM FEMORAL HD. 52MM
|
Facility
|
IP
|
$23,980.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,117.50 |
| Max. Negotiated Rate |
$23,021.52 |
| Rate for Payer: Aetna Commercial |
$18,465.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,704.98
|
| Rate for Payer: Cash Price |
$11,990.38
|
| Rate for Payer: Cigna Commercial |
$19,904.02
|
| Rate for Payer: First Health Commercial |
$22,781.71
|
| Rate for Payer: Humana Commercial |
$20,383.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,664.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,697.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,194.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,103.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,985.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,796.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,117.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,434.03
|
| Rate for Payer: PHCS Commercial |
$23,021.52
|
| Rate for Payer: United Healthcare All Payer |
$21,103.06
|
|
|
BHR ACTBNLR CUP W IMPCTR 52MM
|
Facility
|
IP
|
$20,622.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,680.96 |
| Max. Negotiated Rate |
$19,797.84 |
| Rate for Payer: Aetna Commercial |
$15,879.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,085.74
|
| Rate for Payer: Cash Price |
$10,311.38
|
| Rate for Payer: Cigna Commercial |
$17,116.88
|
| Rate for Payer: First Health Commercial |
$19,591.61
|
| Rate for Payer: Humana Commercial |
$17,529.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,910.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,219.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,186.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,148.02
|
| Rate for Payer: Ohio Health Group HMO |
$15,467.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,124.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,680.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,393.05
|
| Rate for Payer: PHCS Commercial |
$19,797.84
|
| Rate for Payer: United Healthcare All Payer |
$18,148.02
|
|
|
BHR ACTBNLR CUP W IMPCTR 52MM
|
Facility
|
OP
|
$20,622.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,680.96 |
| Max. Negotiated Rate |
$19,797.84 |
| Rate for Payer: Aetna Commercial |
$15,879.52
|
| Rate for Payer: Anthem Medicaid |
$7,092.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,085.74
|
| Rate for Payer: Cash Price |
$10,311.38
|
| Rate for Payer: Cigna Commercial |
$17,116.88
|
| Rate for Payer: First Health Commercial |
$19,591.61
|
| Rate for Payer: Humana Commercial |
$17,529.34
|
| Rate for Payer: Humana KY Medicaid |
$7,092.16
|
| Rate for Payer: Kentucky WC Medicaid |
$7,164.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,910.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,219.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,186.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,234.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,148.02
|
| Rate for Payer: Ohio Health Group HMO |
$15,467.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,124.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,680.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,393.05
|
| Rate for Payer: PHCS Commercial |
$19,797.84
|
| Rate for Payer: United Healthcare All Payer |
$18,148.02
|
|
|
BHR FEMORAL HEAD 44 MM
|
Facility
|
IP
|
$23,980.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,117.50 |
| Max. Negotiated Rate |
$23,021.52 |
| Rate for Payer: Aetna Commercial |
$18,465.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,704.98
|
| Rate for Payer: Cash Price |
$11,990.38
|
| Rate for Payer: Cigna Commercial |
$19,904.02
|
| Rate for Payer: First Health Commercial |
$22,781.71
|
| Rate for Payer: Humana Commercial |
$20,383.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,664.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,697.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,194.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,103.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,985.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,796.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,117.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,434.03
|
| Rate for Payer: PHCS Commercial |
$23,021.52
|
| Rate for Payer: United Healthcare All Payer |
$21,103.06
|
|
|
BHR FEMORAL HEAD 44 MM
|
Facility
|
OP
|
$23,980.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,117.50 |
| Max. Negotiated Rate |
$23,021.52 |
| Rate for Payer: Cigna Commercial |
$19,904.02
|
| Rate for Payer: Aetna Commercial |
$18,465.18
|
| Rate for Payer: Anthem Medicaid |
$8,246.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,704.98
|
| Rate for Payer: Cash Price |
$11,990.38
|
| Rate for Payer: First Health Commercial |
$22,781.71
|
| Rate for Payer: Humana Commercial |
$20,383.64
|
| Rate for Payer: Humana KY Medicaid |
$8,246.98
|
| Rate for Payer: Kentucky WC Medicaid |
$8,330.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,664.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,697.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,194.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,412.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,103.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,985.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,796.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,117.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,434.03
|
| Rate for Payer: PHCS Commercial |
$23,021.52
|
| Rate for Payer: United Healthcare All Payer |
$21,103.06
|
|
|
BHR GUIDE PINS SHORT
|
Facility
|
OP
|
$548.43
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.30 |
| Max. Negotiated Rate |
$526.49 |
| Rate for Payer: Aetna Commercial |
$422.29
|
| Rate for Payer: Anthem Medicaid |
$188.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$427.78
|
| Rate for Payer: Cash Price |
$274.21
|
| Rate for Payer: Cigna Commercial |
$455.20
|
| Rate for Payer: First Health Commercial |
$521.01
|
| Rate for Payer: Humana Commercial |
$466.17
|
| Rate for Payer: Humana KY Medicaid |
$188.61
|
| Rate for Payer: Kentucky WC Medicaid |
$190.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$449.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$404.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$192.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$482.62
|
| Rate for Payer: Ohio Health Group HMO |
$411.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$109.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$170.01
|
| Rate for Payer: PHCS Commercial |
$526.49
|
| Rate for Payer: United Healthcare All Payer |
$482.62
|
|
|
BHR GUIDE PINS SHORT
|
Facility
|
IP
|
$548.43
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.30 |
| Max. Negotiated Rate |
$526.49 |
| Rate for Payer: Aetna Commercial |
$422.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$427.78
|
| Rate for Payer: Cash Price |
$274.21
|
| Rate for Payer: Cigna Commercial |
$455.20
|
| Rate for Payer: First Health Commercial |
$521.01
|
| Rate for Payer: Humana Commercial |
$466.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$449.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$404.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$482.62
|
| Rate for Payer: Ohio Health Group HMO |
$411.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$109.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$170.01
|
| Rate for Payer: PHCS Commercial |
$526.49
|
| Rate for Payer: United Healthcare All Payer |
$482.62
|
|
