|
AS INVERSE HUM CUP-10DEG RETRO
|
Facility
|
IP
|
$8,635.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,590.68 |
| Max. Negotiated Rate |
$8,290.18 |
| Rate for Payer: Aetna Commercial |
$6,649.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,735.77
|
| Rate for Payer: Cash Price |
$4,317.80
|
| Rate for Payer: Cigna Commercial |
$7,167.55
|
| Rate for Payer: First Health Commercial |
$8,203.82
|
| Rate for Payer: Humana Commercial |
$7,340.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,081.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,373.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,590.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,599.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,476.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,908.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,512.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,958.56
|
| Rate for Payer: PHCS Commercial |
$8,290.18
|
| Rate for Payer: United Healthcare All Payer |
$7,599.33
|
|
|
AS INVERSE HUM PE-INLAY 36*0MM
|
Facility
|
IP
|
$7,239.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,171.95 |
| Max. Negotiated Rate |
$6,950.25 |
| Rate for Payer: Aetna Commercial |
$5,574.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,647.08
|
| Rate for Payer: Cash Price |
$3,619.92
|
| Rate for Payer: Cigna Commercial |
$6,009.07
|
| Rate for Payer: First Health Commercial |
$6,877.85
|
| Rate for Payer: Humana Commercial |
$6,153.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,936.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,343.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,171.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,371.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,791.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,298.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,995.49
|
| Rate for Payer: PHCS Commercial |
$6,950.25
|
| Rate for Payer: United Healthcare All Payer |
$6,371.06
|
|
|
AS INVERSE HUM PE-INLAY 36*0MM
|
Facility
|
OP
|
$7,239.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,171.95 |
| Max. Negotiated Rate |
$6,950.25 |
| Rate for Payer: Aetna Commercial |
$5,574.68
|
| Rate for Payer: Anthem Medicaid |
$2,489.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,647.08
|
| Rate for Payer: Cash Price |
$3,619.92
|
| Rate for Payer: Cigna Commercial |
$6,009.07
|
| Rate for Payer: First Health Commercial |
$6,877.85
|
| Rate for Payer: Humana Commercial |
$6,153.86
|
| Rate for Payer: Humana KY Medicaid |
$2,489.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,515.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,936.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,343.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,171.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,539.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,371.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,791.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,298.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,995.49
|
| Rate for Payer: PHCS Commercial |
$6,950.25
|
| Rate for Payer: United Healthcare All Payer |
$6,371.06
|
|
|
AS INVERSE HUM PE-INLAY 40*0MM
|
Facility
|
OP
|
$7,239.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,171.95 |
| Max. Negotiated Rate |
$6,950.25 |
| Rate for Payer: Aetna Commercial |
$5,574.68
|
| Rate for Payer: Anthem Medicaid |
$2,489.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,647.08
|
| Rate for Payer: Cash Price |
$3,619.92
|
| Rate for Payer: Cigna Commercial |
$6,009.07
|
| Rate for Payer: First Health Commercial |
$6,877.85
|
| Rate for Payer: Humana Commercial |
$6,153.86
|
| Rate for Payer: Humana KY Medicaid |
$2,489.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,515.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,936.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,343.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,171.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,539.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,371.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,791.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,298.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,995.49
|
| Rate for Payer: PHCS Commercial |
$6,950.25
|
| Rate for Payer: United Healthcare All Payer |
$6,371.06
|
|
|
AS INVERSE HUM PE-INLAY 40*0MM
|
Facility
|
IP
|
$7,239.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,171.95 |
| Max. Negotiated Rate |
$6,950.25 |
| Rate for Payer: Aetna Commercial |
$5,574.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,647.08
|
| Rate for Payer: Cash Price |
$3,619.92
|
| Rate for Payer: Cigna Commercial |
$6,009.07
|
| Rate for Payer: First Health Commercial |
$6,877.85
|
| Rate for Payer: Humana Commercial |
$6,153.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,936.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,343.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,171.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,371.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,791.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,298.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,995.49
|
| Rate for Payer: PHCS Commercial |
$6,950.25
|
| Rate for Payer: United Healthcare All Payer |
$6,371.06
|
|
|
AS INVERSE HUM PE-INLAY 40*3MM
|
Facility
|
IP
|
$7,239.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,171.95 |
| Max. Negotiated Rate |
$6,950.25 |
| Rate for Payer: Aetna Commercial |
$5,574.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,647.08
|
| Rate for Payer: Cash Price |
$3,619.92
|
| Rate for Payer: Cigna Commercial |
$6,009.07
|
| Rate for Payer: First Health Commercial |
$6,877.85
|
| Rate for Payer: Humana Commercial |
$6,153.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,936.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,343.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,171.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,371.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,791.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,298.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,995.49
|
| Rate for Payer: PHCS Commercial |
$6,950.25
|
| Rate for Payer: United Healthcare All Payer |
$6,371.06
|
|
|
AS INVERSE HUM PE-INLAY 40*3MM
|
Facility
|
OP
|
$7,239.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,171.95 |
| Max. Negotiated Rate |
$6,950.25 |
| Rate for Payer: Aetna Commercial |
$5,574.68
|
| Rate for Payer: Anthem Medicaid |
$2,489.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,647.08
|
| Rate for Payer: Cash Price |
$3,619.92
|
| Rate for Payer: Cigna Commercial |
$6,009.07
|
| Rate for Payer: First Health Commercial |
$6,877.85
|
| Rate for Payer: Humana Commercial |
$6,153.86
|
| Rate for Payer: Humana KY Medicaid |
$2,489.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,515.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,936.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,343.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,171.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,539.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,371.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,791.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,298.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,995.49
|
| Rate for Payer: PHCS Commercial |
$6,950.25
|
| Rate for Payer: United Healthcare All Payer |
$6,371.06
|
|
|
AS INVERSE HUM PE-INLAY 40*6MM
|
Facility
|
IP
|
$7,239.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,171.95 |
| Max. Negotiated Rate |
$6,950.25 |
| Rate for Payer: Aetna Commercial |
$5,574.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,647.08
|
| Rate for Payer: Cash Price |
$3,619.92
|
| Rate for Payer: Cigna Commercial |
$6,009.07
|
| Rate for Payer: First Health Commercial |
$6,877.85
|
| Rate for Payer: Humana Commercial |
$6,153.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,936.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,343.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,171.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,371.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,791.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,298.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,995.49
|
| Rate for Payer: PHCS Commercial |
$6,950.25
|
| Rate for Payer: United Healthcare All Payer |
$6,371.06
|
|
|
AS INVERSE HUM PE-INLAY 40*6MM
|
Facility
|
OP
|
$7,239.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,171.95 |
| Max. Negotiated Rate |
$6,950.25 |
| Rate for Payer: Aetna Commercial |
$5,574.68
|
| Rate for Payer: Anthem Medicaid |
$2,489.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,647.08
|
| Rate for Payer: Cash Price |
$3,619.92
|
| Rate for Payer: Cigna Commercial |
$6,009.07
|
| Rate for Payer: First Health Commercial |
$6,877.85
|
| Rate for Payer: Humana Commercial |
$6,153.86
|
| Rate for Payer: Humana KY Medicaid |
$2,489.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,515.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,936.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,343.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,171.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,539.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,371.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,791.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,298.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,995.49
|
| Rate for Payer: PHCS Commercial |
$6,950.25
|
| Rate for Payer: United Healthcare All Payer |
$6,371.06
|
|
|
AS INV HUM CUP+9M 0 DEG RETR+6
|
Facility
|
OP
|
$8,974.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,692.30 |
| Max. Negotiated Rate |
$8,615.35 |
| Rate for Payer: Aetna Commercial |
$6,910.23
|
| Rate for Payer: Anthem Medicaid |
$3,086.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,999.97
|
| Rate for Payer: Cash Price |
$4,487.16
|
| Rate for Payer: Cigna Commercial |
$7,448.69
|
| Rate for Payer: First Health Commercial |
$8,525.60
|
| Rate for Payer: Humana Commercial |
$7,628.17
|
| Rate for Payer: Humana KY Medicaid |
$3,086.27
|
| Rate for Payer: Kentucky WC Medicaid |
$3,117.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,358.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,623.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,692.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,148.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,897.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,730.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,179.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,807.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,192.28
|
| Rate for Payer: PHCS Commercial |
$8,615.35
|
| Rate for Payer: United Healthcare All Payer |
$7,897.40
|
|
|
AS INV HUM CUP+9M 0 DEG RETR+6
|
Facility
|
IP
|
$8,974.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,692.30 |
| Max. Negotiated Rate |
$8,615.35 |
| Rate for Payer: Aetna Commercial |
$6,910.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,999.97
|
| Rate for Payer: Cash Price |
$4,487.16
|
| Rate for Payer: Cigna Commercial |
$7,448.69
|
| Rate for Payer: First Health Commercial |
$8,525.60
|
| Rate for Payer: Humana Commercial |
$7,628.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,358.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,623.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,692.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,897.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,730.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,179.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,807.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,192.28
|
| Rate for Payer: PHCS Commercial |
$8,615.35
|
| Rate for Payer: United Healthcare All Payer |
$7,897.40
|
|
|
AS INV HUM CUP+9MM 0 DEG RETRO
|
Facility
|
IP
|
$8,974.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,692.30 |
| Max. Negotiated Rate |
$8,615.35 |
| Rate for Payer: Aetna Commercial |
$6,910.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,999.97
|
| Rate for Payer: Cash Price |
$4,487.16
|
| Rate for Payer: Cigna Commercial |
$7,448.69
|
| Rate for Payer: First Health Commercial |
$8,525.60
|
| Rate for Payer: Humana Commercial |
$7,628.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,358.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,623.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,692.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,897.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,730.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,179.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,807.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,192.28
|
| Rate for Payer: PHCS Commercial |
$8,615.35
|
| Rate for Payer: United Healthcare All Payer |
$7,897.40
|
|
|
AS INV HUM CUP+9MM 0 DEG RETRO
|
Facility
|
OP
|
$8,974.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,692.30 |
| Max. Negotiated Rate |
$8,615.35 |
| Rate for Payer: Aetna Commercial |
$6,910.23
|
| Rate for Payer: Anthem Medicaid |
$3,086.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,999.97
|
| Rate for Payer: Cash Price |
$4,487.16
|
| Rate for Payer: Cigna Commercial |
$7,448.69
|
| Rate for Payer: First Health Commercial |
$8,525.60
|
| Rate for Payer: Humana Commercial |
$7,628.17
|
| Rate for Payer: Humana KY Medicaid |
$3,086.27
|
| Rate for Payer: Kentucky WC Medicaid |
$3,117.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,358.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,623.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,692.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,148.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,897.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,730.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,179.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,807.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,192.28
|
| Rate for Payer: PHCS Commercial |
$8,615.35
|
| Rate for Payer: United Healthcare All Payer |
$7,897.40
|
|
|
AS INV HUM PE-INLY 0MM 40MM HD
|
Facility
|
OP
|
$7,239.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,171.95 |
| Max. Negotiated Rate |
$6,950.25 |
| Rate for Payer: Aetna Commercial |
$5,574.68
|
| Rate for Payer: Anthem Medicaid |
$2,489.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,647.08
|
| Rate for Payer: Cash Price |
$3,619.92
|
| Rate for Payer: Cigna Commercial |
$6,009.07
|
| Rate for Payer: First Health Commercial |
$6,877.85
|
| Rate for Payer: Humana Commercial |
$6,153.86
|
| Rate for Payer: Humana KY Medicaid |
$2,489.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,515.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,936.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,343.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,171.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,539.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,371.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,791.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,298.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,995.49
|
| Rate for Payer: PHCS Commercial |
$6,950.25
|
| Rate for Payer: United Healthcare All Payer |
$6,371.06
|
|
|
AS INV HUM PE-INLY 0MM 40MM HD
|
Facility
|
IP
|
$7,239.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,171.95 |
| Max. Negotiated Rate |
$6,950.25 |
| Rate for Payer: Aetna Commercial |
$5,574.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,647.08
|
| Rate for Payer: Cash Price |
$3,619.92
|
| Rate for Payer: Cigna Commercial |
$6,009.07
|
| Rate for Payer: First Health Commercial |
$6,877.85
|
| Rate for Payer: Humana Commercial |
$6,153.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,936.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,343.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,171.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,371.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,791.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,298.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,995.49
|
| Rate for Payer: PHCS Commercial |
$6,950.25
|
| Rate for Payer: United Healthcare All Payer |
$6,371.06
|
|
|
AS INV HUM PE-INLY 3MM 40MM HD
|
Facility
|
IP
|
$7,022.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,106.69 |
| Max. Negotiated Rate |
$6,741.41 |
| Rate for Payer: Aetna Commercial |
$5,407.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,477.39
|
| Rate for Payer: Cash Price |
$3,511.15
|
| Rate for Payer: Cigna Commercial |
$5,828.51
|
| Rate for Payer: First Health Commercial |
$6,671.19
|
| Rate for Payer: Humana Commercial |
$5,968.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,758.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,182.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,106.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,179.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,266.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,617.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,109.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,845.39
|
| Rate for Payer: PHCS Commercial |
$6,741.41
|
| Rate for Payer: United Healthcare All Payer |
$6,179.62
|
|
|
AS INV HUM PE-INLY 3MM 40MM HD
|
Facility
|
OP
|
$7,022.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,106.69 |
| Max. Negotiated Rate |
$6,741.41 |
| Rate for Payer: Aetna Commercial |
$5,407.17
|
| Rate for Payer: Anthem Medicaid |
$2,414.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,477.39
|
| Rate for Payer: Cash Price |
$3,511.15
|
| Rate for Payer: Cigna Commercial |
$5,828.51
|
| Rate for Payer: First Health Commercial |
$6,671.19
|
| Rate for Payer: Humana Commercial |
$5,968.95
|
| Rate for Payer: Humana KY Medicaid |
$2,414.97
|
| Rate for Payer: Kentucky WC Medicaid |
$2,439.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,758.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,182.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,106.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,463.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,179.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,266.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,617.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,109.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,845.39
|
| Rate for Payer: PHCS Commercial |
$6,741.41
|
| Rate for Payer: United Healthcare All Payer |
$6,179.62
|
|
|
AS INV HUM PE-INLY 6MM 40MM HD
|
Facility
|
IP
|
$7,022.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,106.69 |
| Max. Negotiated Rate |
$6,741.41 |
| Rate for Payer: Aetna Commercial |
$5,407.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,477.39
|
| Rate for Payer: Cash Price |
$3,511.15
|
| Rate for Payer: Cigna Commercial |
$5,828.51
|
| Rate for Payer: First Health Commercial |
$6,671.19
|
| Rate for Payer: Humana Commercial |
$5,968.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,758.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,182.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,106.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,179.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,266.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,617.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,109.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,845.39
|
| Rate for Payer: PHCS Commercial |
$6,741.41
|
| Rate for Payer: United Healthcare All Payer |
$6,179.62
|
|
|
AS INV HUM PE-INLY 6MM 40MM HD
|
Facility
|
OP
|
$7,022.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,106.69 |
| Max. Negotiated Rate |
$6,741.41 |
| Rate for Payer: Aetna Commercial |
$5,407.17
|
| Rate for Payer: Anthem Medicaid |
$2,414.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,477.39
|
| Rate for Payer: Cash Price |
$3,511.15
|
| Rate for Payer: Cigna Commercial |
$5,828.51
|
| Rate for Payer: First Health Commercial |
$6,671.19
|
| Rate for Payer: Humana Commercial |
$5,968.95
|
| Rate for Payer: Humana KY Medicaid |
$2,414.97
|
| Rate for Payer: Kentucky WC Medicaid |
$2,439.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,758.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,182.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,106.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,463.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,179.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,266.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,617.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,109.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,845.39
|
| Rate for Payer: PHCS Commercial |
$6,741.41
|
| Rate for Payer: United Healthcare All Payer |
$6,179.62
|
|
|
AS INVRS HUM CUP +20 DEG RETRO
|
Facility
|
OP
|
$8,635.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,590.68 |
| Max. Negotiated Rate |
$8,290.18 |
| Rate for Payer: Aetna Commercial |
$6,649.41
|
| Rate for Payer: Anthem Medicaid |
$2,969.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,735.77
|
| Rate for Payer: Cash Price |
$4,317.80
|
| Rate for Payer: Cigna Commercial |
$7,167.55
|
| Rate for Payer: First Health Commercial |
$8,203.82
|
| Rate for Payer: Humana Commercial |
$7,340.26
|
| Rate for Payer: Humana KY Medicaid |
$2,969.78
|
| Rate for Payer: Kentucky WC Medicaid |
$3,000.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,081.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,373.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,590.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,029.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,599.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,476.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,908.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,512.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,958.56
|
| Rate for Payer: PHCS Commercial |
$8,290.18
|
| Rate for Payer: United Healthcare All Payer |
$7,599.33
|
|
|
AS INVRS HUM CUP +20 DEG RETRO
|
Facility
|
IP
|
$8,635.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,590.68 |
| Max. Negotiated Rate |
$8,290.18 |
| Rate for Payer: Aetna Commercial |
$6,649.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,735.77
|
| Rate for Payer: Cash Price |
$4,317.80
|
| Rate for Payer: Cigna Commercial |
$7,167.55
|
| Rate for Payer: First Health Commercial |
$8,203.82
|
| Rate for Payer: Humana Commercial |
$7,340.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,081.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,373.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,590.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,599.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,476.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,908.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,512.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,958.56
|
| Rate for Payer: PHCS Commercial |
$8,290.18
|
| Rate for Payer: United Healthcare All Payer |
$7,599.33
|
|
|
AS INVRS HUM CUP -20 DEG RETRO
|
Facility
|
IP
|
$8,635.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,590.68 |
| Max. Negotiated Rate |
$8,290.18 |
| Rate for Payer: Aetna Commercial |
$6,649.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,735.77
|
| Rate for Payer: Cash Price |
$4,317.80
|
| Rate for Payer: Cigna Commercial |
$7,167.55
|
| Rate for Payer: First Health Commercial |
$8,203.82
|
| Rate for Payer: Humana Commercial |
$7,340.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,081.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,373.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,590.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,599.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,476.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,908.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,512.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,958.56
|
| Rate for Payer: PHCS Commercial |
$8,290.18
|
| Rate for Payer: United Healthcare All Payer |
$7,599.33
|
|
|
AS INVRS HUM CUP -20 DEG RETRO
|
Facility
|
OP
|
$8,635.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,590.68 |
| Max. Negotiated Rate |
$8,290.18 |
| Rate for Payer: Aetna Commercial |
$6,649.41
|
| Rate for Payer: Anthem Medicaid |
$2,969.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,735.77
|
| Rate for Payer: Cash Price |
$4,317.80
|
| Rate for Payer: Cigna Commercial |
$7,167.55
|
| Rate for Payer: First Health Commercial |
$8,203.82
|
| Rate for Payer: Humana Commercial |
$7,340.26
|
| Rate for Payer: Humana KY Medicaid |
$2,969.78
|
| Rate for Payer: Kentucky WC Medicaid |
$3,000.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,081.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,373.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,590.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,029.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,599.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,476.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,908.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,512.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,958.56
|
| Rate for Payer: PHCS Commercial |
$8,290.18
|
| Rate for Payer: United Healthcare All Payer |
$7,599.33
|
|
|
AS INVRS HUM CUP +9 0DEG RETR
|
Facility
|
IP
|
$8,635.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,590.68 |
| Max. Negotiated Rate |
$8,290.18 |
| Rate for Payer: Aetna Commercial |
$6,649.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,735.77
|
| Rate for Payer: Cash Price |
$4,317.80
|
| Rate for Payer: Cigna Commercial |
$7,167.55
|
| Rate for Payer: First Health Commercial |
$8,203.82
|
| Rate for Payer: Humana Commercial |
$7,340.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,081.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,373.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,590.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,599.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,476.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,908.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,512.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,958.56
|
| Rate for Payer: PHCS Commercial |
$8,290.18
|
| Rate for Payer: United Healthcare All Payer |
$7,599.33
|
|
|
AS INVRS HUM CUP +9 0DEG RETR
|
Facility
|
OP
|
$8,635.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,590.68 |
| Max. Negotiated Rate |
$8,290.18 |
| Rate for Payer: Aetna Commercial |
$6,649.41
|
| Rate for Payer: Anthem Medicaid |
$2,969.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,735.77
|
| Rate for Payer: Cash Price |
$4,317.80
|
| Rate for Payer: Cigna Commercial |
$7,167.55
|
| Rate for Payer: First Health Commercial |
$8,203.82
|
| Rate for Payer: Humana Commercial |
$7,340.26
|
| Rate for Payer: Humana KY Medicaid |
$2,969.78
|
| Rate for Payer: Kentucky WC Medicaid |
$3,000.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,081.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,373.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,590.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,029.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,599.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,476.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,908.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,512.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,958.56
|
| Rate for Payer: PHCS Commercial |
$8,290.18
|
| Rate for Payer: United Healthcare All Payer |
$7,599.33
|
|
