|
SROM NRH DIST AUG XS/S/MED 5MM
|
Facility
|
IP
|
$8,411.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,093.54 |
| Max. Negotiated Rate |
$8,075.40 |
| Rate for Payer: Aetna Commercial |
$6,477.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,561.27
|
| Rate for Payer: Cash Price |
$4,205.94
|
| Rate for Payer: Cigna Commercial |
$6,981.86
|
| Rate for Payer: First Health Commercial |
$7,991.29
|
| Rate for Payer: Humana Commercial |
$7,150.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,897.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,207.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,523.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,402.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,308.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,682.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,093.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,607.68
|
| Rate for Payer: PHCS Commercial |
$8,075.40
|
| Rate for Payer: United Healthcare All Payer |
$7,402.45
|
|
|
SROM NRH FEM W/PIN MED LT 71*6
|
Facility
|
IP
|
$66,354.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,626.10 |
| Max. Negotiated Rate |
$63,700.45 |
| Rate for Payer: Aetna Commercial |
$51,093.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51,756.62
|
| Rate for Payer: Cash Price |
$33,177.32
|
| Rate for Payer: Cigna Commercial |
$55,074.35
|
| Rate for Payer: First Health Commercial |
$63,036.91
|
| Rate for Payer: Humana Commercial |
$56,401.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54,410.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48,969.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,906.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$58,392.08
|
| Rate for Payer: Ohio Health Group HMO |
$49,765.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,270.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,626.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,569.94
|
| Rate for Payer: PHCS Commercial |
$63,700.45
|
| Rate for Payer: United Healthcare All Payer |
$58,392.08
|
|
|
SROM NRH FEM W/PIN MED LT 71*6
|
Facility
|
OP
|
$66,354.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,626.10 |
| Max. Negotiated Rate |
$63,700.45 |
| Rate for Payer: Aetna Commercial |
$51,093.07
|
| Rate for Payer: Anthem Medicaid |
$22,819.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51,756.62
|
| Rate for Payer: Cash Price |
$33,177.32
|
| Rate for Payer: Cigna Commercial |
$55,074.35
|
| Rate for Payer: First Health Commercial |
$63,036.91
|
| Rate for Payer: Humana Commercial |
$56,401.44
|
| Rate for Payer: Humana KY Medicaid |
$22,819.36
|
| Rate for Payer: Kentucky WC Medicaid |
$23,051.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54,410.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48,969.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,906.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,277.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$58,392.08
|
| Rate for Payer: Ohio Health Group HMO |
$49,765.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,270.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,626.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,569.94
|
| Rate for Payer: PHCS Commercial |
$63,700.45
|
| Rate for Payer: United Healthcare All Payer |
$58,392.08
|
|
|
SROM NRH FEM W/PIN SM LT 66*62
|
Facility
|
OP
|
$72,858.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,471.59 |
| Max. Negotiated Rate |
$69,944.06 |
| Rate for Payer: Aetna Commercial |
$56,100.97
|
| Rate for Payer: Anthem Medicaid |
$25,056.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,829.55
|
| Rate for Payer: Cash Price |
$36,429.20
|
| Rate for Payer: Cigna Commercial |
$60,472.47
|
| Rate for Payer: First Health Commercial |
$69,215.48
|
| Rate for Payer: Humana Commercial |
$61,929.64
|
| Rate for Payer: Humana KY Medicaid |
$25,056.00
|
| Rate for Payer: Kentucky WC Medicaid |
$25,311.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,743.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,769.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,857.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,558.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,115.39
|
| Rate for Payer: Ohio Health Group HMO |
$54,643.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,571.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,471.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,586.10
|
| Rate for Payer: PHCS Commercial |
$69,944.06
|
| Rate for Payer: United Healthcare All Payer |
$64,115.39
|
|
|
SROM NRH FEM W/PIN SM LT 66*62
|
Facility
|
IP
|
$72,858.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,471.59 |
| Max. Negotiated Rate |
$69,944.06 |
| Rate for Payer: Aetna Commercial |
$56,100.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,829.55
|
| Rate for Payer: Cash Price |
$36,429.20
|
| Rate for Payer: Cigna Commercial |
$60,472.47
|
| Rate for Payer: First Health Commercial |
$69,215.48
|
| Rate for Payer: Humana Commercial |
$61,929.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,743.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,769.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,857.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,115.39
|
| Rate for Payer: Ohio Health Group HMO |
$54,643.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,571.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,471.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,586.10
|
| Rate for Payer: PHCS Commercial |
$69,944.06
|
| Rate for Payer: United Healthcare All Payer |
$64,115.39
|
|
|
SROM NRH FEM W/PIN SM RT 66*62
|
Facility
|
IP
|
$66,354.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,626.10 |
| Max. Negotiated Rate |
$63,700.45 |
| Rate for Payer: Aetna Commercial |
$51,093.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51,756.62
|
| Rate for Payer: Cash Price |
$33,177.32
|
| Rate for Payer: Cigna Commercial |
$55,074.35
|
| Rate for Payer: First Health Commercial |
$63,036.91
|
| Rate for Payer: Humana Commercial |
$56,401.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54,410.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48,969.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,906.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$58,392.08
|
| Rate for Payer: Ohio Health Group HMO |
$49,765.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,270.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,626.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,569.94
|
| Rate for Payer: PHCS Commercial |
$63,700.45
|
| Rate for Payer: United Healthcare All Payer |
$58,392.08
|
|
|
SROM NRH FEM W/PIN SM RT 66*62
|
Facility
|
OP
|
$66,354.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,626.10 |
| Max. Negotiated Rate |
$63,700.45 |
| Rate for Payer: Aetna Commercial |
$51,093.07
|
| Rate for Payer: Anthem Medicaid |
$22,819.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51,756.62
|
| Rate for Payer: Cash Price |
$33,177.32
|
| Rate for Payer: Cigna Commercial |
$55,074.35
|
| Rate for Payer: First Health Commercial |
$63,036.91
|
| Rate for Payer: Humana Commercial |
$56,401.44
|
| Rate for Payer: Humana KY Medicaid |
$22,819.36
|
| Rate for Payer: Kentucky WC Medicaid |
$23,051.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54,410.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48,969.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,906.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,277.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$58,392.08
|
| Rate for Payer: Ohio Health Group HMO |
$49,765.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,270.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,626.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,569.94
|
| Rate for Payer: PHCS Commercial |
$63,700.45
|
| Rate for Payer: United Healthcare All Payer |
$58,392.08
|
|
|
SROM NRH FEM W/PIN XSM LT 66*5
|
Facility
|
IP
|
$72,858.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,471.59 |
| Max. Negotiated Rate |
$69,944.06 |
| Rate for Payer: Aetna Commercial |
$56,100.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,829.55
|
| Rate for Payer: Cash Price |
$36,429.20
|
| Rate for Payer: Cigna Commercial |
$60,472.47
|
| Rate for Payer: First Health Commercial |
$69,215.48
|
| Rate for Payer: Humana Commercial |
$61,929.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,743.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,769.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,857.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,115.39
|
| Rate for Payer: Ohio Health Group HMO |
$54,643.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,571.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,471.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,586.10
|
| Rate for Payer: PHCS Commercial |
$69,944.06
|
| Rate for Payer: United Healthcare All Payer |
$64,115.39
|
|
|
SROM NRH FEM W/PIN XSM LT 66*5
|
Facility
|
OP
|
$72,858.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,471.59 |
| Max. Negotiated Rate |
$69,944.06 |
| Rate for Payer: Aetna Commercial |
$56,100.97
|
| Rate for Payer: Anthem Medicaid |
$25,056.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,829.55
|
| Rate for Payer: Cash Price |
$36,429.20
|
| Rate for Payer: Cigna Commercial |
$60,472.47
|
| Rate for Payer: First Health Commercial |
$69,215.48
|
| Rate for Payer: Humana Commercial |
$61,929.64
|
| Rate for Payer: Humana KY Medicaid |
$25,056.00
|
| Rate for Payer: Kentucky WC Medicaid |
$25,311.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,743.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,769.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,857.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,558.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,115.39
|
| Rate for Payer: Ohio Health Group HMO |
$54,643.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,571.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,471.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,586.10
|
| Rate for Payer: PHCS Commercial |
$69,944.06
|
| Rate for Payer: United Healthcare All Payer |
$64,115.39
|
|
|
SROM NRH FEM W/PIN XSM RT 66*5
|
Facility
|
IP
|
$74,541.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,690.38 |
| Max. Negotiated Rate |
$71,559.74 |
| Rate for Payer: Aetna Commercial |
$57,396.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,142.29
|
| Rate for Payer: Cash Price |
$37,270.70
|
| Rate for Payer: Cigna Commercial |
$61,869.36
|
| Rate for Payer: First Health Commercial |
$70,814.33
|
| Rate for Payer: Humana Commercial |
$63,360.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,123.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,011.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,362.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,596.43
|
| Rate for Payer: Ohio Health Group HMO |
$55,906.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,908.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,690.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,107.83
|
| Rate for Payer: PHCS Commercial |
$71,559.74
|
| Rate for Payer: United Healthcare All Payer |
$65,596.43
|
|
|
SROM NRH FEM W/PIN XSM RT 66*5
|
Facility
|
OP
|
$74,541.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,690.38 |
| Max. Negotiated Rate |
$71,559.74 |
| Rate for Payer: Aetna Commercial |
$57,396.88
|
| Rate for Payer: Anthem Medicaid |
$25,634.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,142.29
|
| Rate for Payer: Cash Price |
$37,270.70
|
| Rate for Payer: Cigna Commercial |
$61,869.36
|
| Rate for Payer: First Health Commercial |
$70,814.33
|
| Rate for Payer: Humana Commercial |
$63,360.19
|
| Rate for Payer: Humana KY Medicaid |
$25,634.79
|
| Rate for Payer: Kentucky WC Medicaid |
$25,895.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,123.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,011.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,362.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,149.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,596.43
|
| Rate for Payer: Ohio Health Group HMO |
$55,906.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,908.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,690.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,107.83
|
| Rate for Payer: PHCS Commercial |
$71,559.74
|
| Rate for Payer: United Healthcare All Payer |
$65,596.43
|
|
|
SROM NRH FM W/PIN MED RT 71*66
|
Facility
|
IP
|
$66,932.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,701.26 |
| Max. Negotiated Rate |
$64,255.49 |
| Rate for Payer: Aetna Commercial |
$51,538.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52,207.58
|
| Rate for Payer: Cash Price |
$33,466.40
|
| Rate for Payer: Cigna Commercial |
$55,554.22
|
| Rate for Payer: First Health Commercial |
$63,586.16
|
| Rate for Payer: Humana Commercial |
$56,892.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54,884.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49,396.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,079.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$58,900.86
|
| Rate for Payer: Ohio Health Group HMO |
$50,199.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,386.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,701.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,749.17
|
| Rate for Payer: PHCS Commercial |
$64,255.49
|
| Rate for Payer: United Healthcare All Payer |
$58,900.86
|
|
|
SROM NRH FM W/PIN MED RT 71*66
|
Facility
|
OP
|
$66,932.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,701.26 |
| Max. Negotiated Rate |
$64,255.49 |
| Rate for Payer: Aetna Commercial |
$51,538.26
|
| Rate for Payer: Anthem Medicaid |
$23,018.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52,207.58
|
| Rate for Payer: Cash Price |
$33,466.40
|
| Rate for Payer: Cigna Commercial |
$55,554.22
|
| Rate for Payer: First Health Commercial |
$63,586.16
|
| Rate for Payer: Humana Commercial |
$56,892.88
|
| Rate for Payer: Humana KY Medicaid |
$23,018.19
|
| Rate for Payer: Kentucky WC Medicaid |
$23,252.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54,884.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49,396.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,079.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,480.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$58,900.86
|
| Rate for Payer: Ohio Health Group HMO |
$50,199.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,386.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,701.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,749.17
|
| Rate for Payer: PHCS Commercial |
$64,255.49
|
| Rate for Payer: United Healthcare All Payer |
$58,900.86
|
|
|
SROM NRH PLAT ASSY MED 16MM
|
Facility
|
OP
|
$13,245.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,721.88 |
| Max. Negotiated Rate |
$12,715.45 |
| Rate for Payer: Aetna Commercial |
$10,198.85
|
| Rate for Payer: Anthem Medicaid |
$4,555.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,331.30
|
| Rate for Payer: Cash Price |
$6,622.63
|
| Rate for Payer: Cigna Commercial |
$10,993.57
|
| Rate for Payer: First Health Commercial |
$12,583.00
|
| Rate for Payer: Humana Commercial |
$11,258.47
|
| Rate for Payer: Humana KY Medicaid |
$4,555.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,601.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,861.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,775.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,973.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,646.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,655.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,933.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,649.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,721.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,106.03
|
| Rate for Payer: PHCS Commercial |
$12,715.45
|
| Rate for Payer: United Healthcare All Payer |
$11,655.83
|
|
|
SROM NRH PLAT ASSY MED 16MM
|
Facility
|
IP
|
$13,245.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,721.88 |
| Max. Negotiated Rate |
$12,715.45 |
| Rate for Payer: Aetna Commercial |
$10,198.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,331.30
|
| Rate for Payer: Cash Price |
$6,622.63
|
| Rate for Payer: Cigna Commercial |
$10,993.57
|
| Rate for Payer: First Health Commercial |
$12,583.00
|
| Rate for Payer: Humana Commercial |
$11,258.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,861.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,775.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,973.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,655.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,933.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,649.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,721.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,106.03
|
| Rate for Payer: PHCS Commercial |
$12,715.45
|
| Rate for Payer: United Healthcare All Payer |
$11,655.83
|
|
|
SROM NRH PLAT ASSY MED 21MM
|
Facility
|
IP
|
$13,245.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,721.88 |
| Max. Negotiated Rate |
$12,715.45 |
| Rate for Payer: Aetna Commercial |
$10,198.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,331.30
|
| Rate for Payer: Cash Price |
$6,622.63
|
| Rate for Payer: Cigna Commercial |
$10,993.57
|
| Rate for Payer: First Health Commercial |
$12,583.00
|
| Rate for Payer: Humana Commercial |
$11,258.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,861.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,775.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,973.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,655.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,933.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,649.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,721.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,106.03
|
| Rate for Payer: PHCS Commercial |
$12,715.45
|
| Rate for Payer: United Healthcare All Payer |
$11,655.83
|
|
|
SROM NRH PLAT ASSY MED 21MM
|
Facility
|
OP
|
$13,245.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,721.88 |
| Max. Negotiated Rate |
$12,715.45 |
| Rate for Payer: Aetna Commercial |
$10,198.85
|
| Rate for Payer: Anthem Medicaid |
$4,555.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,331.30
|
| Rate for Payer: Cash Price |
$6,622.63
|
| Rate for Payer: Cigna Commercial |
$10,993.57
|
| Rate for Payer: First Health Commercial |
$12,583.00
|
| Rate for Payer: Humana Commercial |
$11,258.47
|
| Rate for Payer: Humana KY Medicaid |
$4,555.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,601.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,861.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,775.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,973.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,646.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,655.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,933.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,649.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,721.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,106.03
|
| Rate for Payer: PHCS Commercial |
$12,715.45
|
| Rate for Payer: United Healthcare All Payer |
$11,655.83
|
|
|
SROM NRH PLAT ASSY MED 26MM
|
Facility
|
OP
|
$13,245.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,721.88 |
| Max. Negotiated Rate |
$12,715.45 |
| Rate for Payer: Aetna Commercial |
$10,198.85
|
| Rate for Payer: Anthem Medicaid |
$4,555.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,331.30
|
| Rate for Payer: Cash Price |
$6,622.63
|
| Rate for Payer: Cigna Commercial |
$10,993.57
|
| Rate for Payer: First Health Commercial |
$12,583.00
|
| Rate for Payer: Humana Commercial |
$11,258.47
|
| Rate for Payer: Humana KY Medicaid |
$4,555.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,601.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,861.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,775.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,973.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,646.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,655.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,933.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,649.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,721.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,106.03
|
| Rate for Payer: PHCS Commercial |
$12,715.45
|
| Rate for Payer: United Healthcare All Payer |
$11,655.83
|
|
|
SROM NRH PLAT ASSY MED 26MM
|
Facility
|
IP
|
$13,245.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,721.88 |
| Max. Negotiated Rate |
$12,715.45 |
| Rate for Payer: Aetna Commercial |
$10,198.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,331.30
|
| Rate for Payer: Cash Price |
$6,622.63
|
| Rate for Payer: Cigna Commercial |
$10,993.57
|
| Rate for Payer: First Health Commercial |
$12,583.00
|
| Rate for Payer: Humana Commercial |
$11,258.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,861.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,775.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,973.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,655.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,933.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,649.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,721.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,106.03
|
| Rate for Payer: PHCS Commercial |
$12,715.45
|
| Rate for Payer: United Healthcare All Payer |
$11,655.83
|
|
|
SROM NRH PLAT ASSY MED 31MM
|
Facility
|
IP
|
$13,245.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,721.88 |
| Max. Negotiated Rate |
$12,715.45 |
| Rate for Payer: Aetna Commercial |
$10,198.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,331.30
|
| Rate for Payer: Cash Price |
$6,622.63
|
| Rate for Payer: Cigna Commercial |
$10,993.57
|
| Rate for Payer: First Health Commercial |
$12,583.00
|
| Rate for Payer: Humana Commercial |
$11,258.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,861.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,775.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,973.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,655.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,933.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,649.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,721.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,106.03
|
| Rate for Payer: PHCS Commercial |
$12,715.45
|
| Rate for Payer: United Healthcare All Payer |
$11,655.83
|
|
|
SROM NRH PLAT ASSY MED 31MM
|
Facility
|
OP
|
$13,245.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,721.88 |
| Max. Negotiated Rate |
$12,715.45 |
| Rate for Payer: Aetna Commercial |
$10,198.85
|
| Rate for Payer: Anthem Medicaid |
$4,555.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,331.30
|
| Rate for Payer: Cash Price |
$6,622.63
|
| Rate for Payer: Cigna Commercial |
$10,993.57
|
| Rate for Payer: First Health Commercial |
$12,583.00
|
| Rate for Payer: Humana Commercial |
$11,258.47
|
| Rate for Payer: Humana KY Medicaid |
$4,555.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,601.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,861.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,775.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,973.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,646.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,655.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,933.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,649.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,721.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,106.03
|
| Rate for Payer: PHCS Commercial |
$12,715.45
|
| Rate for Payer: United Healthcare All Payer |
$11,655.83
|
|
|
SROM NRH PLAT ASSY SM 12MM
|
Facility
|
IP
|
$13,245.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,721.88 |
| Max. Negotiated Rate |
$12,715.45 |
| Rate for Payer: Aetna Commercial |
$10,198.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,331.30
|
| Rate for Payer: Cash Price |
$6,622.63
|
| Rate for Payer: Cigna Commercial |
$10,993.57
|
| Rate for Payer: First Health Commercial |
$12,583.00
|
| Rate for Payer: Humana Commercial |
$11,258.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,861.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,775.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,973.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,655.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,933.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,649.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,721.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,106.03
|
| Rate for Payer: PHCS Commercial |
$12,715.45
|
| Rate for Payer: United Healthcare All Payer |
$11,655.83
|
|
|
SROM NRH PLAT ASSY SM 12MM
|
Facility
|
OP
|
$13,245.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,721.88 |
| Max. Negotiated Rate |
$12,715.45 |
| Rate for Payer: Aetna Commercial |
$10,198.85
|
| Rate for Payer: Anthem Medicaid |
$4,555.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,331.30
|
| Rate for Payer: Cash Price |
$6,622.63
|
| Rate for Payer: Cigna Commercial |
$10,993.57
|
| Rate for Payer: First Health Commercial |
$12,583.00
|
| Rate for Payer: Humana Commercial |
$11,258.47
|
| Rate for Payer: Humana KY Medicaid |
$4,555.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,601.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,861.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,775.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,973.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,646.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,655.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,933.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,649.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,721.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,106.03
|
| Rate for Payer: PHCS Commercial |
$12,715.45
|
| Rate for Payer: United Healthcare All Payer |
$11,655.83
|
|
|
SROM NRH PLAT ASSY SM 16MM
|
Facility
|
IP
|
$13,245.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,721.88 |
| Max. Negotiated Rate |
$12,715.45 |
| Rate for Payer: Aetna Commercial |
$10,198.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,331.30
|
| Rate for Payer: Cash Price |
$6,622.63
|
| Rate for Payer: Cigna Commercial |
$10,993.57
|
| Rate for Payer: First Health Commercial |
$12,583.00
|
| Rate for Payer: Humana Commercial |
$11,258.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,861.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,775.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,973.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,655.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,933.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,649.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,721.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,106.03
|
| Rate for Payer: PHCS Commercial |
$12,715.45
|
| Rate for Payer: United Healthcare All Payer |
$11,655.83
|
|
|
SROM NRH PLAT ASSY SM 16MM
|
Facility
|
OP
|
$13,245.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,721.88 |
| Max. Negotiated Rate |
$12,715.45 |
| Rate for Payer: Aetna Commercial |
$10,198.85
|
| Rate for Payer: Anthem Medicaid |
$4,555.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,331.30
|
| Rate for Payer: Cash Price |
$6,622.63
|
| Rate for Payer: Cigna Commercial |
$10,993.57
|
| Rate for Payer: First Health Commercial |
$12,583.00
|
| Rate for Payer: Humana Commercial |
$11,258.47
|
| Rate for Payer: Humana KY Medicaid |
$4,555.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,601.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,861.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,775.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,973.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,646.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,655.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,933.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,649.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,721.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,106.03
|
| Rate for Payer: PHCS Commercial |
$12,715.45
|
| Rate for Payer: United Healthcare All Payer |
$11,655.83
|
|
