|
SROM NRH DIST AUG XS/S/MED 5MM
|
Facility
|
OP
|
$8,611.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.56 |
| Max. Negotiated Rate |
$8,267.40 |
| Rate for Payer: Aetna Commercial |
$6,631.15
|
| Rate for Payer: Anthem Medicaid |
$2,961.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,717.27
|
| Rate for Payer: Cash Price |
$4,305.94
|
| Rate for Payer: Cigna Commercial |
$7,147.86
|
| Rate for Payer: First Health Commercial |
$8,181.29
|
| Rate for Payer: Humana Commercial |
$7,320.10
|
| Rate for Payer: Humana KY Medicaid |
$2,961.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,991.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,355.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,021.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,578.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,889.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,492.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,942.20
|
| Rate for Payer: PHCS Commercial |
$8,267.40
|
| Rate for Payer: United Healthcare All Payer |
$7,578.45
|
|
|
SROM NRH DIST AUG XS/S/MED 5MM
|
Facility
|
IP
|
$8,611.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.56 |
| Max. Negotiated Rate |
$8,267.40 |
| Rate for Payer: Aetna Commercial |
$6,631.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,717.27
|
| Rate for Payer: Cash Price |
$4,305.94
|
| Rate for Payer: Cigna Commercial |
$7,147.86
|
| Rate for Payer: First Health Commercial |
$8,181.29
|
| Rate for Payer: Humana Commercial |
$7,320.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,355.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,578.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,889.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,492.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,942.20
|
| Rate for Payer: PHCS Commercial |
$8,267.40
|
| Rate for Payer: United Healthcare All Payer |
$7,578.45
|
|
|
SROM NRH FEM W/PIN MED LT 71*6
|
Facility
|
OP
|
$68,402.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,520.64 |
| Max. Negotiated Rate |
$65,666.04 |
| Rate for Payer: Aetna Commercial |
$52,669.63
|
| Rate for Payer: Anthem Medicaid |
$23,523.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,353.65
|
| Rate for Payer: Cash Price |
$34,201.06
|
| Rate for Payer: Cigna Commercial |
$56,773.76
|
| Rate for Payer: First Health Commercial |
$64,982.01
|
| Rate for Payer: Humana Commercial |
$58,141.80
|
| Rate for Payer: Humana KY Medicaid |
$23,523.49
|
| Rate for Payer: Kentucky WC Medicaid |
$23,762.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,089.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,480.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,520.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,995.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,193.87
|
| Rate for Payer: Ohio Health Group HMO |
$51,301.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54,721.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59,509.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47,197.46
|
| Rate for Payer: PHCS Commercial |
$65,666.04
|
| Rate for Payer: United Healthcare All Payer |
$60,193.87
|
|
|
SROM NRH FEM W/PIN MED LT 71*6
|
Facility
|
IP
|
$68,402.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,520.64 |
| Max. Negotiated Rate |
$65,666.04 |
| Rate for Payer: Aetna Commercial |
$52,669.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,353.65
|
| Rate for Payer: Cash Price |
$34,201.06
|
| Rate for Payer: Cigna Commercial |
$56,773.76
|
| Rate for Payer: First Health Commercial |
$64,982.01
|
| Rate for Payer: Humana Commercial |
$58,141.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,089.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,480.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,520.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,193.87
|
| Rate for Payer: Ohio Health Group HMO |
$51,301.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54,721.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59,509.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47,197.46
|
| Rate for Payer: PHCS Commercial |
$65,666.04
|
| Rate for Payer: United Healthcare All Payer |
$60,193.87
|
|
|
SROM NRH FEM W/PIN SM LT 66*62
|
Facility
|
IP
|
$75,267.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,580.16 |
| Max. Negotiated Rate |
$72,256.51 |
| Rate for Payer: Aetna Commercial |
$57,955.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,708.42
|
| Rate for Payer: Cash Price |
$37,633.60
|
| Rate for Payer: Cigna Commercial |
$62,471.78
|
| Rate for Payer: First Health Commercial |
$71,503.84
|
| Rate for Payer: Humana Commercial |
$63,977.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,719.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,547.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,580.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,235.14
|
| Rate for Payer: Ohio Health Group HMO |
$56,450.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,213.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,482.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,934.37
|
| Rate for Payer: PHCS Commercial |
$72,256.51
|
| Rate for Payer: United Healthcare All Payer |
$66,235.14
|
|
|
SROM NRH FEM W/PIN SM LT 66*62
|
Facility
|
OP
|
$75,267.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,580.16 |
| Max. Negotiated Rate |
$72,256.51 |
| Rate for Payer: Aetna Commercial |
$57,955.74
|
| Rate for Payer: Anthem Medicaid |
$25,884.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,708.42
|
| Rate for Payer: Cash Price |
$37,633.60
|
| Rate for Payer: Cigna Commercial |
$62,471.78
|
| Rate for Payer: First Health Commercial |
$71,503.84
|
| Rate for Payer: Humana Commercial |
$63,977.12
|
| Rate for Payer: Humana KY Medicaid |
$25,884.39
|
| Rate for Payer: Kentucky WC Medicaid |
$26,147.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,719.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,547.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,580.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,403.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,235.14
|
| Rate for Payer: Ohio Health Group HMO |
$56,450.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,213.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,482.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,934.37
|
| Rate for Payer: PHCS Commercial |
$72,256.51
|
| Rate for Payer: United Healthcare All Payer |
$66,235.14
|
|
|
SROM NRH FEM W/PIN SM RT 66*62
|
Facility
|
IP
|
$68,402.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,520.64 |
| Max. Negotiated Rate |
$65,666.04 |
| Rate for Payer: Aetna Commercial |
$52,669.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,353.65
|
| Rate for Payer: Cash Price |
$34,201.06
|
| Rate for Payer: Cigna Commercial |
$56,773.76
|
| Rate for Payer: First Health Commercial |
$64,982.01
|
| Rate for Payer: Humana Commercial |
$58,141.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,089.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,480.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,520.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,193.87
|
| Rate for Payer: Ohio Health Group HMO |
$51,301.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54,721.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59,509.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47,197.46
|
| Rate for Payer: PHCS Commercial |
$65,666.04
|
| Rate for Payer: United Healthcare All Payer |
$60,193.87
|
|
|
SROM NRH FEM W/PIN SM RT 66*62
|
Facility
|
OP
|
$68,402.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,520.64 |
| Max. Negotiated Rate |
$65,666.04 |
| Rate for Payer: Aetna Commercial |
$52,669.63
|
| Rate for Payer: Anthem Medicaid |
$23,523.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,353.65
|
| Rate for Payer: Cash Price |
$34,201.06
|
| Rate for Payer: Cigna Commercial |
$56,773.76
|
| Rate for Payer: First Health Commercial |
$64,982.01
|
| Rate for Payer: Humana Commercial |
$58,141.80
|
| Rate for Payer: Humana KY Medicaid |
$23,523.49
|
| Rate for Payer: Kentucky WC Medicaid |
$23,762.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,089.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,480.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,520.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,995.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,193.87
|
| Rate for Payer: Ohio Health Group HMO |
$51,301.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54,721.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59,509.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47,197.46
|
| Rate for Payer: PHCS Commercial |
$65,666.04
|
| Rate for Payer: United Healthcare All Payer |
$60,193.87
|
|
|
SROM NRH FEM W/PIN XSM LT 66*5
|
Facility
|
OP
|
$75,267.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,580.16 |
| Max. Negotiated Rate |
$72,256.51 |
| Rate for Payer: Aetna Commercial |
$57,955.74
|
| Rate for Payer: Anthem Medicaid |
$25,884.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,708.42
|
| Rate for Payer: Cash Price |
$37,633.60
|
| Rate for Payer: Cigna Commercial |
$62,471.78
|
| Rate for Payer: First Health Commercial |
$71,503.84
|
| Rate for Payer: Humana Commercial |
$63,977.12
|
| Rate for Payer: Humana KY Medicaid |
$25,884.39
|
| Rate for Payer: Kentucky WC Medicaid |
$26,147.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,719.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,547.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,580.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,403.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,235.14
|
| Rate for Payer: Ohio Health Group HMO |
$56,450.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,213.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,482.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,934.37
|
| Rate for Payer: PHCS Commercial |
$72,256.51
|
| Rate for Payer: United Healthcare All Payer |
$66,235.14
|
|
|
SROM NRH FEM W/PIN XSM LT 66*5
|
Facility
|
IP
|
$75,267.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,580.16 |
| Max. Negotiated Rate |
$72,256.51 |
| Rate for Payer: Aetna Commercial |
$57,955.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,708.42
|
| Rate for Payer: Cash Price |
$37,633.60
|
| Rate for Payer: Cigna Commercial |
$62,471.78
|
| Rate for Payer: First Health Commercial |
$71,503.84
|
| Rate for Payer: Humana Commercial |
$63,977.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,719.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,547.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,580.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,235.14
|
| Rate for Payer: Ohio Health Group HMO |
$56,450.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,213.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,482.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,934.37
|
| Rate for Payer: PHCS Commercial |
$72,256.51
|
| Rate for Payer: United Healthcare All Payer |
$66,235.14
|
|
|
SROM NRH FEM W/PIN XSM RT 66*5
|
Facility
|
IP
|
$77,043.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,113.11 |
| Max. Negotiated Rate |
$73,961.95 |
| Rate for Payer: Aetna Commercial |
$59,323.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,094.09
|
| Rate for Payer: Cash Price |
$38,521.85
|
| Rate for Payer: Cigna Commercial |
$63,946.27
|
| Rate for Payer: First Health Commercial |
$73,191.51
|
| Rate for Payer: Humana Commercial |
$65,487.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63,175.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,858.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,113.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,798.46
|
| Rate for Payer: Ohio Health Group HMO |
$57,782.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61,634.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67,028.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,160.15
|
| Rate for Payer: PHCS Commercial |
$73,961.95
|
| Rate for Payer: United Healthcare All Payer |
$67,798.46
|
|
|
SROM NRH FEM W/PIN XSM RT 66*5
|
Facility
|
OP
|
$77,043.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,113.11 |
| Max. Negotiated Rate |
$73,961.95 |
| Rate for Payer: Aetna Commercial |
$59,323.65
|
| Rate for Payer: Anthem Medicaid |
$26,495.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60,094.09
|
| Rate for Payer: Cash Price |
$38,521.85
|
| Rate for Payer: Cigna Commercial |
$63,946.27
|
| Rate for Payer: First Health Commercial |
$73,191.51
|
| Rate for Payer: Humana Commercial |
$65,487.14
|
| Rate for Payer: Humana KY Medicaid |
$26,495.33
|
| Rate for Payer: Kentucky WC Medicaid |
$26,764.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63,175.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,858.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,113.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,026.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,798.46
|
| Rate for Payer: Ohio Health Group HMO |
$57,782.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61,634.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67,028.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53,160.15
|
| Rate for Payer: PHCS Commercial |
$73,961.95
|
| Rate for Payer: United Healthcare All Payer |
$67,798.46
|
|
|
SROM NRH FM W/PIN MED RT 71*66
|
Facility
|
OP
|
$69,012.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,703.72 |
| Max. Negotiated Rate |
$66,251.90 |
| Rate for Payer: Aetna Commercial |
$53,139.55
|
| Rate for Payer: Anthem Medicaid |
$23,733.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,829.67
|
| Rate for Payer: Cash Price |
$34,506.20
|
| Rate for Payer: Cigna Commercial |
$57,280.29
|
| Rate for Payer: First Health Commercial |
$65,561.78
|
| Rate for Payer: Humana Commercial |
$58,660.54
|
| Rate for Payer: Humana KY Medicaid |
$23,733.36
|
| Rate for Payer: Kentucky WC Medicaid |
$23,974.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,590.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,931.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,703.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,209.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,730.91
|
| Rate for Payer: Ohio Health Group HMO |
$51,759.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55,209.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60,040.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47,618.56
|
| Rate for Payer: PHCS Commercial |
$66,251.90
|
| Rate for Payer: United Healthcare All Payer |
$60,730.91
|
|
|
SROM NRH FM W/PIN MED RT 71*66
|
Facility
|
IP
|
$69,012.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,703.72 |
| Max. Negotiated Rate |
$66,251.90 |
| Rate for Payer: Aetna Commercial |
$53,139.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,829.67
|
| Rate for Payer: Cash Price |
$34,506.20
|
| Rate for Payer: Cigna Commercial |
$57,280.29
|
| Rate for Payer: First Health Commercial |
$65,561.78
|
| Rate for Payer: Humana Commercial |
$58,660.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,590.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,931.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,703.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,730.91
|
| Rate for Payer: Ohio Health Group HMO |
$51,759.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55,209.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60,040.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47,618.56
|
| Rate for Payer: PHCS Commercial |
$66,251.90
|
| Rate for Payer: United Healthcare All Payer |
$60,730.91
|
|
|
SROM NRH PLAT ASSY MED 16MM
|
Facility
|
IP
|
$13,499.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,049.93 |
| Max. Negotiated Rate |
$12,959.77 |
| Rate for Payer: Aetna Commercial |
$10,394.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,529.81
|
| Rate for Payer: Cash Price |
$6,749.88
|
| Rate for Payer: Cigna Commercial |
$11,204.80
|
| Rate for Payer: First Health Commercial |
$12,824.77
|
| Rate for Payer: Humana Commercial |
$11,474.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,069.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,962.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,049.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,879.79
|
| Rate for Payer: Ohio Health Group HMO |
$10,124.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,799.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,744.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,314.83
|
| Rate for Payer: PHCS Commercial |
$12,959.77
|
| Rate for Payer: United Healthcare All Payer |
$11,879.79
|
|
|
SROM NRH PLAT ASSY MED 16MM
|
Facility
|
OP
|
$13,499.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,049.93 |
| Max. Negotiated Rate |
$12,959.77 |
| Rate for Payer: Aetna Commercial |
$10,394.82
|
| Rate for Payer: Anthem Medicaid |
$4,642.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,529.81
|
| Rate for Payer: Cash Price |
$6,749.88
|
| Rate for Payer: Cigna Commercial |
$11,204.80
|
| Rate for Payer: First Health Commercial |
$12,824.77
|
| Rate for Payer: Humana Commercial |
$11,474.80
|
| Rate for Payer: Humana KY Medicaid |
$4,642.57
|
| Rate for Payer: Kentucky WC Medicaid |
$4,689.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,069.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,962.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,049.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,735.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,879.79
|
| Rate for Payer: Ohio Health Group HMO |
$10,124.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,799.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,744.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,314.83
|
| Rate for Payer: PHCS Commercial |
$12,959.77
|
| Rate for Payer: United Healthcare All Payer |
$11,879.79
|
|
|
SROM NRH PLAT ASSY MED 21MM
|
Facility
|
IP
|
$13,499.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,049.93 |
| Max. Negotiated Rate |
$12,959.77 |
| Rate for Payer: Aetna Commercial |
$10,394.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,529.81
|
| Rate for Payer: Cash Price |
$6,749.88
|
| Rate for Payer: Cigna Commercial |
$11,204.80
|
| Rate for Payer: First Health Commercial |
$12,824.77
|
| Rate for Payer: Humana Commercial |
$11,474.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,069.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,962.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,049.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,879.79
|
| Rate for Payer: Ohio Health Group HMO |
$10,124.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,799.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,744.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,314.83
|
| Rate for Payer: PHCS Commercial |
$12,959.77
|
| Rate for Payer: United Healthcare All Payer |
$11,879.79
|
|
|
SROM NRH PLAT ASSY MED 21MM
|
Facility
|
OP
|
$13,499.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,049.93 |
| Max. Negotiated Rate |
$12,959.77 |
| Rate for Payer: Aetna Commercial |
$10,394.82
|
| Rate for Payer: Anthem Medicaid |
$4,642.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,529.81
|
| Rate for Payer: Cash Price |
$6,749.88
|
| Rate for Payer: Cigna Commercial |
$11,204.80
|
| Rate for Payer: First Health Commercial |
$12,824.77
|
| Rate for Payer: Humana Commercial |
$11,474.80
|
| Rate for Payer: Humana KY Medicaid |
$4,642.57
|
| Rate for Payer: Kentucky WC Medicaid |
$4,689.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,069.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,962.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,049.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,735.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,879.79
|
| Rate for Payer: Ohio Health Group HMO |
$10,124.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,799.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,744.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,314.83
|
| Rate for Payer: PHCS Commercial |
$12,959.77
|
| Rate for Payer: United Healthcare All Payer |
$11,879.79
|
|
|
SROM NRH PLAT ASSY MED 26MM
|
Facility
|
OP
|
$13,499.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,049.93 |
| Max. Negotiated Rate |
$12,959.77 |
| Rate for Payer: Aetna Commercial |
$10,394.82
|
| Rate for Payer: Anthem Medicaid |
$4,642.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,529.81
|
| Rate for Payer: Cash Price |
$6,749.88
|
| Rate for Payer: Cigna Commercial |
$11,204.80
|
| Rate for Payer: First Health Commercial |
$12,824.77
|
| Rate for Payer: Humana Commercial |
$11,474.80
|
| Rate for Payer: Humana KY Medicaid |
$4,642.57
|
| Rate for Payer: Kentucky WC Medicaid |
$4,689.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,069.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,962.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,049.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,735.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,879.79
|
| Rate for Payer: Ohio Health Group HMO |
$10,124.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,799.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,744.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,314.83
|
| Rate for Payer: PHCS Commercial |
$12,959.77
|
| Rate for Payer: United Healthcare All Payer |
$11,879.79
|
|
|
SROM NRH PLAT ASSY MED 26MM
|
Facility
|
IP
|
$13,499.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,049.93 |
| Max. Negotiated Rate |
$12,959.77 |
| Rate for Payer: Aetna Commercial |
$10,394.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,529.81
|
| Rate for Payer: Cash Price |
$6,749.88
|
| Rate for Payer: Cigna Commercial |
$11,204.80
|
| Rate for Payer: First Health Commercial |
$12,824.77
|
| Rate for Payer: Humana Commercial |
$11,474.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,069.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,962.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,049.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,879.79
|
| Rate for Payer: Ohio Health Group HMO |
$10,124.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,799.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,744.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,314.83
|
| Rate for Payer: PHCS Commercial |
$12,959.77
|
| Rate for Payer: United Healthcare All Payer |
$11,879.79
|
|
|
SROM NRH PLAT ASSY MED 31MM
|
Facility
|
OP
|
$13,499.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,049.93 |
| Max. Negotiated Rate |
$12,959.77 |
| Rate for Payer: Aetna Commercial |
$10,394.82
|
| Rate for Payer: Anthem Medicaid |
$4,642.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,529.81
|
| Rate for Payer: Cash Price |
$6,749.88
|
| Rate for Payer: Cigna Commercial |
$11,204.80
|
| Rate for Payer: First Health Commercial |
$12,824.77
|
| Rate for Payer: Humana Commercial |
$11,474.80
|
| Rate for Payer: Humana KY Medicaid |
$4,642.57
|
| Rate for Payer: Kentucky WC Medicaid |
$4,689.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,069.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,962.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,049.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,735.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,879.79
|
| Rate for Payer: Ohio Health Group HMO |
$10,124.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,799.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,744.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,314.83
|
| Rate for Payer: PHCS Commercial |
$12,959.77
|
| Rate for Payer: United Healthcare All Payer |
$11,879.79
|
|
|
SROM NRH PLAT ASSY MED 31MM
|
Facility
|
IP
|
$13,499.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,049.93 |
| Max. Negotiated Rate |
$12,959.77 |
| Rate for Payer: Aetna Commercial |
$10,394.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,529.81
|
| Rate for Payer: Cash Price |
$6,749.88
|
| Rate for Payer: Cigna Commercial |
$11,204.80
|
| Rate for Payer: First Health Commercial |
$12,824.77
|
| Rate for Payer: Humana Commercial |
$11,474.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,069.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,962.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,049.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,879.79
|
| Rate for Payer: Ohio Health Group HMO |
$10,124.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,799.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,744.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,314.83
|
| Rate for Payer: PHCS Commercial |
$12,959.77
|
| Rate for Payer: United Healthcare All Payer |
$11,879.79
|
|
|
SROM NRH PLAT ASSY SM 12MM
|
Facility
|
OP
|
$13,499.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,049.93 |
| Max. Negotiated Rate |
$12,959.77 |
| Rate for Payer: Aetna Commercial |
$10,394.82
|
| Rate for Payer: Anthem Medicaid |
$4,642.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,529.81
|
| Rate for Payer: Cash Price |
$6,749.88
|
| Rate for Payer: Cigna Commercial |
$11,204.80
|
| Rate for Payer: First Health Commercial |
$12,824.77
|
| Rate for Payer: Humana Commercial |
$11,474.80
|
| Rate for Payer: Humana KY Medicaid |
$4,642.57
|
| Rate for Payer: Kentucky WC Medicaid |
$4,689.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,069.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,962.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,049.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,735.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,879.79
|
| Rate for Payer: Ohio Health Group HMO |
$10,124.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,799.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,744.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,314.83
|
| Rate for Payer: PHCS Commercial |
$12,959.77
|
| Rate for Payer: United Healthcare All Payer |
$11,879.79
|
|
|
SROM NRH PLAT ASSY SM 12MM
|
Facility
|
IP
|
$13,499.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,049.93 |
| Max. Negotiated Rate |
$12,959.77 |
| Rate for Payer: Aetna Commercial |
$10,394.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,529.81
|
| Rate for Payer: Cash Price |
$6,749.88
|
| Rate for Payer: Cigna Commercial |
$11,204.80
|
| Rate for Payer: First Health Commercial |
$12,824.77
|
| Rate for Payer: Humana Commercial |
$11,474.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,069.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,962.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,049.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,879.79
|
| Rate for Payer: Ohio Health Group HMO |
$10,124.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,799.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,744.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,314.83
|
| Rate for Payer: PHCS Commercial |
$12,959.77
|
| Rate for Payer: United Healthcare All Payer |
$11,879.79
|
|
|
SROM NRH PLAT ASSY SM 16MM
|
Facility
|
OP
|
$13,499.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,049.93 |
| Max. Negotiated Rate |
$12,959.77 |
| Rate for Payer: Aetna Commercial |
$10,394.82
|
| Rate for Payer: Anthem Medicaid |
$4,642.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,529.81
|
| Rate for Payer: Cash Price |
$6,749.88
|
| Rate for Payer: Cigna Commercial |
$11,204.80
|
| Rate for Payer: First Health Commercial |
$12,824.77
|
| Rate for Payer: Humana Commercial |
$11,474.80
|
| Rate for Payer: Humana KY Medicaid |
$4,642.57
|
| Rate for Payer: Kentucky WC Medicaid |
$4,689.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,069.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,962.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,049.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,735.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,879.79
|
| Rate for Payer: Ohio Health Group HMO |
$10,124.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,799.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,744.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,314.83
|
| Rate for Payer: PHCS Commercial |
$12,959.77
|
| Rate for Payer: United Healthcare All Payer |
$11,879.79
|
|
