|
BEARINGS PSN MC VE 12MM 12/J
|
Facility
|
OP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem Medicaid |
$2,876.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Humana KY Medicaid |
$2,876.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,906.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,934.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
BEARINGS PSN MC VE 13MM 12/GH
|
Facility
|
IP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
BEARINGS PSN MC VE 13MM 12/GH
|
Facility
|
OP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem Medicaid |
$2,876.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Humana KY Medicaid |
$2,876.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,906.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,934.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
BEARINGS PSN MC VE 13MM 12/J
|
Facility
|
OP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem Medicaid |
$2,876.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Humana KY Medicaid |
$2,876.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,906.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,934.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
BEARINGS PSN MC VE 13MM 12/J
|
Facility
|
IP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
BEARINGS PSN MC VE 14MM 12/GH
|
Facility
|
IP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
BEARINGS PSN MC VE 14MM 12/GH
|
Facility
|
OP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem Medicaid |
$2,876.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Humana KY Medicaid |
$2,876.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,906.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,934.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
BEARINGS PSN MC VE 14MM 12/J
|
Facility
|
IP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
BEARINGS PSN MC VE 14MM 12/J
|
Facility
|
OP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem Medicaid |
$2,876.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Humana KY Medicaid |
$2,876.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,906.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,934.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
BEARINGS PSN MC VE 16MM 12/GH
|
Facility
|
OP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem Medicaid |
$2,876.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Humana KY Medicaid |
$2,876.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,906.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,934.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
BEARINGS PSN MC VE 16MM 12/GH
|
Facility
|
IP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
BEARINGS PSN MC VE 16MM 12/J
|
Facility
|
IP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
BEARINGS PSN MC VE 16MM 12/J
|
Facility
|
OP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem Medicaid |
$2,876.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Humana KY Medicaid |
$2,876.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,906.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,934.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
BEARINGS PSN MC VE 18MM 12/GH
|
Facility
|
IP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
BEARINGS PSN MC VE 18MM 12/GH
|
Facility
|
OP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem Medicaid |
$2,876.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Humana KY Medicaid |
$2,876.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,906.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,934.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
BEARINGS PSN MC VE 18MM 12/J
|
Facility
|
IP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
BEARINGS PSN MC VE 18MM 12/J
|
Facility
|
OP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem Medicaid |
$2,876.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Humana KY Medicaid |
$2,876.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,906.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,934.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
BEARINGS PSN MCVE18MM 4-5/EF L
|
Facility
|
OP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem Medicaid |
$2,876.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Humana KY Medicaid |
$2,876.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,906.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,934.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
BEARINGS PSN MCVE18MM 4-5/EF L
|
Facility
|
IP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
BEARINGS PSN MC VE 20MM 12/GH
|
Facility
|
IP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
BEARINGS PSN MC VE 20MM 12/GH
|
Facility
|
OP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem Medicaid |
$2,876.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Humana KY Medicaid |
$2,876.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,906.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,934.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
BEARINGS PSN MC VE 20MM 12/J
|
Facility
|
OP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem Medicaid |
$2,876.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Humana KY Medicaid |
$2,876.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,906.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,934.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
BEARINGS PSN MC VE 20MM 12/J
|
Facility
|
IP
|
$8,365.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,509.65 |
| Max. Negotiated Rate |
$8,030.88 |
| Rate for Payer: Aetna Commercial |
$6,441.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,525.09
|
| Rate for Payer: Cash Price |
$4,182.75
|
| Rate for Payer: Cigna Commercial |
$6,943.36
|
| Rate for Payer: First Health Commercial |
$7,947.23
|
| Rate for Payer: Humana Commercial |
$7,110.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,859.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,173.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,509.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,361.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,274.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,277.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,772.19
|
| Rate for Payer: PHCS Commercial |
$8,030.88
|
| Rate for Payer: United Healthcare All Payer |
$7,361.64
|
|
|
BEARNG E1 ANTIOX INFSD 28*44MM
|
Facility
|
OP
|
$13,676.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,103.07 |
| Max. Negotiated Rate |
$13,129.83 |
| Rate for Payer: Aetna Commercial |
$10,531.22
|
| Rate for Payer: Anthem Medicaid |
$4,703.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,667.99
|
| Rate for Payer: Cash Price |
$6,838.46
|
| Rate for Payer: Cigna Commercial |
$11,351.84
|
| Rate for Payer: First Health Commercial |
$12,993.06
|
| Rate for Payer: Humana Commercial |
$11,625.37
|
| Rate for Payer: Humana KY Medicaid |
$4,703.49
|
| Rate for Payer: Kentucky WC Medicaid |
$4,751.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,215.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,093.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,103.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,797.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,035.68
|
| Rate for Payer: Ohio Health Group HMO |
$10,257.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,941.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,898.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,437.07
|
| Rate for Payer: PHCS Commercial |
$13,129.83
|
| Rate for Payer: United Healthcare All Payer |
$12,035.68
|
|
|
BEARNG E1 ANTIOX INFSD 28*44MM
|
Facility
|
IP
|
$13,676.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,103.07 |
| Max. Negotiated Rate |
$13,129.83 |
| Rate for Payer: Aetna Commercial |
$10,531.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,667.99
|
| Rate for Payer: Cash Price |
$6,838.46
|
| Rate for Payer: Cigna Commercial |
$11,351.84
|
| Rate for Payer: First Health Commercial |
$12,993.06
|
| Rate for Payer: Humana Commercial |
$11,625.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,215.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,093.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,103.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,035.68
|
| Rate for Payer: Ohio Health Group HMO |
$10,257.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,941.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,898.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,437.07
|
| Rate for Payer: PHCS Commercial |
$13,129.83
|
| Rate for Payer: United Healthcare All Payer |
$12,035.68
|
|
