|
BHR-2MM ACE CUO HAP SZ 48/54
|
Facility
|
IP
|
$21,256.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,376.88 |
| Max. Negotiated Rate |
$20,406.00 |
| Rate for Payer: Aetna Commercial |
$16,367.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,579.88
|
| Rate for Payer: Cash Price |
$10,628.12
|
| Rate for Payer: Cigna Commercial |
$17,642.69
|
| Rate for Payer: First Health Commercial |
$20,193.44
|
| Rate for Payer: Humana Commercial |
$18,067.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,430.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,687.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,376.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,705.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,942.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,005.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,492.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,666.81
|
| Rate for Payer: PHCS Commercial |
$20,406.00
|
| Rate for Payer: United Healthcare All Payer |
$18,705.50
|
|
|
BHR 2MM ACE CUP HAP AZ 48/56
|
Facility
|
OP
|
$21,256.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,376.88 |
| Max. Negotiated Rate |
$20,406.00 |
| Rate for Payer: Aetna Commercial |
$16,367.31
|
| Rate for Payer: Anthem Medicaid |
$7,310.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,579.88
|
| Rate for Payer: Cash Price |
$10,628.12
|
| Rate for Payer: Cigna Commercial |
$17,642.69
|
| Rate for Payer: First Health Commercial |
$20,193.44
|
| Rate for Payer: Humana Commercial |
$18,067.81
|
| Rate for Payer: Humana KY Medicaid |
$7,310.02
|
| Rate for Payer: Kentucky WC Medicaid |
$7,384.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,430.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,687.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,376.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,456.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,705.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,942.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,005.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,492.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,666.81
|
| Rate for Payer: PHCS Commercial |
$20,406.00
|
| Rate for Payer: United Healthcare All Payer |
$18,705.50
|
|
|
BHR 2MM ACE CUP HAP AZ 48/56
|
Facility
|
IP
|
$21,256.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,376.88 |
| Max. Negotiated Rate |
$20,406.00 |
| Rate for Payer: Aetna Commercial |
$16,367.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,579.88
|
| Rate for Payer: Cash Price |
$10,628.12
|
| Rate for Payer: Cigna Commercial |
$17,642.69
|
| Rate for Payer: First Health Commercial |
$20,193.44
|
| Rate for Payer: Humana Commercial |
$18,067.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,430.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,687.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,376.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,705.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,942.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,005.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,492.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,666.81
|
| Rate for Payer: PHCS Commercial |
$20,406.00
|
| Rate for Payer: United Healthcare All Payer |
$18,705.50
|
|
|
BHR 2MM ACE CUP HAP SZ 40/46
|
Facility
|
IP
|
$21,256.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,376.88 |
| Max. Negotiated Rate |
$20,406.00 |
| Rate for Payer: Aetna Commercial |
$16,367.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,579.88
|
| Rate for Payer: Cash Price |
$10,628.12
|
| Rate for Payer: Cigna Commercial |
$17,642.69
|
| Rate for Payer: First Health Commercial |
$20,193.44
|
| Rate for Payer: Humana Commercial |
$18,067.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,430.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,687.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,376.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,705.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,942.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,005.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,492.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,666.81
|
| Rate for Payer: PHCS Commercial |
$20,406.00
|
| Rate for Payer: United Healthcare All Payer |
$18,705.50
|
|
|
BHR 2MM ACE CUP HAP SZ 40/46
|
Facility
|
OP
|
$21,256.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,376.88 |
| Max. Negotiated Rate |
$20,406.00 |
| Rate for Payer: Aetna Commercial |
$16,367.31
|
| Rate for Payer: Anthem Medicaid |
$7,310.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,579.88
|
| Rate for Payer: Cash Price |
$10,628.12
|
| Rate for Payer: Cigna Commercial |
$17,642.69
|
| Rate for Payer: First Health Commercial |
$20,193.44
|
| Rate for Payer: Humana Commercial |
$18,067.81
|
| Rate for Payer: Humana KY Medicaid |
$7,310.02
|
| Rate for Payer: Kentucky WC Medicaid |
$7,384.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,430.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,687.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,376.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,456.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,705.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,942.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,005.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,492.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,666.81
|
| Rate for Payer: PHCS Commercial |
$20,406.00
|
| Rate for Payer: United Healthcare All Payer |
$18,705.50
|
|
|
BHR 2MM ACE CUP HAP SZ 40/48
|
Facility
|
IP
|
$21,256.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,376.88 |
| Max. Negotiated Rate |
$20,406.00 |
| Rate for Payer: Aetna Commercial |
$16,367.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,579.88
|
| Rate for Payer: Cash Price |
$10,628.12
|
| Rate for Payer: Cigna Commercial |
$17,642.69
|
| Rate for Payer: First Health Commercial |
$20,193.44
|
| Rate for Payer: Humana Commercial |
$18,067.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,430.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,687.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,376.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,705.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,942.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,005.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,492.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,666.81
|
| Rate for Payer: PHCS Commercial |
$20,406.00
|
| Rate for Payer: United Healthcare All Payer |
$18,705.50
|
|
|
BHR 2MM ACE CUP HAP SZ 40/48
|
Facility
|
OP
|
$21,256.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,376.88 |
| Max. Negotiated Rate |
$20,406.00 |
| Rate for Payer: Aetna Commercial |
$16,367.31
|
| Rate for Payer: Anthem Medicaid |
$7,310.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,579.88
|
| Rate for Payer: Cash Price |
$10,628.12
|
| Rate for Payer: Cigna Commercial |
$17,642.69
|
| Rate for Payer: First Health Commercial |
$20,193.44
|
| Rate for Payer: Humana Commercial |
$18,067.81
|
| Rate for Payer: Humana KY Medicaid |
$7,310.02
|
| Rate for Payer: Kentucky WC Medicaid |
$7,384.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,430.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,687.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,376.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,456.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,705.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,942.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,005.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,492.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,666.81
|
| Rate for Payer: PHCS Commercial |
$20,406.00
|
| Rate for Payer: United Healthcare All Payer |
$18,705.50
|
|
|
BHR 2MM ACE CUP HAP SZ 44/50
|
Facility
|
IP
|
$21,256.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,376.88 |
| Max. Negotiated Rate |
$20,406.00 |
| Rate for Payer: Aetna Commercial |
$16,367.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,579.88
|
| Rate for Payer: Cash Price |
$10,628.12
|
| Rate for Payer: Cigna Commercial |
$17,642.69
|
| Rate for Payer: First Health Commercial |
$20,193.44
|
| Rate for Payer: Humana Commercial |
$18,067.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,430.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,687.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,376.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,705.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,942.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,005.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,492.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,666.81
|
| Rate for Payer: PHCS Commercial |
$20,406.00
|
| Rate for Payer: United Healthcare All Payer |
$18,705.50
|
|
|
BHR 2MM ACE CUP HAP SZ 44/50
|
Facility
|
OP
|
$21,256.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,376.88 |
| Max. Negotiated Rate |
$20,406.00 |
| Rate for Payer: Aetna Commercial |
$16,367.31
|
| Rate for Payer: Anthem Medicaid |
$7,310.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,579.88
|
| Rate for Payer: Cash Price |
$10,628.12
|
| Rate for Payer: Cigna Commercial |
$17,642.69
|
| Rate for Payer: First Health Commercial |
$20,193.44
|
| Rate for Payer: Humana Commercial |
$18,067.81
|
| Rate for Payer: Humana KY Medicaid |
$7,310.02
|
| Rate for Payer: Kentucky WC Medicaid |
$7,384.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,430.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,687.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,376.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,456.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,705.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,942.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,005.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,492.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,666.81
|
| Rate for Payer: PHCS Commercial |
$20,406.00
|
| Rate for Payer: United Healthcare All Payer |
$18,705.50
|
|
|
BHR 2MM ACE CUP HAP SZ 52/48
|
Facility
|
IP
|
$21,256.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,376.88 |
| Max. Negotiated Rate |
$20,406.00 |
| Rate for Payer: Aetna Commercial |
$16,367.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,579.88
|
| Rate for Payer: Cash Price |
$10,628.12
|
| Rate for Payer: Cigna Commercial |
$17,642.69
|
| Rate for Payer: First Health Commercial |
$20,193.44
|
| Rate for Payer: Humana Commercial |
$18,067.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,430.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,687.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,376.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,705.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,942.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,005.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,492.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,666.81
|
| Rate for Payer: PHCS Commercial |
$20,406.00
|
| Rate for Payer: United Healthcare All Payer |
$18,705.50
|
|
|
BHR 2MM ACE CUP HAP SZ 52/48
|
Facility
|
OP
|
$21,256.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,376.88 |
| Max. Negotiated Rate |
$20,406.00 |
| Rate for Payer: Aetna Commercial |
$16,367.31
|
| Rate for Payer: Anthem Medicaid |
$7,310.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,579.88
|
| Rate for Payer: Cash Price |
$10,628.12
|
| Rate for Payer: Cigna Commercial |
$17,642.69
|
| Rate for Payer: First Health Commercial |
$20,193.44
|
| Rate for Payer: Humana Commercial |
$18,067.81
|
| Rate for Payer: Humana KY Medicaid |
$7,310.02
|
| Rate for Payer: Kentucky WC Medicaid |
$7,384.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,430.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,687.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,376.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,456.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,705.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,942.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,005.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,492.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,666.81
|
| Rate for Payer: PHCS Commercial |
$20,406.00
|
| Rate for Payer: United Healthcare All Payer |
$18,705.50
|
|
|
BHR 2MM ACE CUP HAP SZ 52/60
|
Facility
|
IP
|
$21,256.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,376.88 |
| Max. Negotiated Rate |
$20,406.00 |
| Rate for Payer: Aetna Commercial |
$16,367.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,579.88
|
| Rate for Payer: Cash Price |
$10,628.12
|
| Rate for Payer: Cigna Commercial |
$17,642.69
|
| Rate for Payer: First Health Commercial |
$20,193.44
|
| Rate for Payer: Humana Commercial |
$18,067.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,430.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,687.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,376.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,705.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,942.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,005.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,492.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,666.81
|
| Rate for Payer: PHCS Commercial |
$20,406.00
|
| Rate for Payer: United Healthcare All Payer |
$18,705.50
|
|
|
BHR 2MM ACE CUP HAP SZ 52/60
|
Facility
|
OP
|
$21,256.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,376.88 |
| Max. Negotiated Rate |
$20,406.00 |
| Rate for Payer: Aetna Commercial |
$16,367.31
|
| Rate for Payer: Anthem Medicaid |
$7,310.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,579.88
|
| Rate for Payer: Cash Price |
$10,628.12
|
| Rate for Payer: Cigna Commercial |
$17,642.69
|
| Rate for Payer: First Health Commercial |
$20,193.44
|
| Rate for Payer: Humana Commercial |
$18,067.81
|
| Rate for Payer: Humana KY Medicaid |
$7,310.02
|
| Rate for Payer: Kentucky WC Medicaid |
$7,384.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,430.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,687.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,376.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,456.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,705.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,942.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,005.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,492.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,666.81
|
| Rate for Payer: PHCS Commercial |
$20,406.00
|
| Rate for Payer: United Healthcare All Payer |
$18,705.50
|
|
|
BHR 2MM ACE CUP HAP SZ 56/62
|
Facility
|
OP
|
$21,256.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,376.88 |
| Max. Negotiated Rate |
$20,406.00 |
| Rate for Payer: Aetna Commercial |
$16,367.31
|
| Rate for Payer: Anthem Medicaid |
$7,310.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,579.88
|
| Rate for Payer: Cash Price |
$10,628.12
|
| Rate for Payer: Cigna Commercial |
$17,642.69
|
| Rate for Payer: First Health Commercial |
$20,193.44
|
| Rate for Payer: Humana Commercial |
$18,067.81
|
| Rate for Payer: Humana KY Medicaid |
$7,310.02
|
| Rate for Payer: Kentucky WC Medicaid |
$7,384.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,430.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,687.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,376.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,456.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,705.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,942.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,005.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,492.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,666.81
|
| Rate for Payer: PHCS Commercial |
$20,406.00
|
| Rate for Payer: United Healthcare All Payer |
$18,705.50
|
|
|
BHR 2MM ACE CUP HAP SZ 56/62
|
Facility
|
IP
|
$21,256.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,376.88 |
| Max. Negotiated Rate |
$20,406.00 |
| Rate for Payer: Aetna Commercial |
$16,367.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,579.88
|
| Rate for Payer: Cash Price |
$10,628.12
|
| Rate for Payer: Cigna Commercial |
$17,642.69
|
| Rate for Payer: First Health Commercial |
$20,193.44
|
| Rate for Payer: Humana Commercial |
$18,067.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,430.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,687.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,376.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,705.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,942.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,005.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,492.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,666.81
|
| Rate for Payer: PHCS Commercial |
$20,406.00
|
| Rate for Payer: United Healthcare All Payer |
$18,705.50
|
|
|
BHR 2MM ACE CUP HAP SZ 56/64
|
Facility
|
OP
|
$21,256.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,376.88 |
| Max. Negotiated Rate |
$20,406.00 |
| Rate for Payer: Aetna Commercial |
$16,367.31
|
| Rate for Payer: Anthem Medicaid |
$7,310.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,579.88
|
| Rate for Payer: Cash Price |
$10,628.12
|
| Rate for Payer: Cigna Commercial |
$17,642.69
|
| Rate for Payer: First Health Commercial |
$20,193.44
|
| Rate for Payer: Humana Commercial |
$18,067.81
|
| Rate for Payer: Humana KY Medicaid |
$7,310.02
|
| Rate for Payer: Kentucky WC Medicaid |
$7,384.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,430.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,687.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,376.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,456.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,705.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,942.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,005.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,492.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,666.81
|
| Rate for Payer: PHCS Commercial |
$20,406.00
|
| Rate for Payer: United Healthcare All Payer |
$18,705.50
|
|
|
BHR 2MM ACE CUP HAP SZ 56/64
|
Facility
|
IP
|
$21,256.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,376.88 |
| Max. Negotiated Rate |
$20,406.00 |
| Rate for Payer: Aetna Commercial |
$16,367.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,579.88
|
| Rate for Payer: Cash Price |
$10,628.12
|
| Rate for Payer: Cigna Commercial |
$17,642.69
|
| Rate for Payer: First Health Commercial |
$20,193.44
|
| Rate for Payer: Humana Commercial |
$18,067.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,430.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,687.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,376.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,705.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,942.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,005.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,492.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,666.81
|
| Rate for Payer: PHCS Commercial |
$20,406.00
|
| Rate for Payer: United Healthcare All Payer |
$18,705.50
|
|
|
BHR 2MM FEMEROL HEAD 56MM
|
Facility
|
IP
|
$24,706.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,411.88 |
| Max. Negotiated Rate |
$23,718.00 |
| Rate for Payer: Aetna Commercial |
$19,023.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,270.88
|
| Rate for Payer: Cash Price |
$12,353.12
|
| Rate for Payer: Cigna Commercial |
$20,506.19
|
| Rate for Payer: First Health Commercial |
$23,470.94
|
| Rate for Payer: Humana Commercial |
$21,000.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,259.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,233.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,411.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,741.50
|
| Rate for Payer: Ohio Health Group HMO |
$18,529.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,765.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,494.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,047.31
|
| Rate for Payer: PHCS Commercial |
$23,718.00
|
| Rate for Payer: United Healthcare All Payer |
$21,741.50
|
|
|
BHR 2MM FEMEROL HEAD 56MM
|
Facility
|
OP
|
$24,706.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,411.88 |
| Max. Negotiated Rate |
$23,718.00 |
| Rate for Payer: Aetna Commercial |
$19,023.81
|
| Rate for Payer: Anthem Medicaid |
$8,496.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,270.88
|
| Rate for Payer: Cash Price |
$12,353.12
|
| Rate for Payer: Cigna Commercial |
$20,506.19
|
| Rate for Payer: First Health Commercial |
$23,470.94
|
| Rate for Payer: Humana Commercial |
$21,000.31
|
| Rate for Payer: Humana KY Medicaid |
$8,496.48
|
| Rate for Payer: Kentucky WC Medicaid |
$8,582.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,259.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,233.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,411.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,666.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,741.50
|
| Rate for Payer: Ohio Health Group HMO |
$18,529.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,765.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,494.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,047.31
|
| Rate for Payer: PHCS Commercial |
$23,718.00
|
| Rate for Payer: United Healthcare All Payer |
$21,741.50
|
|
|
BHR 2MM FEMOARL HD. 40MM
|
Facility
|
OP
|
$24,706.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,411.88 |
| Max. Negotiated Rate |
$23,718.00 |
| Rate for Payer: Aetna Commercial |
$19,023.81
|
| Rate for Payer: Anthem Medicaid |
$8,496.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,270.88
|
| Rate for Payer: Cash Price |
$12,353.12
|
| Rate for Payer: Cigna Commercial |
$20,506.19
|
| Rate for Payer: First Health Commercial |
$23,470.94
|
| Rate for Payer: Humana Commercial |
$21,000.31
|
| Rate for Payer: Humana KY Medicaid |
$8,496.48
|
| Rate for Payer: Kentucky WC Medicaid |
$8,582.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,259.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,233.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,411.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,666.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,741.50
|
| Rate for Payer: Ohio Health Group HMO |
$18,529.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,765.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,494.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,047.31
|
| Rate for Payer: PHCS Commercial |
$23,718.00
|
| Rate for Payer: United Healthcare All Payer |
$21,741.50
|
|
|
BHR 2MM FEMOARL HD. 40MM
|
Facility
|
IP
|
$24,706.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,411.88 |
| Max. Negotiated Rate |
$23,718.00 |
| Rate for Payer: Aetna Commercial |
$19,023.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,270.88
|
| Rate for Payer: Cash Price |
$12,353.12
|
| Rate for Payer: Cigna Commercial |
$20,506.19
|
| Rate for Payer: First Health Commercial |
$23,470.94
|
| Rate for Payer: Humana Commercial |
$21,000.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,259.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,233.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,411.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,741.50
|
| Rate for Payer: Ohio Health Group HMO |
$18,529.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,765.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,494.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,047.31
|
| Rate for Payer: PHCS Commercial |
$23,718.00
|
| Rate for Payer: United Healthcare All Payer |
$21,741.50
|
|
|
BHR 2MM FEMORAL HD. 48MM
|
Facility
|
IP
|
$24,706.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,411.88 |
| Max. Negotiated Rate |
$23,718.00 |
| Rate for Payer: Aetna Commercial |
$19,023.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,270.88
|
| Rate for Payer: Cash Price |
$12,353.12
|
| Rate for Payer: Cigna Commercial |
$20,506.19
|
| Rate for Payer: First Health Commercial |
$23,470.94
|
| Rate for Payer: Humana Commercial |
$21,000.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,259.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,233.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,411.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,741.50
|
| Rate for Payer: Ohio Health Group HMO |
$18,529.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,765.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,494.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,047.31
|
| Rate for Payer: PHCS Commercial |
$23,718.00
|
| Rate for Payer: United Healthcare All Payer |
$21,741.50
|
|
|
BHR 2MM FEMORAL HD. 48MM
|
Facility
|
OP
|
$24,706.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,411.88 |
| Max. Negotiated Rate |
$23,718.00 |
| Rate for Payer: Aetna Commercial |
$19,023.81
|
| Rate for Payer: Anthem Medicaid |
$8,496.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,270.88
|
| Rate for Payer: Cash Price |
$12,353.12
|
| Rate for Payer: Cigna Commercial |
$20,506.19
|
| Rate for Payer: First Health Commercial |
$23,470.94
|
| Rate for Payer: Humana Commercial |
$21,000.31
|
| Rate for Payer: Humana KY Medicaid |
$8,496.48
|
| Rate for Payer: Kentucky WC Medicaid |
$8,582.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,259.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,233.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,411.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,666.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,741.50
|
| Rate for Payer: Ohio Health Group HMO |
$18,529.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,765.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,494.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,047.31
|
| Rate for Payer: PHCS Commercial |
$23,718.00
|
| Rate for Payer: United Healthcare All Payer |
$21,741.50
|
|
|
BHR 2MM FEMORAL HD. 52MM
|
Facility
|
OP
|
$24,706.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,411.88 |
| Max. Negotiated Rate |
$23,718.00 |
| Rate for Payer: Aetna Commercial |
$19,023.81
|
| Rate for Payer: Anthem Medicaid |
$8,496.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,270.88
|
| Rate for Payer: Cash Price |
$12,353.12
|
| Rate for Payer: Cigna Commercial |
$20,506.19
|
| Rate for Payer: First Health Commercial |
$23,470.94
|
| Rate for Payer: Humana Commercial |
$21,000.31
|
| Rate for Payer: Humana KY Medicaid |
$8,496.48
|
| Rate for Payer: Kentucky WC Medicaid |
$8,582.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,259.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,233.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,411.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,666.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,741.50
|
| Rate for Payer: Ohio Health Group HMO |
$18,529.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,765.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,494.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,047.31
|
| Rate for Payer: PHCS Commercial |
$23,718.00
|
| Rate for Payer: United Healthcare All Payer |
$21,741.50
|
|
|
BHR 2MM FEMORAL HD. 52MM
|
Facility
|
IP
|
$24,706.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,411.88 |
| Max. Negotiated Rate |
$23,718.00 |
| Rate for Payer: Aetna Commercial |
$19,023.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,270.88
|
| Rate for Payer: Cash Price |
$12,353.12
|
| Rate for Payer: Cigna Commercial |
$20,506.19
|
| Rate for Payer: First Health Commercial |
$23,470.94
|
| Rate for Payer: Humana Commercial |
$21,000.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,259.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,233.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,411.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,741.50
|
| Rate for Payer: Ohio Health Group HMO |
$18,529.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,765.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,494.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,047.31
|
| Rate for Payer: PHCS Commercial |
$23,718.00
|
| Rate for Payer: United Healthcare All Payer |
$21,741.50
|
|
