VERSA-DIAL 42*21*43MM HMRL HED
|
Facility
|
IP
|
$8,753.15
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,137.91 |
Max. Negotiated Rate |
$8,403.02 |
Rate for Payer: Aetna Commercial |
$6,739.93
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,827.46
|
Rate for Payer: Cash Price |
$4,376.58
|
Rate for Payer: Cigna Commercial |
$7,265.11
|
Rate for Payer: First Health Commercial |
$8,315.49
|
Rate for Payer: Humana Commercial |
$7,440.18
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,177.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,459.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,625.94
|
Rate for Payer: Ohio Health Choice Commercial |
$7,702.77
|
Rate for Payer: Ohio Health Group HMO |
$6,564.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,750.63
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,137.91
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,713.48
|
Rate for Payer: PHCS Commercial |
$8,403.02
|
Rate for Payer: United Healthcare All Payer |
$7,702.77
|
|
VERSA-DIAL 42*21*43MM HMRL HED
|
Facility
|
OP
|
$8,753.15
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,137.91 |
Max. Negotiated Rate |
$8,403.02 |
Rate for Payer: Aetna Commercial |
$6,739.93
|
Rate for Payer: Anthem Medicaid |
$3,010.21
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,827.46
|
Rate for Payer: Cash Price |
$4,376.58
|
Rate for Payer: Cigna Commercial |
$7,265.11
|
Rate for Payer: First Health Commercial |
$8,315.49
|
Rate for Payer: Humana Commercial |
$7,440.18
|
Rate for Payer: Humana KY Medicaid |
$3,010.21
|
Rate for Payer: Kentucky WC Medicaid |
$3,040.84
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,177.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,459.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,625.94
|
Rate for Payer: Molina Healthcare Medicaid |
$3,070.61
|
Rate for Payer: Ohio Health Choice Commercial |
$7,702.77
|
Rate for Payer: Ohio Health Group HMO |
$6,564.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,750.63
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,137.91
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,713.48
|
Rate for Payer: PHCS Commercial |
$8,403.02
|
Rate for Payer: United Healthcare All Payer |
$7,702.77
|
|
VERSA-DIAL 42*24*42MM HMRL HED
|
Facility
|
OP
|
$8,753.15
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,137.91 |
Max. Negotiated Rate |
$8,403.02 |
Rate for Payer: Aetna Commercial |
$6,739.93
|
Rate for Payer: Anthem Medicaid |
$3,010.21
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,827.46
|
Rate for Payer: Cash Price |
$4,376.58
|
Rate for Payer: Cigna Commercial |
$7,265.11
|
Rate for Payer: First Health Commercial |
$8,315.49
|
Rate for Payer: Humana Commercial |
$7,440.18
|
Rate for Payer: Humana KY Medicaid |
$3,010.21
|
Rate for Payer: Kentucky WC Medicaid |
$3,040.84
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,177.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,459.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,625.94
|
Rate for Payer: Molina Healthcare Medicaid |
$3,070.61
|
Rate for Payer: Ohio Health Choice Commercial |
$7,702.77
|
Rate for Payer: Ohio Health Group HMO |
$6,564.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,750.63
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,137.91
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,713.48
|
Rate for Payer: PHCS Commercial |
$8,403.02
|
Rate for Payer: United Healthcare All Payer |
$7,702.77
|
|
VERSA-DIAL 42*24*42MM HMRL HED
|
Facility
|
IP
|
$8,753.15
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,137.91 |
Max. Negotiated Rate |
$8,403.02 |
Rate for Payer: Aetna Commercial |
$6,739.93
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,827.46
|
Rate for Payer: Cash Price |
$4,376.58
|
Rate for Payer: Cigna Commercial |
$7,265.11
|
Rate for Payer: First Health Commercial |
$8,315.49
|
Rate for Payer: Humana Commercial |
$7,440.18
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,177.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,459.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,625.94
|
Rate for Payer: Ohio Health Choice Commercial |
$7,702.77
|
Rate for Payer: Ohio Health Group HMO |
$6,564.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,750.63
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,137.91
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,713.48
|
Rate for Payer: PHCS Commercial |
$8,403.02
|
Rate for Payer: United Healthcare All Payer |
$7,702.77
|
|
VERSA-DIAL 46*18*53MM HMRL HED
|
Facility
|
OP
|
$8,753.15
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,137.91 |
Max. Negotiated Rate |
$8,403.02 |
Rate for Payer: Aetna Commercial |
$6,739.93
|
Rate for Payer: Anthem Medicaid |
$3,010.21
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,827.46
|
Rate for Payer: Cash Price |
$4,376.58
|
Rate for Payer: Cigna Commercial |
$7,265.11
|
Rate for Payer: First Health Commercial |
$8,315.49
|
Rate for Payer: Humana Commercial |
$7,440.18
|
Rate for Payer: Humana KY Medicaid |
$3,010.21
|
Rate for Payer: Kentucky WC Medicaid |
$3,040.84
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,177.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,459.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,625.94
|
Rate for Payer: Molina Healthcare Medicaid |
$3,070.61
|
Rate for Payer: Ohio Health Choice Commercial |
$7,702.77
|
Rate for Payer: Ohio Health Group HMO |
$6,564.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,750.63
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,137.91
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,713.48
|
Rate for Payer: PHCS Commercial |
$8,403.02
|
Rate for Payer: United Healthcare All Payer |
$7,702.77
|
|
VERSA-DIAL 46*18*53MM HMRL HED
|
Facility
|
IP
|
$8,753.15
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,137.91 |
Max. Negotiated Rate |
$8,403.02 |
Rate for Payer: Aetna Commercial |
$6,739.93
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,827.46
|
Rate for Payer: Cash Price |
$4,376.58
|
Rate for Payer: Cigna Commercial |
$7,265.11
|
Rate for Payer: First Health Commercial |
$8,315.49
|
Rate for Payer: Humana Commercial |
$7,440.18
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,177.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,459.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,625.94
|
Rate for Payer: Ohio Health Choice Commercial |
$7,702.77
|
Rate for Payer: Ohio Health Group HMO |
$6,564.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,750.63
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,137.91
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,713.48
|
Rate for Payer: PHCS Commercial |
$8,403.02
|
Rate for Payer: United Healthcare All Payer |
$7,702.77
|
|
VERSA-DIAL 46*21*50MM HMRL HED
|
Facility
|
IP
|
$8,753.15
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,137.91 |
Max. Negotiated Rate |
$8,403.02 |
Rate for Payer: Aetna Commercial |
$6,739.93
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,827.46
|
Rate for Payer: Cash Price |
$4,376.58
|
Rate for Payer: Cigna Commercial |
$7,265.11
|
Rate for Payer: First Health Commercial |
$8,315.49
|
Rate for Payer: Humana Commercial |
$7,440.18
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,177.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,459.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,625.94
|
Rate for Payer: Ohio Health Choice Commercial |
$7,702.77
|
Rate for Payer: Ohio Health Group HMO |
$6,564.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,750.63
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,137.91
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,713.48
|
Rate for Payer: PHCS Commercial |
$8,403.02
|
Rate for Payer: United Healthcare All Payer |
$7,702.77
|
|
VERSA-DIAL 46*21*50MM HMRL HED
|
Facility
|
OP
|
$8,753.15
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,137.91 |
Max. Negotiated Rate |
$8,403.02 |
Rate for Payer: Aetna Commercial |
$6,739.93
|
Rate for Payer: Anthem Medicaid |
$3,010.21
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,827.46
|
Rate for Payer: Cash Price |
$4,376.58
|
Rate for Payer: Cigna Commercial |
$7,265.11
|
Rate for Payer: First Health Commercial |
$8,315.49
|
Rate for Payer: Humana Commercial |
$7,440.18
|
Rate for Payer: Humana KY Medicaid |
$3,010.21
|
Rate for Payer: Kentucky WC Medicaid |
$3,040.84
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,177.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,459.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,625.94
|
Rate for Payer: Molina Healthcare Medicaid |
$3,070.61
|
Rate for Payer: Ohio Health Choice Commercial |
$7,702.77
|
Rate for Payer: Ohio Health Group HMO |
$6,564.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,750.63
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,137.91
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,713.48
|
Rate for Payer: PHCS Commercial |
$8,403.02
|
Rate for Payer: United Healthcare All Payer |
$7,702.77
|
|
VERSA-DIAL 46*24*47MM HMRL HED
|
Facility
|
IP
|
$8,753.15
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,137.91 |
Max. Negotiated Rate |
$8,403.02 |
Rate for Payer: Aetna Commercial |
$6,739.93
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,827.46
|
Rate for Payer: Cash Price |
$4,376.58
|
Rate for Payer: Cigna Commercial |
$7,265.11
|
Rate for Payer: First Health Commercial |
$8,315.49
|
Rate for Payer: Humana Commercial |
$7,440.18
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,177.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,459.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,625.94
|
Rate for Payer: Ohio Health Choice Commercial |
$7,702.77
|
Rate for Payer: Ohio Health Group HMO |
$6,564.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,750.63
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,137.91
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,713.48
|
Rate for Payer: PHCS Commercial |
$8,403.02
|
Rate for Payer: United Healthcare All Payer |
$7,702.77
|
|
VERSA-DIAL 46*24*47MM HMRL HED
|
Facility
|
OP
|
$8,753.15
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,137.91 |
Max. Negotiated Rate |
$8,403.02 |
Rate for Payer: Aetna Commercial |
$6,739.93
|
Rate for Payer: Anthem Medicaid |
$3,010.21
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,827.46
|
Rate for Payer: Cash Price |
$4,376.58
|
Rate for Payer: Cigna Commercial |
$7,265.11
|
Rate for Payer: First Health Commercial |
$8,315.49
|
Rate for Payer: Humana Commercial |
$7,440.18
|
Rate for Payer: Humana KY Medicaid |
$3,010.21
|
Rate for Payer: Kentucky WC Medicaid |
$3,040.84
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,177.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,459.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,625.94
|
Rate for Payer: Molina Healthcare Medicaid |
$3,070.61
|
Rate for Payer: Ohio Health Choice Commercial |
$7,702.77
|
Rate for Payer: Ohio Health Group HMO |
$6,564.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,750.63
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,137.91
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,713.48
|
Rate for Payer: PHCS Commercial |
$8,403.02
|
Rate for Payer: United Healthcare All Payer |
$7,702.77
|
|
VERSA-DIAL 46*27*46MM HMRL HED
|
Facility
|
OP
|
$8,753.15
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,137.91 |
Max. Negotiated Rate |
$8,403.02 |
Rate for Payer: Aetna Commercial |
$6,739.93
|
Rate for Payer: Anthem Medicaid |
$3,010.21
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,827.46
|
Rate for Payer: Cash Price |
$4,376.58
|
Rate for Payer: Cigna Commercial |
$7,265.11
|
Rate for Payer: First Health Commercial |
$8,315.49
|
Rate for Payer: Humana Commercial |
$7,440.18
|
Rate for Payer: Humana KY Medicaid |
$3,010.21
|
Rate for Payer: Kentucky WC Medicaid |
$3,040.84
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,177.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,459.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,625.94
|
Rate for Payer: Molina Healthcare Medicaid |
$3,070.61
|
Rate for Payer: Ohio Health Choice Commercial |
$7,702.77
|
Rate for Payer: Ohio Health Group HMO |
$6,564.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,750.63
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,137.91
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,713.48
|
Rate for Payer: PHCS Commercial |
$8,403.02
|
Rate for Payer: United Healthcare All Payer |
$7,702.77
|
|
VERSA-DIAL 46*27*46MM HMRL HED
|
Facility
|
IP
|
$8,753.15
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,137.91 |
Max. Negotiated Rate |
$8,403.02 |
Rate for Payer: Aetna Commercial |
$6,739.93
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,827.46
|
Rate for Payer: Cash Price |
$4,376.58
|
Rate for Payer: Cigna Commercial |
$7,265.11
|
Rate for Payer: First Health Commercial |
$8,315.49
|
Rate for Payer: Humana Commercial |
$7,440.18
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,177.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,459.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,625.94
|
Rate for Payer: Ohio Health Choice Commercial |
$7,702.77
|
Rate for Payer: Ohio Health Group HMO |
$6,564.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,750.63
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,137.91
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,713.48
|
Rate for Payer: PHCS Commercial |
$8,403.02
|
Rate for Payer: United Healthcare All Payer |
$7,702.77
|
|
VERSA-DIAL 50*21*57MM HMRL HED
|
Facility
|
IP
|
$8,753.15
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,137.91 |
Max. Negotiated Rate |
$8,403.02 |
Rate for Payer: Aetna Commercial |
$6,739.93
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,827.46
|
Rate for Payer: Cash Price |
$4,376.58
|
Rate for Payer: Cigna Commercial |
$7,265.11
|
Rate for Payer: First Health Commercial |
$8,315.49
|
Rate for Payer: Humana Commercial |
$7,440.18
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,177.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,459.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,625.94
|
Rate for Payer: Ohio Health Choice Commercial |
$7,702.77
|
Rate for Payer: Ohio Health Group HMO |
$6,564.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,750.63
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,137.91
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,713.48
|
Rate for Payer: PHCS Commercial |
$8,403.02
|
Rate for Payer: United Healthcare All Payer |
$7,702.77
|
|
VERSA-DIAL 50*21*57MM HMRL HED
|
Facility
|
OP
|
$8,753.15
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,137.91 |
Max. Negotiated Rate |
$8,403.02 |
Rate for Payer: Aetna Commercial |
$6,739.93
|
Rate for Payer: Anthem Medicaid |
$3,010.21
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,827.46
|
Rate for Payer: Cash Price |
$4,376.58
|
Rate for Payer: Cigna Commercial |
$7,265.11
|
Rate for Payer: First Health Commercial |
$8,315.49
|
Rate for Payer: Humana Commercial |
$7,440.18
|
Rate for Payer: Humana KY Medicaid |
$3,010.21
|
Rate for Payer: Kentucky WC Medicaid |
$3,040.84
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,177.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,459.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,625.94
|
Rate for Payer: Molina Healthcare Medicaid |
$3,070.61
|
Rate for Payer: Ohio Health Choice Commercial |
$7,702.77
|
Rate for Payer: Ohio Health Group HMO |
$6,564.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,750.63
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,137.91
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,713.48
|
Rate for Payer: PHCS Commercial |
$8,403.02
|
Rate for Payer: United Healthcare All Payer |
$7,702.77
|
|
VERSA-DIAL 50*24*52MM HMRL HED
|
Facility
|
OP
|
$8,753.15
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,137.91 |
Max. Negotiated Rate |
$8,403.02 |
Rate for Payer: Aetna Commercial |
$6,739.93
|
Rate for Payer: Anthem Medicaid |
$3,010.21
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,827.46
|
Rate for Payer: Cash Price |
$4,376.58
|
Rate for Payer: Cigna Commercial |
$7,265.11
|
Rate for Payer: First Health Commercial |
$8,315.49
|
Rate for Payer: Humana Commercial |
$7,440.18
|
Rate for Payer: Humana KY Medicaid |
$3,010.21
|
Rate for Payer: Kentucky WC Medicaid |
$3,040.84
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,177.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,459.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,625.94
|
Rate for Payer: Molina Healthcare Medicaid |
$3,070.61
|
Rate for Payer: Ohio Health Choice Commercial |
$7,702.77
|
Rate for Payer: Ohio Health Group HMO |
$6,564.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,750.63
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,137.91
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,713.48
|
Rate for Payer: PHCS Commercial |
$8,403.02
|
Rate for Payer: United Healthcare All Payer |
$7,702.77
|
|
VERSA-DIAL 50*24*52MM HMRL HED
|
Facility
|
IP
|
$8,753.15
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,137.91 |
Max. Negotiated Rate |
$8,403.02 |
Rate for Payer: Aetna Commercial |
$6,739.93
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,827.46
|
Rate for Payer: Cash Price |
$4,376.58
|
Rate for Payer: Cigna Commercial |
$7,265.11
|
Rate for Payer: First Health Commercial |
$8,315.49
|
Rate for Payer: Humana Commercial |
$7,440.18
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,177.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,459.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,625.94
|
Rate for Payer: Ohio Health Choice Commercial |
$7,702.77
|
Rate for Payer: Ohio Health Group HMO |
$6,564.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,750.63
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,137.91
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,713.48
|
Rate for Payer: PHCS Commercial |
$8,403.02
|
Rate for Payer: United Healthcare All Payer |
$7,702.77
|
|
VERSA-DIAL 50*27*50MM HMRL HED
|
Facility
|
OP
|
$8,753.15
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,137.91 |
Max. Negotiated Rate |
$8,403.02 |
Rate for Payer: Aetna Commercial |
$6,739.93
|
Rate for Payer: Anthem Medicaid |
$3,010.21
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,827.46
|
Rate for Payer: Cash Price |
$4,376.58
|
Rate for Payer: Cigna Commercial |
$7,265.11
|
Rate for Payer: First Health Commercial |
$8,315.49
|
Rate for Payer: Humana Commercial |
$7,440.18
|
Rate for Payer: Humana KY Medicaid |
$3,010.21
|
Rate for Payer: Kentucky WC Medicaid |
$3,040.84
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,177.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,459.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,625.94
|
Rate for Payer: Molina Healthcare Medicaid |
$3,070.61
|
Rate for Payer: Ohio Health Choice Commercial |
$7,702.77
|
Rate for Payer: Ohio Health Group HMO |
$6,564.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,750.63
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,137.91
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,713.48
|
Rate for Payer: PHCS Commercial |
$8,403.02
|
Rate for Payer: United Healthcare All Payer |
$7,702.77
|
|
VERSA-DIAL 50*27*50MM HMRL HED
|
Facility
|
IP
|
$8,753.15
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,137.91 |
Max. Negotiated Rate |
$8,403.02 |
Rate for Payer: Aetna Commercial |
$6,739.93
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,827.46
|
Rate for Payer: Cash Price |
$4,376.58
|
Rate for Payer: Cigna Commercial |
$7,265.11
|
Rate for Payer: First Health Commercial |
$8,315.49
|
Rate for Payer: Humana Commercial |
$7,440.18
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,177.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,459.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,625.94
|
Rate for Payer: Ohio Health Choice Commercial |
$7,702.77
|
Rate for Payer: Ohio Health Group HMO |
$6,564.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,750.63
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,137.91
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,713.48
|
Rate for Payer: PHCS Commercial |
$8,403.02
|
Rate for Payer: United Healthcare All Payer |
$7,702.77
|
|
VERSA-DIAL 54*21*64MM HMRL HED
|
Facility
|
IP
|
$8,753.15
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,137.91 |
Max. Negotiated Rate |
$8,403.02 |
Rate for Payer: Aetna Commercial |
$6,739.93
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,827.46
|
Rate for Payer: Cash Price |
$4,376.58
|
Rate for Payer: Cigna Commercial |
$7,265.11
|
Rate for Payer: First Health Commercial |
$8,315.49
|
Rate for Payer: Humana Commercial |
$7,440.18
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,177.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,459.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,625.94
|
Rate for Payer: Ohio Health Choice Commercial |
$7,702.77
|
Rate for Payer: Ohio Health Group HMO |
$6,564.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,750.63
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,137.91
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,713.48
|
Rate for Payer: PHCS Commercial |
$8,403.02
|
Rate for Payer: United Healthcare All Payer |
$7,702.77
|
|
VERSA-DIAL 54*21*64MM HMRL HED
|
Facility
|
OP
|
$8,753.15
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,137.91 |
Max. Negotiated Rate |
$8,403.02 |
Rate for Payer: Aetna Commercial |
$6,739.93
|
Rate for Payer: Anthem Medicaid |
$3,010.21
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,827.46
|
Rate for Payer: Cash Price |
$4,376.58
|
Rate for Payer: Cigna Commercial |
$7,265.11
|
Rate for Payer: First Health Commercial |
$8,315.49
|
Rate for Payer: Humana Commercial |
$7,440.18
|
Rate for Payer: Humana KY Medicaid |
$3,010.21
|
Rate for Payer: Kentucky WC Medicaid |
$3,040.84
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,177.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,459.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,625.94
|
Rate for Payer: Molina Healthcare Medicaid |
$3,070.61
|
Rate for Payer: Ohio Health Choice Commercial |
$7,702.77
|
Rate for Payer: Ohio Health Group HMO |
$6,564.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,750.63
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,137.91
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,713.48
|
Rate for Payer: PHCS Commercial |
$8,403.02
|
Rate for Payer: United Healthcare All Payer |
$7,702.77
|
|
VERSA-DIAL 54*24*58MM HMRL HED
|
Facility
|
OP
|
$8,753.15
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,137.91 |
Max. Negotiated Rate |
$8,403.02 |
Rate for Payer: Aetna Commercial |
$6,739.93
|
Rate for Payer: Anthem Medicaid |
$3,010.21
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,827.46
|
Rate for Payer: Cash Price |
$4,376.58
|
Rate for Payer: Cigna Commercial |
$7,265.11
|
Rate for Payer: First Health Commercial |
$8,315.49
|
Rate for Payer: Humana Commercial |
$7,440.18
|
Rate for Payer: Humana KY Medicaid |
$3,010.21
|
Rate for Payer: Kentucky WC Medicaid |
$3,040.84
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,177.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,459.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,625.94
|
Rate for Payer: Molina Healthcare Medicaid |
$3,070.61
|
Rate for Payer: Ohio Health Choice Commercial |
$7,702.77
|
Rate for Payer: Ohio Health Group HMO |
$6,564.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,750.63
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,137.91
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,713.48
|
Rate for Payer: PHCS Commercial |
$8,403.02
|
Rate for Payer: United Healthcare All Payer |
$7,702.77
|
|
VERSA-DIAL 54*24*58MM HMRL HED
|
Facility
|
IP
|
$8,753.15
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,137.91 |
Max. Negotiated Rate |
$8,403.02 |
Rate for Payer: Aetna Commercial |
$6,739.93
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,827.46
|
Rate for Payer: Cash Price |
$4,376.58
|
Rate for Payer: Cigna Commercial |
$7,265.11
|
Rate for Payer: First Health Commercial |
$8,315.49
|
Rate for Payer: Humana Commercial |
$7,440.18
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,177.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,459.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,625.94
|
Rate for Payer: Ohio Health Choice Commercial |
$7,702.77
|
Rate for Payer: Ohio Health Group HMO |
$6,564.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,750.63
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,137.91
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,713.48
|
Rate for Payer: PHCS Commercial |
$8,403.02
|
Rate for Payer: United Healthcare All Payer |
$7,702.77
|
|
VERSA-DIAL 54*27*55MM HMRL HED
|
Facility
|
IP
|
$8,753.15
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,137.91 |
Max. Negotiated Rate |
$8,403.02 |
Rate for Payer: Aetna Commercial |
$6,739.93
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,827.46
|
Rate for Payer: Cash Price |
$4,376.58
|
Rate for Payer: Cigna Commercial |
$7,265.11
|
Rate for Payer: First Health Commercial |
$8,315.49
|
Rate for Payer: Humana Commercial |
$7,440.18
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,177.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,459.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,625.94
|
Rate for Payer: Ohio Health Choice Commercial |
$7,702.77
|
Rate for Payer: Ohio Health Group HMO |
$6,564.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,750.63
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,137.91
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,713.48
|
Rate for Payer: PHCS Commercial |
$8,403.02
|
Rate for Payer: United Healthcare All Payer |
$7,702.77
|
|
VERSA-DIAL 54*27*55MM HMRL HED
|
Facility
|
OP
|
$8,753.15
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,137.91 |
Max. Negotiated Rate |
$8,403.02 |
Rate for Payer: Aetna Commercial |
$6,739.93
|
Rate for Payer: Anthem Medicaid |
$3,010.21
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,827.46
|
Rate for Payer: Cash Price |
$4,376.58
|
Rate for Payer: Cigna Commercial |
$7,265.11
|
Rate for Payer: First Health Commercial |
$8,315.49
|
Rate for Payer: Humana Commercial |
$7,440.18
|
Rate for Payer: Humana KY Medicaid |
$3,010.21
|
Rate for Payer: Kentucky WC Medicaid |
$3,040.84
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,177.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,459.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,625.94
|
Rate for Payer: Molina Healthcare Medicaid |
$3,070.61
|
Rate for Payer: Ohio Health Choice Commercial |
$7,702.77
|
Rate for Payer: Ohio Health Group HMO |
$6,564.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,750.63
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,137.91
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,713.48
|
Rate for Payer: PHCS Commercial |
$8,403.02
|
Rate for Payer: United Healthcare All Payer |
$7,702.77
|
|
VERSA-DIAL 58*24*64MM HMRL HED
|
Facility
|
OP
|
$8,753.15
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,137.91 |
Max. Negotiated Rate |
$8,403.02 |
Rate for Payer: Aetna Commercial |
$6,739.93
|
Rate for Payer: Anthem Medicaid |
$3,010.21
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,827.46
|
Rate for Payer: Cash Price |
$4,376.58
|
Rate for Payer: Cigna Commercial |
$7,265.11
|
Rate for Payer: First Health Commercial |
$8,315.49
|
Rate for Payer: Humana Commercial |
$7,440.18
|
Rate for Payer: Humana KY Medicaid |
$3,010.21
|
Rate for Payer: Kentucky WC Medicaid |
$3,040.84
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,177.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,459.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,625.94
|
Rate for Payer: Molina Healthcare Medicaid |
$3,070.61
|
Rate for Payer: Ohio Health Choice Commercial |
$7,702.77
|
Rate for Payer: Ohio Health Group HMO |
$6,564.86
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,750.63
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,137.91
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,713.48
|
Rate for Payer: PHCS Commercial |
$8,403.02
|
Rate for Payer: United Healthcare All Payer |
$7,702.77
|
|