|
ADAPTER TM REV SHL W/BAY 52MM
|
Facility
|
OP
|
$8,756.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,138.38 |
| Max. Negotiated Rate |
$8,406.53 |
| Rate for Payer: Aetna Commercial |
$6,742.74
|
| Rate for Payer: Anthem Medicaid |
$3,011.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,830.30
|
| Rate for Payer: Cash Price |
$4,378.40
|
| Rate for Payer: Cigna Commercial |
$7,268.14
|
| Rate for Payer: First Health Commercial |
$8,318.96
|
| Rate for Payer: Humana Commercial |
$7,443.28
|
| Rate for Payer: Humana KY Medicaid |
$3,011.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,042.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,180.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,462.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,627.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,071.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,705.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,567.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,751.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,138.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,714.61
|
| Rate for Payer: PHCS Commercial |
$8,406.53
|
| Rate for Payer: United Healthcare All Payer |
$7,705.98
|
|
|
ADAPTER TM REV SHL W/BAY 54MM
|
Facility
|
IP
|
$8,756.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,138.38 |
| Max. Negotiated Rate |
$8,406.53 |
| Rate for Payer: Aetna Commercial |
$6,742.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,830.30
|
| Rate for Payer: Cash Price |
$4,378.40
|
| Rate for Payer: Cigna Commercial |
$7,268.14
|
| Rate for Payer: First Health Commercial |
$8,318.96
|
| Rate for Payer: Humana Commercial |
$7,443.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,180.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,462.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,627.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,705.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,567.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,751.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,138.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,714.61
|
| Rate for Payer: PHCS Commercial |
$8,406.53
|
| Rate for Payer: United Healthcare All Payer |
$7,705.98
|
|
|
ADAPTER TM REV SHL W/BAY 54MM
|
Facility
|
OP
|
$8,756.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,138.38 |
| Max. Negotiated Rate |
$8,406.53 |
| Rate for Payer: Aetna Commercial |
$6,742.74
|
| Rate for Payer: Anthem Medicaid |
$3,011.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,830.30
|
| Rate for Payer: Cash Price |
$4,378.40
|
| Rate for Payer: Cigna Commercial |
$7,268.14
|
| Rate for Payer: First Health Commercial |
$8,318.96
|
| Rate for Payer: Humana Commercial |
$7,443.28
|
| Rate for Payer: Humana KY Medicaid |
$3,011.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,042.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,180.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,462.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,627.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,071.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,705.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,567.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,751.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,138.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,714.61
|
| Rate for Payer: PHCS Commercial |
$8,406.53
|
| Rate for Payer: United Healthcare All Payer |
$7,705.98
|
|
|
ADAPTER TM REV SHL W/BAY 56MM
|
Facility
|
OP
|
$8,756.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,138.38 |
| Max. Negotiated Rate |
$8,406.53 |
| Rate for Payer: Aetna Commercial |
$6,742.74
|
| Rate for Payer: Anthem Medicaid |
$3,011.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,830.30
|
| Rate for Payer: Cash Price |
$4,378.40
|
| Rate for Payer: Cigna Commercial |
$7,268.14
|
| Rate for Payer: First Health Commercial |
$8,318.96
|
| Rate for Payer: Humana Commercial |
$7,443.28
|
| Rate for Payer: Humana KY Medicaid |
$3,011.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,042.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,180.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,462.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,627.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,071.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,705.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,567.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,751.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,138.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,714.61
|
| Rate for Payer: PHCS Commercial |
$8,406.53
|
| Rate for Payer: United Healthcare All Payer |
$7,705.98
|
|
|
ADAPTER TM REV SHL W/BAY 56MM
|
Facility
|
IP
|
$8,756.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,138.38 |
| Max. Negotiated Rate |
$8,406.53 |
| Rate for Payer: Aetna Commercial |
$6,742.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,830.30
|
| Rate for Payer: Cash Price |
$4,378.40
|
| Rate for Payer: Cigna Commercial |
$7,268.14
|
| Rate for Payer: First Health Commercial |
$8,318.96
|
| Rate for Payer: Humana Commercial |
$7,443.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,180.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,462.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,627.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,705.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,567.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,751.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,138.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,714.61
|
| Rate for Payer: PHCS Commercial |
$8,406.53
|
| Rate for Payer: United Healthcare All Payer |
$7,705.98
|
|
|
ADAPTER TM REV SHL W/BAY 58MM
|
Facility
|
IP
|
$8,756.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,138.38 |
| Max. Negotiated Rate |
$8,406.53 |
| Rate for Payer: Aetna Commercial |
$6,742.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,830.30
|
| Rate for Payer: Cash Price |
$4,378.40
|
| Rate for Payer: Cigna Commercial |
$7,268.14
|
| Rate for Payer: First Health Commercial |
$8,318.96
|
| Rate for Payer: Humana Commercial |
$7,443.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,180.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,462.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,627.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,705.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,567.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,751.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,138.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,714.61
|
| Rate for Payer: PHCS Commercial |
$8,406.53
|
| Rate for Payer: United Healthcare All Payer |
$7,705.98
|
|
|
ADAPTER TM REV SHL W/BAY 58MM
|
Facility
|
OP
|
$8,756.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,138.38 |
| Max. Negotiated Rate |
$8,406.53 |
| Rate for Payer: Aetna Commercial |
$6,742.74
|
| Rate for Payer: Anthem Medicaid |
$3,011.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,830.30
|
| Rate for Payer: Cash Price |
$4,378.40
|
| Rate for Payer: Cigna Commercial |
$7,268.14
|
| Rate for Payer: First Health Commercial |
$8,318.96
|
| Rate for Payer: Humana Commercial |
$7,443.28
|
| Rate for Payer: Humana KY Medicaid |
$3,011.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,042.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,180.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,462.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,627.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,071.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,705.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,567.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,751.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,138.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,714.61
|
| Rate for Payer: PHCS Commercial |
$8,406.53
|
| Rate for Payer: United Healthcare All Payer |
$7,705.98
|
|
|
ADAPTER TM REV SHL W/BAY 60MM
|
Facility
|
IP
|
$8,756.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,138.38 |
| Max. Negotiated Rate |
$8,406.53 |
| Rate for Payer: Aetna Commercial |
$6,742.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,830.30
|
| Rate for Payer: Cash Price |
$4,378.40
|
| Rate for Payer: Cigna Commercial |
$7,268.14
|
| Rate for Payer: First Health Commercial |
$8,318.96
|
| Rate for Payer: Humana Commercial |
$7,443.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,180.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,462.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,627.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,705.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,567.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,751.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,138.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,714.61
|
| Rate for Payer: PHCS Commercial |
$8,406.53
|
| Rate for Payer: United Healthcare All Payer |
$7,705.98
|
|
|
ADAPTER TM REV SHL W/BAY 60MM
|
Facility
|
OP
|
$8,756.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,138.38 |
| Max. Negotiated Rate |
$8,406.53 |
| Rate for Payer: Aetna Commercial |
$6,742.74
|
| Rate for Payer: Anthem Medicaid |
$3,011.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,830.30
|
| Rate for Payer: Cash Price |
$4,378.40
|
| Rate for Payer: Cigna Commercial |
$7,268.14
|
| Rate for Payer: First Health Commercial |
$8,318.96
|
| Rate for Payer: Humana Commercial |
$7,443.28
|
| Rate for Payer: Humana KY Medicaid |
$3,011.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,042.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,180.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,462.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,627.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,071.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,705.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,567.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,751.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,138.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,714.61
|
| Rate for Payer: PHCS Commercial |
$8,406.53
|
| Rate for Payer: United Healthcare All Payer |
$7,705.98
|
|
|
ADAPTER TM REV SHL W/BAY 62MM
|
Facility
|
IP
|
$8,756.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,138.38 |
| Max. Negotiated Rate |
$8,406.53 |
| Rate for Payer: Aetna Commercial |
$6,742.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,830.30
|
| Rate for Payer: Cash Price |
$4,378.40
|
| Rate for Payer: Cigna Commercial |
$7,268.14
|
| Rate for Payer: First Health Commercial |
$8,318.96
|
| Rate for Payer: Humana Commercial |
$7,443.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,180.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,462.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,627.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,705.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,567.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,751.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,138.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,714.61
|
| Rate for Payer: PHCS Commercial |
$8,406.53
|
| Rate for Payer: United Healthcare All Payer |
$7,705.98
|
|
|
ADAPTER TM REV SHL W/BAY 62MM
|
Facility
|
OP
|
$8,756.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,138.38 |
| Max. Negotiated Rate |
$8,406.53 |
| Rate for Payer: Aetna Commercial |
$6,742.74
|
| Rate for Payer: Anthem Medicaid |
$3,011.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,830.30
|
| Rate for Payer: Cash Price |
$4,378.40
|
| Rate for Payer: Cigna Commercial |
$7,268.14
|
| Rate for Payer: First Health Commercial |
$8,318.96
|
| Rate for Payer: Humana Commercial |
$7,443.28
|
| Rate for Payer: Humana KY Medicaid |
$3,011.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,042.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,180.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,462.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,627.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,071.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,705.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,567.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,751.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,138.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,714.61
|
| Rate for Payer: PHCS Commercial |
$8,406.53
|
| Rate for Payer: United Healthcare All Payer |
$7,705.98
|
|
|
ADAPTER TM REV SHL W/BAY 64MM
|
Facility
|
OP
|
$8,756.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,138.38 |
| Max. Negotiated Rate |
$8,406.53 |
| Rate for Payer: Aetna Commercial |
$6,742.74
|
| Rate for Payer: Anthem Medicaid |
$3,011.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,830.30
|
| Rate for Payer: Cash Price |
$4,378.40
|
| Rate for Payer: Cigna Commercial |
$7,268.14
|
| Rate for Payer: First Health Commercial |
$8,318.96
|
| Rate for Payer: Humana Commercial |
$7,443.28
|
| Rate for Payer: Humana KY Medicaid |
$3,011.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,042.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,180.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,462.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,627.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,071.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,705.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,567.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,751.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,138.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,714.61
|
| Rate for Payer: PHCS Commercial |
$8,406.53
|
| Rate for Payer: United Healthcare All Payer |
$7,705.98
|
|
|
ADAPTER TM REV SHL W/BAY 64MM
|
Facility
|
IP
|
$8,756.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,138.38 |
| Max. Negotiated Rate |
$8,406.53 |
| Rate for Payer: Aetna Commercial |
$6,742.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,830.30
|
| Rate for Payer: Cash Price |
$4,378.40
|
| Rate for Payer: Cigna Commercial |
$7,268.14
|
| Rate for Payer: First Health Commercial |
$8,318.96
|
| Rate for Payer: Humana Commercial |
$7,443.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,180.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,462.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,627.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,705.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,567.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,751.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,138.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,714.61
|
| Rate for Payer: PHCS Commercial |
$8,406.53
|
| Rate for Payer: United Healthcare All Payer |
$7,705.98
|
|
|
ADAPTER TM REV SHL W/BAY 66MM
|
Facility
|
OP
|
$8,756.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,138.38 |
| Max. Negotiated Rate |
$8,406.53 |
| Rate for Payer: Aetna Commercial |
$6,742.74
|
| Rate for Payer: Anthem Medicaid |
$3,011.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,830.30
|
| Rate for Payer: Cash Price |
$4,378.40
|
| Rate for Payer: Cigna Commercial |
$7,268.14
|
| Rate for Payer: First Health Commercial |
$8,318.96
|
| Rate for Payer: Humana Commercial |
$7,443.28
|
| Rate for Payer: Humana KY Medicaid |
$3,011.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,042.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,180.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,462.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,627.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,071.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,705.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,567.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,751.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,138.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,714.61
|
| Rate for Payer: PHCS Commercial |
$8,406.53
|
| Rate for Payer: United Healthcare All Payer |
$7,705.98
|
|
|
ADAPTER TM REV SHL W/BAY 66MM
|
Facility
|
IP
|
$8,756.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,138.38 |
| Max. Negotiated Rate |
$8,406.53 |
| Rate for Payer: Aetna Commercial |
$6,742.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,830.30
|
| Rate for Payer: Cash Price |
$4,378.40
|
| Rate for Payer: Cigna Commercial |
$7,268.14
|
| Rate for Payer: First Health Commercial |
$8,318.96
|
| Rate for Payer: Humana Commercial |
$7,443.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,180.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,462.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,627.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,705.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,567.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,751.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,138.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,714.61
|
| Rate for Payer: PHCS Commercial |
$8,406.53
|
| Rate for Payer: United Healthcare All Payer |
$7,705.98
|
|
|
ADAPTER TM REV SHL W/BAY 68MM
|
Facility
|
OP
|
$8,756.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,138.38 |
| Max. Negotiated Rate |
$8,406.53 |
| Rate for Payer: Aetna Commercial |
$6,742.74
|
| Rate for Payer: Anthem Medicaid |
$3,011.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,830.30
|
| Rate for Payer: Cash Price |
$4,378.40
|
| Rate for Payer: Cigna Commercial |
$7,268.14
|
| Rate for Payer: First Health Commercial |
$8,318.96
|
| Rate for Payer: Humana Commercial |
$7,443.28
|
| Rate for Payer: Humana KY Medicaid |
$3,011.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,042.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,180.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,462.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,627.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,071.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,705.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,567.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,751.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,138.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,714.61
|
| Rate for Payer: PHCS Commercial |
$8,406.53
|
| Rate for Payer: United Healthcare All Payer |
$7,705.98
|
|
|
ADAPTER TM REV SHL W/BAY 68MM
|
Facility
|
IP
|
$8,756.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,138.38 |
| Max. Negotiated Rate |
$8,406.53 |
| Rate for Payer: Aetna Commercial |
$6,742.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,830.30
|
| Rate for Payer: Cash Price |
$4,378.40
|
| Rate for Payer: Cigna Commercial |
$7,268.14
|
| Rate for Payer: First Health Commercial |
$8,318.96
|
| Rate for Payer: Humana Commercial |
$7,443.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,180.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,462.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,627.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,705.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,567.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,751.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,138.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,714.61
|
| Rate for Payer: PHCS Commercial |
$8,406.53
|
| Rate for Payer: United Healthcare All Payer |
$7,705.98
|
|
|
ADAPTER TM REV SHL W/BAY 70MM
|
Facility
|
IP
|
$8,756.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,138.38 |
| Max. Negotiated Rate |
$8,406.53 |
| Rate for Payer: Aetna Commercial |
$6,742.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,830.30
|
| Rate for Payer: Cash Price |
$4,378.40
|
| Rate for Payer: Cigna Commercial |
$7,268.14
|
| Rate for Payer: First Health Commercial |
$8,318.96
|
| Rate for Payer: Humana Commercial |
$7,443.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,180.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,462.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,627.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,705.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,567.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,751.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,138.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,714.61
|
| Rate for Payer: PHCS Commercial |
$8,406.53
|
| Rate for Payer: United Healthcare All Payer |
$7,705.98
|
|
|
ADAPTER TM REV SHL W/BAY 70MM
|
Facility
|
OP
|
$8,756.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,138.38 |
| Max. Negotiated Rate |
$8,406.53 |
| Rate for Payer: Aetna Commercial |
$6,742.74
|
| Rate for Payer: Anthem Medicaid |
$3,011.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,830.30
|
| Rate for Payer: Cash Price |
$4,378.40
|
| Rate for Payer: Cigna Commercial |
$7,268.14
|
| Rate for Payer: First Health Commercial |
$8,318.96
|
| Rate for Payer: Humana Commercial |
$7,443.28
|
| Rate for Payer: Humana KY Medicaid |
$3,011.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,042.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,180.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,462.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,627.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,071.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,705.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,567.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,751.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,138.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,714.61
|
| Rate for Payer: PHCS Commercial |
$8,406.53
|
| Rate for Payer: United Healthcare All Payer |
$7,705.98
|
|
|
ADAPTOR 3MM OFFSET
|
Facility
|
IP
|
$5,196.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$675.48 |
| Max. Negotiated Rate |
$4,988.16 |
| Rate for Payer: Aetna Commercial |
$4,000.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,052.88
|
| Rate for Payer: Cash Price |
$2,598.00
|
| Rate for Payer: Cigna Commercial |
$4,312.68
|
| Rate for Payer: First Health Commercial |
$4,936.20
|
| Rate for Payer: Humana Commercial |
$4,416.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,260.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,834.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,558.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,572.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,897.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,039.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$675.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,610.76
|
| Rate for Payer: PHCS Commercial |
$4,988.16
|
| Rate for Payer: United Healthcare All Payer |
$4,572.48
|
|
|
ADAPTOR 3MM OFFSET
|
Facility
|
OP
|
$5,196.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$675.48 |
| Max. Negotiated Rate |
$4,988.16 |
| Rate for Payer: Aetna Commercial |
$4,000.92
|
| Rate for Payer: Anthem Medicaid |
$1,786.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,052.88
|
| Rate for Payer: Cash Price |
$2,598.00
|
| Rate for Payer: Cigna Commercial |
$4,312.68
|
| Rate for Payer: First Health Commercial |
$4,936.20
|
| Rate for Payer: Humana Commercial |
$4,416.60
|
| Rate for Payer: Humana KY Medicaid |
$1,786.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,805.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,260.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,834.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,558.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,822.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,572.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,897.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,039.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$675.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,610.76
|
| Rate for Payer: PHCS Commercial |
$4,988.16
|
| Rate for Payer: United Healthcare All Payer |
$4,572.48
|
|
|
ADAPTOR 4MM OFFSET
|
Facility
|
OP
|
$6,867.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$892.78 |
| Max. Negotiated Rate |
$6,592.86 |
| Rate for Payer: Aetna Commercial |
$5,288.02
|
| Rate for Payer: Anthem Medicaid |
$2,361.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,356.70
|
| Rate for Payer: Cash Price |
$3,433.78
|
| Rate for Payer: Cigna Commercial |
$5,700.07
|
| Rate for Payer: First Health Commercial |
$6,524.18
|
| Rate for Payer: Humana Commercial |
$5,837.43
|
| Rate for Payer: Humana KY Medicaid |
$2,361.75
|
| Rate for Payer: Kentucky WC Medicaid |
$2,385.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,631.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,068.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,060.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,409.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,043.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,150.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,373.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$892.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,128.94
|
| Rate for Payer: PHCS Commercial |
$6,592.86
|
| Rate for Payer: United Healthcare All Payer |
$6,043.45
|
|
|
ADAPTOR 4MM OFFSET
|
Facility
|
IP
|
$6,867.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$892.78 |
| Max. Negotiated Rate |
$6,592.86 |
| Rate for Payer: Aetna Commercial |
$5,288.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,356.70
|
| Rate for Payer: Cash Price |
$3,433.78
|
| Rate for Payer: Cigna Commercial |
$5,700.07
|
| Rate for Payer: First Health Commercial |
$6,524.18
|
| Rate for Payer: Humana Commercial |
$5,837.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,631.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,068.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,060.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,043.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,150.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,373.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$892.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,128.94
|
| Rate for Payer: PHCS Commercial |
$6,592.86
|
| Rate for Payer: United Healthcare All Payer |
$6,043.45
|
|
|
ADAPTOR 8MM OFFSET
|
Facility
|
IP
|
$5,406.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$702.78 |
| Max. Negotiated Rate |
$5,189.76 |
| Rate for Payer: Aetna Commercial |
$4,162.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,216.68
|
| Rate for Payer: Cash Price |
$2,703.00
|
| Rate for Payer: Cigna Commercial |
$4,486.98
|
| Rate for Payer: First Health Commercial |
$5,135.70
|
| Rate for Payer: Humana Commercial |
$4,595.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,432.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,989.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,621.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,757.28
|
| Rate for Payer: Ohio Health Group HMO |
$4,054.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,081.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$702.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,675.86
|
| Rate for Payer: PHCS Commercial |
$5,189.76
|
| Rate for Payer: United Healthcare All Payer |
$4,757.28
|
|
|
ADAPTOR 8MM OFFSET
|
Facility
|
OP
|
$5,406.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$702.78 |
| Max. Negotiated Rate |
$5,189.76 |
| Rate for Payer: Aetna Commercial |
$4,162.62
|
| Rate for Payer: Anthem Medicaid |
$1,859.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,216.68
|
| Rate for Payer: Cash Price |
$2,703.00
|
| Rate for Payer: Cigna Commercial |
$4,486.98
|
| Rate for Payer: First Health Commercial |
$5,135.70
|
| Rate for Payer: Humana Commercial |
$4,595.10
|
| Rate for Payer: Humana KY Medicaid |
$1,859.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,878.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,432.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,989.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,621.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,896.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,757.28
|
| Rate for Payer: Ohio Health Group HMO |
$4,054.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,081.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$702.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,675.86
|
| Rate for Payer: PHCS Commercial |
$5,189.76
|
| Rate for Payer: United Healthcare All Payer |
$4,757.28
|
|
