|
CONTR ACE RECN RNG 74OD 70ID L
|
Facility
|
OP
|
$12,279.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,596.39 |
| Max. Negotiated Rate |
$11,788.71 |
| Rate for Payer: Aetna Commercial |
$9,455.53
|
| Rate for Payer: Anthem Medicaid |
$4,223.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,578.33
|
| Rate for Payer: Cash Price |
$6,139.96
|
| Rate for Payer: Cigna Commercial |
$10,192.33
|
| Rate for Payer: First Health Commercial |
$11,665.91
|
| Rate for Payer: Humana Commercial |
$10,437.92
|
| Rate for Payer: Humana KY Medicaid |
$4,223.06
|
| Rate for Payer: Kentucky WC Medicaid |
$4,266.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,069.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,062.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,307.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,806.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,209.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,806.77
|
| Rate for Payer: PHCS Commercial |
$11,788.71
|
| Rate for Payer: United Healthcare All Payer |
$10,806.32
|
|
|
CONTR ACE RECN RNG 74OD 70ID L
|
Facility
|
IP
|
$12,279.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,596.39 |
| Max. Negotiated Rate |
$11,788.71 |
| Rate for Payer: Aetna Commercial |
$9,455.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,578.33
|
| Rate for Payer: Cash Price |
$6,139.96
|
| Rate for Payer: Cigna Commercial |
$10,192.33
|
| Rate for Payer: First Health Commercial |
$11,665.91
|
| Rate for Payer: Humana Commercial |
$10,437.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,069.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,062.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,806.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,209.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,806.77
|
| Rate for Payer: PHCS Commercial |
$11,788.71
|
| Rate for Payer: United Healthcare All Payer |
$10,806.32
|
|
|
CONTR ACE RECN RNG 74OD 70ID R
|
Facility
|
IP
|
$12,279.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,596.39 |
| Max. Negotiated Rate |
$11,788.71 |
| Rate for Payer: Aetna Commercial |
$9,455.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,578.33
|
| Rate for Payer: Cash Price |
$6,139.96
|
| Rate for Payer: Cigna Commercial |
$10,192.33
|
| Rate for Payer: First Health Commercial |
$11,665.91
|
| Rate for Payer: Humana Commercial |
$10,437.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,069.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,062.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,806.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,209.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,806.77
|
| Rate for Payer: PHCS Commercial |
$11,788.71
|
| Rate for Payer: United Healthcare All Payer |
$10,806.32
|
|
|
CONTR ACE RECN RNG 74OD 70ID R
|
Facility
|
OP
|
$12,279.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,596.39 |
| Max. Negotiated Rate |
$11,788.71 |
| Rate for Payer: Aetna Commercial |
$9,455.53
|
| Rate for Payer: Anthem Medicaid |
$4,223.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,578.33
|
| Rate for Payer: Cash Price |
$6,139.96
|
| Rate for Payer: Cigna Commercial |
$10,192.33
|
| Rate for Payer: First Health Commercial |
$11,665.91
|
| Rate for Payer: Humana Commercial |
$10,437.92
|
| Rate for Payer: Humana KY Medicaid |
$4,223.06
|
| Rate for Payer: Kentucky WC Medicaid |
$4,266.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,069.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,062.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,307.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,806.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,209.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,806.77
|
| Rate for Payer: PHCS Commercial |
$11,788.71
|
| Rate for Payer: United Healthcare All Payer |
$10,806.32
|
|
|
CONTR ACE REINF RING 44OD 40ID
|
Facility
|
OP
|
$12,279.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,596.39 |
| Max. Negotiated Rate |
$11,788.71 |
| Rate for Payer: Aetna Commercial |
$9,455.53
|
| Rate for Payer: Anthem Medicaid |
$4,223.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,578.33
|
| Rate for Payer: Cash Price |
$6,139.96
|
| Rate for Payer: Cigna Commercial |
$10,192.33
|
| Rate for Payer: First Health Commercial |
$11,665.91
|
| Rate for Payer: Humana Commercial |
$10,437.92
|
| Rate for Payer: Humana KY Medicaid |
$4,223.06
|
| Rate for Payer: Kentucky WC Medicaid |
$4,266.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,069.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,062.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,307.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,806.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,209.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,806.77
|
| Rate for Payer: PHCS Commercial |
$11,788.71
|
| Rate for Payer: United Healthcare All Payer |
$10,806.32
|
|
|
CONTR ACE REINF RING 44OD 40ID
|
Facility
|
IP
|
$12,279.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,596.39 |
| Max. Negotiated Rate |
$11,788.71 |
| Rate for Payer: Aetna Commercial |
$9,455.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,578.33
|
| Rate for Payer: Cash Price |
$6,139.96
|
| Rate for Payer: Cigna Commercial |
$10,192.33
|
| Rate for Payer: First Health Commercial |
$11,665.91
|
| Rate for Payer: Humana Commercial |
$10,437.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,069.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,062.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,806.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,209.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,806.77
|
| Rate for Payer: PHCS Commercial |
$11,788.71
|
| Rate for Payer: United Healthcare All Payer |
$10,806.32
|
|
|
CONTR ACE REINF RING 47OD 43ID
|
Facility
|
IP
|
$12,279.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,596.39 |
| Max. Negotiated Rate |
$11,788.71 |
| Rate for Payer: Aetna Commercial |
$9,455.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,578.33
|
| Rate for Payer: Cash Price |
$6,139.96
|
| Rate for Payer: Cigna Commercial |
$10,192.33
|
| Rate for Payer: First Health Commercial |
$11,665.91
|
| Rate for Payer: Humana Commercial |
$10,437.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,069.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,062.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,806.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,209.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,806.77
|
| Rate for Payer: PHCS Commercial |
$11,788.71
|
| Rate for Payer: United Healthcare All Payer |
$10,806.32
|
|
|
CONTR ACE REINF RING 47OD 43ID
|
Facility
|
OP
|
$12,279.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,596.39 |
| Max. Negotiated Rate |
$11,788.71 |
| Rate for Payer: Aetna Commercial |
$9,455.53
|
| Rate for Payer: Anthem Medicaid |
$4,223.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,578.33
|
| Rate for Payer: Cash Price |
$6,139.96
|
| Rate for Payer: Cigna Commercial |
$10,192.33
|
| Rate for Payer: First Health Commercial |
$11,665.91
|
| Rate for Payer: Humana Commercial |
$10,437.92
|
| Rate for Payer: Humana KY Medicaid |
$4,223.06
|
| Rate for Payer: Kentucky WC Medicaid |
$4,266.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,069.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,062.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,307.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,806.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,209.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,806.77
|
| Rate for Payer: PHCS Commercial |
$11,788.71
|
| Rate for Payer: United Healthcare All Payer |
$10,806.32
|
|
|
CONTR ACE REINF RING 50OD 46ID
|
Facility
|
IP
|
$12,279.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,596.39 |
| Max. Negotiated Rate |
$11,788.71 |
| Rate for Payer: Aetna Commercial |
$9,455.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,578.33
|
| Rate for Payer: Cash Price |
$6,139.96
|
| Rate for Payer: Cigna Commercial |
$10,192.33
|
| Rate for Payer: First Health Commercial |
$11,665.91
|
| Rate for Payer: Humana Commercial |
$10,437.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,069.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,062.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,806.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,209.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,806.77
|
| Rate for Payer: PHCS Commercial |
$11,788.71
|
| Rate for Payer: United Healthcare All Payer |
$10,806.32
|
|
|
CONTR ACE REINF RING 50OD 46ID
|
Facility
|
OP
|
$12,279.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,596.39 |
| Max. Negotiated Rate |
$11,788.71 |
| Rate for Payer: Aetna Commercial |
$9,455.53
|
| Rate for Payer: Anthem Medicaid |
$4,223.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,578.33
|
| Rate for Payer: Cash Price |
$6,139.96
|
| Rate for Payer: Cigna Commercial |
$10,192.33
|
| Rate for Payer: First Health Commercial |
$11,665.91
|
| Rate for Payer: Humana Commercial |
$10,437.92
|
| Rate for Payer: Humana KY Medicaid |
$4,223.06
|
| Rate for Payer: Kentucky WC Medicaid |
$4,266.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,069.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,062.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,307.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,806.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,209.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,806.77
|
| Rate for Payer: PHCS Commercial |
$11,788.71
|
| Rate for Payer: United Healthcare All Payer |
$10,806.32
|
|
|
CONTR ACE REINF RING 53OD 49ID
|
Facility
|
OP
|
$12,279.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,596.39 |
| Max. Negotiated Rate |
$11,788.71 |
| Rate for Payer: Aetna Commercial |
$9,455.53
|
| Rate for Payer: Anthem Medicaid |
$4,223.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,578.33
|
| Rate for Payer: Cash Price |
$6,139.96
|
| Rate for Payer: Cigna Commercial |
$10,192.33
|
| Rate for Payer: First Health Commercial |
$11,665.91
|
| Rate for Payer: Humana Commercial |
$10,437.92
|
| Rate for Payer: Humana KY Medicaid |
$4,223.06
|
| Rate for Payer: Kentucky WC Medicaid |
$4,266.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,069.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,062.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,307.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,806.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,209.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,806.77
|
| Rate for Payer: PHCS Commercial |
$11,788.71
|
| Rate for Payer: United Healthcare All Payer |
$10,806.32
|
|
|
CONTR ACE REINF RING 53OD 49ID
|
Facility
|
IP
|
$12,279.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,596.39 |
| Max. Negotiated Rate |
$11,788.71 |
| Rate for Payer: Aetna Commercial |
$9,455.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,578.33
|
| Rate for Payer: Cash Price |
$6,139.96
|
| Rate for Payer: Cigna Commercial |
$10,192.33
|
| Rate for Payer: First Health Commercial |
$11,665.91
|
| Rate for Payer: Humana Commercial |
$10,437.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,069.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,062.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,806.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,209.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,806.77
|
| Rate for Payer: PHCS Commercial |
$11,788.71
|
| Rate for Payer: United Healthcare All Payer |
$10,806.32
|
|
|
CONTR ACE REINF RING 56OD 52ID
|
Facility
|
OP
|
$12,279.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,596.39 |
| Max. Negotiated Rate |
$11,788.71 |
| Rate for Payer: Aetna Commercial |
$9,455.53
|
| Rate for Payer: Anthem Medicaid |
$4,223.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,578.33
|
| Rate for Payer: Cash Price |
$6,139.96
|
| Rate for Payer: Cigna Commercial |
$10,192.33
|
| Rate for Payer: First Health Commercial |
$11,665.91
|
| Rate for Payer: Humana Commercial |
$10,437.92
|
| Rate for Payer: Humana KY Medicaid |
$4,223.06
|
| Rate for Payer: Kentucky WC Medicaid |
$4,266.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,069.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,062.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,307.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,806.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,209.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,806.77
|
| Rate for Payer: PHCS Commercial |
$11,788.71
|
| Rate for Payer: United Healthcare All Payer |
$10,806.32
|
|
|
CONTR ACE REINF RING 56OD 52ID
|
Facility
|
IP
|
$12,279.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,596.39 |
| Max. Negotiated Rate |
$11,788.71 |
| Rate for Payer: Aetna Commercial |
$9,455.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,578.33
|
| Rate for Payer: Cash Price |
$6,139.96
|
| Rate for Payer: Cigna Commercial |
$10,192.33
|
| Rate for Payer: First Health Commercial |
$11,665.91
|
| Rate for Payer: Humana Commercial |
$10,437.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,069.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,062.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,806.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,209.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,806.77
|
| Rate for Payer: PHCS Commercial |
$11,788.71
|
| Rate for Payer: United Healthcare All Payer |
$10,806.32
|
|
|
CONTR ACE REINF RING 59OD 55ID
|
Facility
|
IP
|
$12,279.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,596.39 |
| Max. Negotiated Rate |
$11,788.71 |
| Rate for Payer: Aetna Commercial |
$9,455.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,578.33
|
| Rate for Payer: Cash Price |
$6,139.96
|
| Rate for Payer: Cigna Commercial |
$10,192.33
|
| Rate for Payer: First Health Commercial |
$11,665.91
|
| Rate for Payer: Humana Commercial |
$10,437.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,069.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,062.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,806.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,209.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,806.77
|
| Rate for Payer: PHCS Commercial |
$11,788.71
|
| Rate for Payer: United Healthcare All Payer |
$10,806.32
|
|
|
CONTR ACE REINF RING 59OD 55ID
|
Facility
|
OP
|
$12,279.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,596.39 |
| Max. Negotiated Rate |
$11,788.71 |
| Rate for Payer: Aetna Commercial |
$9,455.53
|
| Rate for Payer: Anthem Medicaid |
$4,223.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,578.33
|
| Rate for Payer: Cash Price |
$6,139.96
|
| Rate for Payer: Cigna Commercial |
$10,192.33
|
| Rate for Payer: First Health Commercial |
$11,665.91
|
| Rate for Payer: Humana Commercial |
$10,437.92
|
| Rate for Payer: Humana KY Medicaid |
$4,223.06
|
| Rate for Payer: Kentucky WC Medicaid |
$4,266.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,069.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,062.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,307.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,806.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,209.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,806.77
|
| Rate for Payer: PHCS Commercial |
$11,788.71
|
| Rate for Payer: United Healthcare All Payer |
$10,806.32
|
|
|
CONTR ACE REINF RING 62OD 58ID
|
Facility
|
IP
|
$12,279.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,596.39 |
| Max. Negotiated Rate |
$11,788.71 |
| Rate for Payer: Aetna Commercial |
$9,455.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,578.33
|
| Rate for Payer: Cash Price |
$6,139.96
|
| Rate for Payer: Cigna Commercial |
$10,192.33
|
| Rate for Payer: First Health Commercial |
$11,665.91
|
| Rate for Payer: Humana Commercial |
$10,437.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,069.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,062.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,806.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,209.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,806.77
|
| Rate for Payer: PHCS Commercial |
$11,788.71
|
| Rate for Payer: United Healthcare All Payer |
$10,806.32
|
|
|
CONTR ACE REINF RING 62OD 58ID
|
Facility
|
OP
|
$12,279.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,596.39 |
| Max. Negotiated Rate |
$11,788.71 |
| Rate for Payer: Aetna Commercial |
$9,455.53
|
| Rate for Payer: Anthem Medicaid |
$4,223.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,578.33
|
| Rate for Payer: Cash Price |
$6,139.96
|
| Rate for Payer: Cigna Commercial |
$10,192.33
|
| Rate for Payer: First Health Commercial |
$11,665.91
|
| Rate for Payer: Humana Commercial |
$10,437.92
|
| Rate for Payer: Humana KY Medicaid |
$4,223.06
|
| Rate for Payer: Kentucky WC Medicaid |
$4,266.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,069.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,062.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,307.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,806.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,209.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,806.77
|
| Rate for Payer: PHCS Commercial |
$11,788.71
|
| Rate for Payer: United Healthcare All Payer |
$10,806.32
|
|
|
CONTR ACE REINF RING 65OD 61ID
|
Facility
|
OP
|
$12,279.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,596.39 |
| Max. Negotiated Rate |
$11,788.71 |
| Rate for Payer: Aetna Commercial |
$9,455.53
|
| Rate for Payer: Anthem Medicaid |
$4,223.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,578.33
|
| Rate for Payer: Cash Price |
$6,139.96
|
| Rate for Payer: Cigna Commercial |
$10,192.33
|
| Rate for Payer: First Health Commercial |
$11,665.91
|
| Rate for Payer: Humana Commercial |
$10,437.92
|
| Rate for Payer: Humana KY Medicaid |
$4,223.06
|
| Rate for Payer: Kentucky WC Medicaid |
$4,266.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,069.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,062.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,307.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,806.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,209.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,806.77
|
| Rate for Payer: PHCS Commercial |
$11,788.71
|
| Rate for Payer: United Healthcare All Payer |
$10,806.32
|
|
|
CONTR ACE REINF RING 65OD 61ID
|
Facility
|
IP
|
$12,279.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,596.39 |
| Max. Negotiated Rate |
$11,788.71 |
| Rate for Payer: Aetna Commercial |
$9,455.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,578.33
|
| Rate for Payer: Cash Price |
$6,139.96
|
| Rate for Payer: Cigna Commercial |
$10,192.33
|
| Rate for Payer: First Health Commercial |
$11,665.91
|
| Rate for Payer: Humana Commercial |
$10,437.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,069.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,062.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,806.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,209.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,806.77
|
| Rate for Payer: PHCS Commercial |
$11,788.71
|
| Rate for Payer: United Healthcare All Payer |
$10,806.32
|
|
|
CONTR ACE REINF RING 68OD 64ID
|
Facility
|
OP
|
$12,279.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,596.39 |
| Max. Negotiated Rate |
$11,788.71 |
| Rate for Payer: Aetna Commercial |
$9,455.53
|
| Rate for Payer: Anthem Medicaid |
$4,223.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,578.33
|
| Rate for Payer: Cash Price |
$6,139.96
|
| Rate for Payer: Cigna Commercial |
$10,192.33
|
| Rate for Payer: First Health Commercial |
$11,665.91
|
| Rate for Payer: Humana Commercial |
$10,437.92
|
| Rate for Payer: Humana KY Medicaid |
$4,223.06
|
| Rate for Payer: Kentucky WC Medicaid |
$4,266.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,069.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,062.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,307.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,806.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,209.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,806.77
|
| Rate for Payer: PHCS Commercial |
$11,788.71
|
| Rate for Payer: United Healthcare All Payer |
$10,806.32
|
|
|
CONTR ACE REINF RING 68OD 64ID
|
Facility
|
IP
|
$12,279.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,596.39 |
| Max. Negotiated Rate |
$11,788.71 |
| Rate for Payer: Aetna Commercial |
$9,455.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,578.33
|
| Rate for Payer: Cash Price |
$6,139.96
|
| Rate for Payer: Cigna Commercial |
$10,192.33
|
| Rate for Payer: First Health Commercial |
$11,665.91
|
| Rate for Payer: Humana Commercial |
$10,437.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,069.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,062.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,806.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,209.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,806.77
|
| Rate for Payer: PHCS Commercial |
$11,788.71
|
| Rate for Payer: United Healthcare All Payer |
$10,806.32
|
|
|
CONTRAST BATH - 15 MIN
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
HCPCS 97034
|
| Hospital Charge Code |
42000014
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$71.04 |
| Rate for Payer: Aetna Commercial |
$56.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.72
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cigna Commercial |
$61.42
|
| Rate for Payer: First Health Commercial |
$70.30
|
| Rate for Payer: Humana Commercial |
$62.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.12
|
| Rate for Payer: Ohio Health Group HMO |
$55.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.94
|
| Rate for Payer: PHCS Commercial |
$71.04
|
| Rate for Payer: United Healthcare All Payer |
$65.12
|
|
|
CONTRAST BATH - 15 MIN
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
HCPCS 97034
|
| Hospital Charge Code |
42000014
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$71.04 |
| Rate for Payer: Aetna Commercial |
$56.98
|
| Rate for Payer: Anthem Medicaid |
$25.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.72
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cigna Commercial |
$61.42
|
| Rate for Payer: First Health Commercial |
$70.30
|
| Rate for Payer: Humana Commercial |
$62.90
|
| Rate for Payer: Humana KY Medicaid |
$25.45
|
| Rate for Payer: Kentucky WC Medicaid |
$25.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.12
|
| Rate for Payer: Ohio Health Group HMO |
$55.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.94
|
| Rate for Payer: PHCS Commercial |
$71.04
|
| Rate for Payer: United Healthcare All Payer |
$65.12
|
|
|
CONTRAST BATH - 15 MINUTES
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
HCPCS 97034
|
| Hospital Charge Code |
43000010
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$71.04 |
| Rate for Payer: Aetna Commercial |
$56.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.72
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cigna Commercial |
$61.42
|
| Rate for Payer: First Health Commercial |
$70.30
|
| Rate for Payer: Humana Commercial |
$62.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.12
|
| Rate for Payer: Ohio Health Group HMO |
$55.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.94
|
| Rate for Payer: PHCS Commercial |
$71.04
|
| Rate for Payer: United Healthcare All Payer |
$65.12
|
|
