|
CONSERVE TOT A-CL FEM HED 56MM
|
Facility
|
OP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem Medicaid |
$2,600.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Humana KY Medicaid |
$2,600.74
|
| Rate for Payer: Kentucky WC Medicaid |
$2,627.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,652.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
CONSERVE TOT NECK SLEEVE XLG
|
Facility
|
OP
|
$2,060.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem Medicaid |
$708.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Humana KY Medicaid |
$708.43
|
| Rate for Payer: Kentucky WC Medicaid |
$715.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.40
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
|
CONSERVE TOT NECK SLEEVE XLG
|
Facility
|
IP
|
$2,060.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.40
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
|
CONSRV TOT A-CL HD LG NCK 36M
|
Facility
|
IP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
CONSRV TOT A-CL HD LG NCK 36M
|
Facility
|
OP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem Medicaid |
$2,600.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Humana KY Medicaid |
$2,600.74
|
| Rate for Payer: Kentucky WC Medicaid |
$2,627.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,652.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
CONSRV TOT A-CL HD LG NCK 38M
|
Facility
|
IP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
CONSRV TOT A-CL HD LG NCK 38M
|
Facility
|
OP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem Medicaid |
$2,600.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Humana KY Medicaid |
$2,600.74
|
| Rate for Payer: Kentucky WC Medicaid |
$2,627.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,652.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
CONSRV TOT A-CL HD LG NCK 40M
|
Facility
|
OP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem Medicaid |
$2,600.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Humana KY Medicaid |
$2,600.74
|
| Rate for Payer: Kentucky WC Medicaid |
$2,627.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,652.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
CONSRV TOT A-CL HD LG NCK 40M
|
Facility
|
IP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
CONSRV TOT A-CL HD LG NCK 42M
|
Facility
|
IP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
CONSRV TOT A-CL HD LG NCK 42M
|
Facility
|
OP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem Medicaid |
$2,600.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Humana KY Medicaid |
$2,600.74
|
| Rate for Payer: Kentucky WC Medicaid |
$2,627.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,652.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
CONSRV TOT A-CL HD LG NCK 44M
|
Facility
|
IP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
CONSRV TOT A-CL HD LG NCK 44M
|
Facility
|
OP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem Medicaid |
$2,600.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Humana KY Medicaid |
$2,600.74
|
| Rate for Payer: Kentucky WC Medicaid |
$2,627.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,652.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
CONSRV TOT A-CL HD LG NCK 46M
|
Facility
|
OP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem Medicaid |
$2,600.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Humana KY Medicaid |
$2,600.74
|
| Rate for Payer: Kentucky WC Medicaid |
$2,627.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,652.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
CONSRV TOT A-CL HD LG NCK 46M
|
Facility
|
IP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
CONSRV TOT A-CL HD LG NCK 48M
|
Facility
|
IP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
CONSRV TOT A-CL HD LG NCK 48M
|
Facility
|
OP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem Medicaid |
$2,600.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Humana KY Medicaid |
$2,600.74
|
| Rate for Payer: Kentucky WC Medicaid |
$2,627.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,652.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
CONSRV TOT A-CL HD LG NCK 50M
|
Facility
|
IP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
CONSRV TOT A-CL HD LG NCK 50M
|
Facility
|
OP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem Medicaid |
$2,600.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Humana KY Medicaid |
$2,600.74
|
| Rate for Payer: Kentucky WC Medicaid |
$2,627.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,652.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
CONSRV TOT A-CL HD LG NCK 52M
|
Facility
|
OP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem Medicaid |
$2,600.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Humana KY Medicaid |
$2,600.74
|
| Rate for Payer: Kentucky WC Medicaid |
$2,627.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,652.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
CONSRV TOT A-CL HD LG NCK 52M
|
Facility
|
IP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
CONSRV TOT A-CL HD LG NCK 54M
|
Facility
|
OP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem Medicaid |
$2,600.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Humana KY Medicaid |
$2,600.74
|
| Rate for Payer: Kentucky WC Medicaid |
$2,627.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,652.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
CONSRV TOT A-CL HD LG NCK 54M
|
Facility
|
IP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
CONSRV TOT A-CL HD LG NCK 56M
|
Facility
|
IP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
CONSRV TOT A-CL HD LG NCK 56M
|
Facility
|
OP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem Medicaid |
$2,600.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Humana KY Medicaid |
$2,600.74
|
| Rate for Payer: Kentucky WC Medicaid |
$2,627.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,652.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
