|
CONTINUUM UNI HOLE SHELL 64OO
|
Facility
|
IP
|
$9,241.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,772.45 |
| Max. Negotiated Rate |
$8,871.84 |
| Rate for Payer: Aetna Commercial |
$7,115.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.37
|
| Rate for Payer: Cash Price |
$4,620.75
|
| Rate for Payer: Cigna Commercial |
$7,670.44
|
| Rate for Payer: First Health Commercial |
$8,779.42
|
| Rate for Payer: Humana Commercial |
$7,855.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,578.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,040.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,376.64
|
| Rate for Payer: PHCS Commercial |
$8,871.84
|
| Rate for Payer: United Healthcare All Payer |
$8,132.52
|
|
|
CONTINUUM UNI HOLE SHELL 64OO
|
Facility
|
OP
|
$9,241.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,772.45 |
| Max. Negotiated Rate |
$8,871.84 |
| Rate for Payer: Aetna Commercial |
$7,115.95
|
| Rate for Payer: Anthem Medicaid |
$3,178.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.37
|
| Rate for Payer: Cash Price |
$4,620.75
|
| Rate for Payer: Cigna Commercial |
$7,670.44
|
| Rate for Payer: First Health Commercial |
$8,779.42
|
| Rate for Payer: Humana Commercial |
$7,855.27
|
| Rate for Payer: Humana KY Medicaid |
$3,178.15
|
| Rate for Payer: Kentucky WC Medicaid |
$3,210.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,578.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,241.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,040.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,376.64
|
| Rate for Payer: PHCS Commercial |
$8,871.84
|
| Rate for Payer: United Healthcare All Payer |
$8,132.52
|
|
|
CONTINUUM UNI HOLE SHELL 66PP
|
Facility
|
IP
|
$9,241.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,772.45 |
| Max. Negotiated Rate |
$8,871.84 |
| Rate for Payer: Aetna Commercial |
$7,115.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.37
|
| Rate for Payer: Cash Price |
$4,620.75
|
| Rate for Payer: Cigna Commercial |
$7,670.44
|
| Rate for Payer: First Health Commercial |
$8,779.42
|
| Rate for Payer: Humana Commercial |
$7,855.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,578.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,040.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,376.64
|
| Rate for Payer: PHCS Commercial |
$8,871.84
|
| Rate for Payer: United Healthcare All Payer |
$8,132.52
|
|
|
CONTINUUM UNI HOLE SHELL 66PP
|
Facility
|
OP
|
$9,241.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,772.45 |
| Max. Negotiated Rate |
$8,871.84 |
| Rate for Payer: Aetna Commercial |
$7,115.95
|
| Rate for Payer: Anthem Medicaid |
$3,178.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.37
|
| Rate for Payer: Cash Price |
$4,620.75
|
| Rate for Payer: Cigna Commercial |
$7,670.44
|
| Rate for Payer: First Health Commercial |
$8,779.42
|
| Rate for Payer: Humana Commercial |
$7,855.27
|
| Rate for Payer: Humana KY Medicaid |
$3,178.15
|
| Rate for Payer: Kentucky WC Medicaid |
$3,210.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,578.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,241.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,040.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,376.64
|
| Rate for Payer: PHCS Commercial |
$8,871.84
|
| Rate for Payer: United Healthcare All Payer |
$8,132.52
|
|
|
CONTINUUM UNI HOLE SHELL 68QU
|
Facility
|
IP
|
$9,241.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,772.45 |
| Max. Negotiated Rate |
$8,871.84 |
| Rate for Payer: Aetna Commercial |
$7,115.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.37
|
| Rate for Payer: Cash Price |
$4,620.75
|
| Rate for Payer: Cigna Commercial |
$7,670.44
|
| Rate for Payer: First Health Commercial |
$8,779.42
|
| Rate for Payer: Humana Commercial |
$7,855.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,578.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,040.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,376.64
|
| Rate for Payer: PHCS Commercial |
$8,871.84
|
| Rate for Payer: United Healthcare All Payer |
$8,132.52
|
|
|
CONTINUUM UNI HOLE SHELL 68QU
|
Facility
|
OP
|
$9,241.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,772.45 |
| Max. Negotiated Rate |
$8,871.84 |
| Rate for Payer: Aetna Commercial |
$7,115.95
|
| Rate for Payer: Anthem Medicaid |
$3,178.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.37
|
| Rate for Payer: Cash Price |
$4,620.75
|
| Rate for Payer: Cigna Commercial |
$7,670.44
|
| Rate for Payer: First Health Commercial |
$8,779.42
|
| Rate for Payer: Humana Commercial |
$7,855.27
|
| Rate for Payer: Humana KY Medicaid |
$3,178.15
|
| Rate for Payer: Kentucky WC Medicaid |
$3,210.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,578.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,241.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,040.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,376.64
|
| Rate for Payer: PHCS Commercial |
$8,871.84
|
| Rate for Payer: United Healthcare All Payer |
$8,132.52
|
|
|
CONTOUR OF FACE BONE LESION
|
Facility
|
OP
|
$7,665.00
|
|
|
Service Code
|
HCPCS 21029
|
| Hospital Charge Code |
76100369
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,635.99 |
| Max. Negotiated Rate |
$7,358.40 |
| Rate for Payer: Aetna Commercial |
$5,902.05
|
| Rate for Payer: Anthem Medicaid |
$2,635.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,978.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$3,832.50
|
| Rate for Payer: Cash Price |
$3,832.50
|
| Rate for Payer: Cigna Commercial |
$6,361.95
|
| Rate for Payer: First Health Commercial |
$7,281.75
|
| Rate for Payer: Humana Commercial |
$6,515.25
|
| Rate for Payer: Humana KY Medicaid |
$2,635.99
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,662.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,285.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,656.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,688.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,745.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,748.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,132.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,668.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,288.85
|
| Rate for Payer: PHCS Commercial |
$7,358.40
|
| Rate for Payer: United Healthcare All Payer |
$6,745.20
|
|
|
CONTOUR OF FACE BONE LESION
|
Facility
|
IP
|
$7,665.00
|
|
|
Service Code
|
HCPCS 21029
|
| Hospital Charge Code |
76100369
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,299.50 |
| Max. Negotiated Rate |
$7,358.40 |
| Rate for Payer: Aetna Commercial |
$5,902.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,978.70
|
| Rate for Payer: Cash Price |
$3,832.50
|
| Rate for Payer: Cigna Commercial |
$6,361.95
|
| Rate for Payer: First Health Commercial |
$7,281.75
|
| Rate for Payer: Humana Commercial |
$6,515.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,285.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,656.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,299.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,745.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,748.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,132.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,668.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,288.85
|
| Rate for Payer: PHCS Commercial |
$7,358.40
|
| Rate for Payer: United Healthcare All Payer |
$6,745.20
|
|
|
CONTOUR OF FACE BONE LESION
|
Professional
|
Both
|
$7,665.00
|
|
|
Service Code
|
HCPCS 21029
|
| Hospital Charge Code |
76100369
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$335.86 |
| Max. Negotiated Rate |
$4,599.00 |
| Rate for Payer: Aetna Commercial |
$903.42
|
| Rate for Payer: Ambetter Exchange |
$592.10
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$335.86
|
| Rate for Payer: Anthem Medicaid |
$478.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$592.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$592.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$710.52
|
| Rate for Payer: Cash Price |
$3,832.50
|
| Rate for Payer: Cash Price |
$3,832.50
|
| Rate for Payer: Cigna Commercial |
$983.10
|
| Rate for Payer: Healthspan PPO |
$955.03
|
| Rate for Payer: Humana Medicaid |
$478.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$803.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$592.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$592.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$487.65
|
| Rate for Payer: Molina Healthcare Passport |
$478.09
|
| Rate for Payer: Multiplan PHCS |
$4,599.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$769.73
|
| Rate for Payer: UHCCP Medicaid |
$352.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$482.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$592.10
|
|
|
CONTOUR OF FACE BONE LESION(P
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 21029
|
| Hospital Charge Code |
761P0369
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$335.86 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$903.42
|
| Rate for Payer: Ambetter Exchange |
$592.10
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$335.86
|
| Rate for Payer: Anthem Medicaid |
$478.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$592.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$592.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$710.52
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$983.10
|
| Rate for Payer: Healthspan PPO |
$955.03
|
| Rate for Payer: Humana Medicaid |
$478.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$803.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$592.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$592.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$487.65
|
| Rate for Payer: Molina Healthcare Passport |
$478.09
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$769.73
|
| Rate for Payer: UHCCP Medicaid |
$352.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$482.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$592.10
|
|
|
CONTOUR OF FACE BONE LESION(T
|
Facility
|
OP
|
$5,865.00
|
|
|
Service Code
|
HCPCS 21029
|
| Hospital Charge Code |
761T0369
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,016.97 |
| Max. Negotiated Rate |
$5,630.40 |
| Rate for Payer: Aetna Commercial |
$4,516.05
|
| Rate for Payer: Anthem Medicaid |
$2,016.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,574.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$2,932.50
|
| Rate for Payer: Cash Price |
$2,932.50
|
| Rate for Payer: Cigna Commercial |
$4,867.95
|
| Rate for Payer: First Health Commercial |
$5,571.75
|
| Rate for Payer: Humana Commercial |
$4,985.25
|
| Rate for Payer: Humana KY Medicaid |
$2,016.97
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,037.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,809.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,328.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,057.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,161.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,692.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,102.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,046.85
|
| Rate for Payer: PHCS Commercial |
$5,630.40
|
| Rate for Payer: United Healthcare All Payer |
$5,161.20
|
|
|
CONTOUR OF FACE BONE LESION(T
|
Facility
|
IP
|
$5,865.00
|
|
|
Service Code
|
HCPCS 21029
|
| Hospital Charge Code |
761T0369
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,759.50 |
| Max. Negotiated Rate |
$5,630.40 |
| Rate for Payer: Aetna Commercial |
$4,516.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,574.70
|
| Rate for Payer: Cash Price |
$2,932.50
|
| Rate for Payer: Cigna Commercial |
$4,867.95
|
| Rate for Payer: First Health Commercial |
$5,571.75
|
| Rate for Payer: Humana Commercial |
$4,985.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,809.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,328.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,759.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,161.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,692.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,102.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,046.85
|
| Rate for Payer: PHCS Commercial |
$5,630.40
|
| Rate for Payer: United Healthcare All Payer |
$5,161.20
|
|
|
CONTR ACE RECN RNG 50OD 46ID L
|
Facility
|
OP
|
$12,529.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,758.74 |
| Max. Negotiated Rate |
$12,027.96 |
| Rate for Payer: Aetna Commercial |
$9,647.42
|
| Rate for Payer: Anthem Medicaid |
$4,308.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,772.71
|
| Rate for Payer: Cash Price |
$6,264.56
|
| Rate for Payer: Cigna Commercial |
$10,399.17
|
| Rate for Payer: First Health Commercial |
$11,902.66
|
| Rate for Payer: Humana Commercial |
$10,649.75
|
| Rate for Payer: Humana KY Medicaid |
$4,308.76
|
| Rate for Payer: Kentucky WC Medicaid |
$4,352.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,758.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,395.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,025.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,396.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,023.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,900.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,645.09
|
| Rate for Payer: PHCS Commercial |
$12,027.96
|
| Rate for Payer: United Healthcare All Payer |
$11,025.63
|
|
|
CONTR ACE RECN RNG 50OD 46ID L
|
Facility
|
IP
|
$12,529.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,758.74 |
| Max. Negotiated Rate |
$12,027.96 |
| Rate for Payer: Aetna Commercial |
$9,647.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,772.71
|
| Rate for Payer: Cash Price |
$6,264.56
|
| Rate for Payer: Cigna Commercial |
$10,399.17
|
| Rate for Payer: First Health Commercial |
$11,902.66
|
| Rate for Payer: Humana Commercial |
$10,649.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,758.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,025.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,396.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,023.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,900.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,645.09
|
| Rate for Payer: PHCS Commercial |
$12,027.96
|
| Rate for Payer: United Healthcare All Payer |
$11,025.63
|
|
|
CONTR ACE RECN RNG 50OD 46ID R
|
Facility
|
OP
|
$12,529.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,758.74 |
| Max. Negotiated Rate |
$12,027.96 |
| Rate for Payer: Aetna Commercial |
$9,647.42
|
| Rate for Payer: Anthem Medicaid |
$4,308.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,772.71
|
| Rate for Payer: Cash Price |
$6,264.56
|
| Rate for Payer: Cigna Commercial |
$10,399.17
|
| Rate for Payer: First Health Commercial |
$11,902.66
|
| Rate for Payer: Humana Commercial |
$10,649.75
|
| Rate for Payer: Humana KY Medicaid |
$4,308.76
|
| Rate for Payer: Kentucky WC Medicaid |
$4,352.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,758.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,395.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,025.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,396.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,023.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,900.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,645.09
|
| Rate for Payer: PHCS Commercial |
$12,027.96
|
| Rate for Payer: United Healthcare All Payer |
$11,025.63
|
|
|
CONTR ACE RECN RNG 50OD 46ID R
|
Facility
|
IP
|
$12,529.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,758.74 |
| Max. Negotiated Rate |
$12,027.96 |
| Rate for Payer: Aetna Commercial |
$9,647.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,772.71
|
| Rate for Payer: Cash Price |
$6,264.56
|
| Rate for Payer: Cigna Commercial |
$10,399.17
|
| Rate for Payer: First Health Commercial |
$11,902.66
|
| Rate for Payer: Humana Commercial |
$10,649.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,758.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,025.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,396.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,023.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,900.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,645.09
|
| Rate for Payer: PHCS Commercial |
$12,027.96
|
| Rate for Payer: United Healthcare All Payer |
$11,025.63
|
|
|
CONTR ACE RECN RNG 56OD 52ID L
|
Facility
|
IP
|
$21,282.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,384.75 |
| Max. Negotiated Rate |
$20,431.20 |
| Rate for Payer: Aetna Commercial |
$16,387.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,600.35
|
| Rate for Payer: Cash Price |
$10,641.25
|
| Rate for Payer: Cigna Commercial |
$17,664.47
|
| Rate for Payer: First Health Commercial |
$20,218.38
|
| Rate for Payer: Humana Commercial |
$18,090.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,451.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,706.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,384.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,728.60
|
| Rate for Payer: Ohio Health Group HMO |
$15,961.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,026.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,515.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,684.92
|
| Rate for Payer: PHCS Commercial |
$20,431.20
|
| Rate for Payer: United Healthcare All Payer |
$18,728.60
|
|
|
CONTR ACE RECN RNG 56OD 52ID L
|
Facility
|
OP
|
$21,282.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,384.75 |
| Max. Negotiated Rate |
$20,431.20 |
| Rate for Payer: Aetna Commercial |
$16,387.53
|
| Rate for Payer: Anthem Medicaid |
$7,319.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,600.35
|
| Rate for Payer: Cash Price |
$10,641.25
|
| Rate for Payer: Cigna Commercial |
$17,664.47
|
| Rate for Payer: First Health Commercial |
$20,218.38
|
| Rate for Payer: Humana Commercial |
$18,090.12
|
| Rate for Payer: Humana KY Medicaid |
$7,319.05
|
| Rate for Payer: Kentucky WC Medicaid |
$7,393.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,451.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,706.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,384.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,465.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,728.60
|
| Rate for Payer: Ohio Health Group HMO |
$15,961.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,026.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,515.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,684.92
|
| Rate for Payer: PHCS Commercial |
$20,431.20
|
| Rate for Payer: United Healthcare All Payer |
$18,728.60
|
|
|
CONTR ACE RECN RNG 56OD 52ID R
|
Facility
|
IP
|
$22,662.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,798.75 |
| Max. Negotiated Rate |
$21,756.00 |
| Rate for Payer: Aetna Commercial |
$17,450.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,676.75
|
| Rate for Payer: Cash Price |
$11,331.25
|
| Rate for Payer: Cigna Commercial |
$18,809.88
|
| Rate for Payer: First Health Commercial |
$21,529.38
|
| Rate for Payer: Humana Commercial |
$19,263.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,583.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,724.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,798.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,943.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,996.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,130.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,716.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,637.12
|
| Rate for Payer: PHCS Commercial |
$21,756.00
|
| Rate for Payer: United Healthcare All Payer |
$19,943.00
|
|
|
CONTR ACE RECN RNG 56OD 52ID R
|
Facility
|
OP
|
$22,662.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,798.75 |
| Max. Negotiated Rate |
$21,756.00 |
| Rate for Payer: Aetna Commercial |
$17,450.12
|
| Rate for Payer: Anthem Medicaid |
$7,793.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,676.75
|
| Rate for Payer: Cash Price |
$11,331.25
|
| Rate for Payer: Cigna Commercial |
$18,809.88
|
| Rate for Payer: First Health Commercial |
$21,529.38
|
| Rate for Payer: Humana Commercial |
$19,263.12
|
| Rate for Payer: Humana KY Medicaid |
$7,793.63
|
| Rate for Payer: Kentucky WC Medicaid |
$7,872.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,583.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,724.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,798.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,950.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,943.00
|
| Rate for Payer: Ohio Health Group HMO |
$16,996.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,130.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,716.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,637.12
|
| Rate for Payer: PHCS Commercial |
$21,756.00
|
| Rate for Payer: United Healthcare All Payer |
$19,943.00
|
|
|
CONTR ACE RECN RNG 62OD 58ID L
|
Facility
|
IP
|
$12,529.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,758.74 |
| Max. Negotiated Rate |
$12,027.96 |
| Rate for Payer: Aetna Commercial |
$9,647.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,772.71
|
| Rate for Payer: Cash Price |
$6,264.56
|
| Rate for Payer: Cigna Commercial |
$10,399.17
|
| Rate for Payer: First Health Commercial |
$11,902.66
|
| Rate for Payer: Humana Commercial |
$10,649.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,758.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,025.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,396.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,023.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,900.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,645.09
|
| Rate for Payer: PHCS Commercial |
$12,027.96
|
| Rate for Payer: United Healthcare All Payer |
$11,025.63
|
|
|
CONTR ACE RECN RNG 62OD 58ID L
|
Facility
|
OP
|
$12,529.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,758.74 |
| Max. Negotiated Rate |
$12,027.96 |
| Rate for Payer: Aetna Commercial |
$9,647.42
|
| Rate for Payer: Anthem Medicaid |
$4,308.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,772.71
|
| Rate for Payer: Cash Price |
$6,264.56
|
| Rate for Payer: Cigna Commercial |
$10,399.17
|
| Rate for Payer: First Health Commercial |
$11,902.66
|
| Rate for Payer: Humana Commercial |
$10,649.75
|
| Rate for Payer: Humana KY Medicaid |
$4,308.76
|
| Rate for Payer: Kentucky WC Medicaid |
$4,352.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,758.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,395.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,025.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,396.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,023.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,900.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,645.09
|
| Rate for Payer: PHCS Commercial |
$12,027.96
|
| Rate for Payer: United Healthcare All Payer |
$11,025.63
|
|
|
CONTR ACE RECN RNG 62OD 58ID R
|
Facility
|
IP
|
$12,529.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,758.74 |
| Max. Negotiated Rate |
$12,027.96 |
| Rate for Payer: Aetna Commercial |
$9,647.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,772.71
|
| Rate for Payer: Cash Price |
$6,264.56
|
| Rate for Payer: Cigna Commercial |
$10,399.17
|
| Rate for Payer: First Health Commercial |
$11,902.66
|
| Rate for Payer: Humana Commercial |
$10,649.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,758.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,025.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,396.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,023.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,900.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,645.09
|
| Rate for Payer: PHCS Commercial |
$12,027.96
|
| Rate for Payer: United Healthcare All Payer |
$11,025.63
|
|
|
CONTR ACE RECN RNG 62OD 58ID R
|
Facility
|
OP
|
$12,529.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,758.74 |
| Max. Negotiated Rate |
$12,027.96 |
| Rate for Payer: Aetna Commercial |
$9,647.42
|
| Rate for Payer: Anthem Medicaid |
$4,308.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,772.71
|
| Rate for Payer: Cash Price |
$6,264.56
|
| Rate for Payer: Cigna Commercial |
$10,399.17
|
| Rate for Payer: First Health Commercial |
$11,902.66
|
| Rate for Payer: Humana Commercial |
$10,649.75
|
| Rate for Payer: Humana KY Medicaid |
$4,308.76
|
| Rate for Payer: Kentucky WC Medicaid |
$4,352.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,758.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,395.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,025.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,396.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,023.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,900.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,645.09
|
| Rate for Payer: PHCS Commercial |
$12,027.96
|
| Rate for Payer: United Healthcare All Payer |
$11,025.63
|
|
|
CONTR ACE RECN RNG 68OD 64ID L
|
Facility
|
OP
|
$12,529.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,758.74 |
| Max. Negotiated Rate |
$12,027.96 |
| Rate for Payer: Aetna Commercial |
$9,647.42
|
| Rate for Payer: Anthem Medicaid |
$4,308.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,772.71
|
| Rate for Payer: Cash Price |
$6,264.56
|
| Rate for Payer: Cigna Commercial |
$10,399.17
|
| Rate for Payer: First Health Commercial |
$11,902.66
|
| Rate for Payer: Humana Commercial |
$10,649.75
|
| Rate for Payer: Humana KY Medicaid |
$4,308.76
|
| Rate for Payer: Kentucky WC Medicaid |
$4,352.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,758.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,395.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,025.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,396.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,023.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,900.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,645.09
|
| Rate for Payer: PHCS Commercial |
$12,027.96
|
| Rate for Payer: United Healthcare All Payer |
$11,025.63
|
|
