|
DELTA CER HEAD 12/14 28MM +5
|
Facility
|
OP
|
$9,050.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,176.53 |
| Max. Negotiated Rate |
$8,688.25 |
| Rate for Payer: Aetna Commercial |
$6,968.70
|
| Rate for Payer: Anthem Medicaid |
$3,112.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,059.20
|
| Rate for Payer: Cash Price |
$4,525.13
|
| Rate for Payer: Cigna Commercial |
$7,511.72
|
| Rate for Payer: First Health Commercial |
$8,597.75
|
| Rate for Payer: Humana Commercial |
$7,692.72
|
| Rate for Payer: Humana KY Medicaid |
$3,112.38
|
| Rate for Payer: Kentucky WC Medicaid |
$3,144.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,421.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,679.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,715.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,174.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,964.23
|
| Rate for Payer: Ohio Health Group HMO |
$6,787.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,810.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,176.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,805.58
|
| Rate for Payer: PHCS Commercial |
$8,688.25
|
| Rate for Payer: United Healthcare All Payer |
$7,964.23
|
|
|
DELTA CER HEAD 12/14 28MM +8.5
|
Facility
|
OP
|
$9,050.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,176.53 |
| Max. Negotiated Rate |
$8,688.25 |
| Rate for Payer: Aetna Commercial |
$6,968.70
|
| Rate for Payer: Anthem Medicaid |
$3,112.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,059.20
|
| Rate for Payer: Cash Price |
$4,525.13
|
| Rate for Payer: Cigna Commercial |
$7,511.72
|
| Rate for Payer: First Health Commercial |
$8,597.75
|
| Rate for Payer: Humana Commercial |
$7,692.72
|
| Rate for Payer: Humana KY Medicaid |
$3,112.38
|
| Rate for Payer: Kentucky WC Medicaid |
$3,144.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,421.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,679.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,715.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,174.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,964.23
|
| Rate for Payer: Ohio Health Group HMO |
$6,787.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,810.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,176.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,805.58
|
| Rate for Payer: PHCS Commercial |
$8,688.25
|
| Rate for Payer: United Healthcare All Payer |
$7,964.23
|
|
|
DELTA CER HEAD 12/14 28MM +8.5
|
Facility
|
IP
|
$9,050.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,176.53 |
| Max. Negotiated Rate |
$8,688.25 |
| Rate for Payer: Aetna Commercial |
$6,968.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,059.20
|
| Rate for Payer: Cash Price |
$4,525.13
|
| Rate for Payer: Cigna Commercial |
$7,511.72
|
| Rate for Payer: First Health Commercial |
$8,597.75
|
| Rate for Payer: Humana Commercial |
$7,692.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,421.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,679.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,715.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,964.23
|
| Rate for Payer: Ohio Health Group HMO |
$6,787.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,810.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,176.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,805.58
|
| Rate for Payer: PHCS Commercial |
$8,688.25
|
| Rate for Payer: United Healthcare All Payer |
$7,964.23
|
|
|
DELTA CER HEAD 12/14 32MM +1
|
Facility
|
IP
|
$9,356.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,216.39 |
| Max. Negotiated Rate |
$8,982.59 |
| Rate for Payer: Aetna Commercial |
$7,204.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,298.35
|
| Rate for Payer: Cash Price |
$4,678.43
|
| Rate for Payer: Cigna Commercial |
$7,766.19
|
| Rate for Payer: First Health Commercial |
$8,889.02
|
| Rate for Payer: Humana Commercial |
$7,953.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,672.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,905.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,234.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,017.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,871.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,216.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,900.63
|
| Rate for Payer: PHCS Commercial |
$8,982.59
|
| Rate for Payer: United Healthcare All Payer |
$8,234.04
|
|
|
DELTA CER HEAD 12/14 32MM +1
|
Facility
|
OP
|
$9,356.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,216.39 |
| Max. Negotiated Rate |
$8,982.59 |
| Rate for Payer: Aetna Commercial |
$7,204.78
|
| Rate for Payer: Anthem Medicaid |
$3,217.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,298.35
|
| Rate for Payer: Cash Price |
$4,678.43
|
| Rate for Payer: Cigna Commercial |
$7,766.19
|
| Rate for Payer: First Health Commercial |
$8,889.02
|
| Rate for Payer: Humana Commercial |
$7,953.33
|
| Rate for Payer: Humana KY Medicaid |
$3,217.82
|
| Rate for Payer: Kentucky WC Medicaid |
$3,250.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,672.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,905.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,282.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,234.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,017.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,871.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,216.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,900.63
|
| Rate for Payer: PHCS Commercial |
$8,982.59
|
| Rate for Payer: United Healthcare All Payer |
$8,234.04
|
|
|
DELTA CER HEAD 12/14 32MM +1.0
|
Facility
|
IP
|
$10,905.87
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,417.76 |
| Max. Negotiated Rate |
$10,469.64 |
| Rate for Payer: Aetna Commercial |
$8,397.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,506.58
|
| Rate for Payer: Cash Price |
$5,452.94
|
| Rate for Payer: Cigna Commercial |
$9,051.87
|
| Rate for Payer: First Health Commercial |
$10,360.58
|
| Rate for Payer: Humana Commercial |
$9,269.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,942.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,048.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,271.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,597.17
|
| Rate for Payer: Ohio Health Group HMO |
$8,179.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,181.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,417.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,380.82
|
| Rate for Payer: PHCS Commercial |
$10,469.64
|
| Rate for Payer: United Healthcare All Payer |
$9,597.17
|
|
|
DELTA CER HEAD 12/14 32MM +1.0
|
Facility
|
OP
|
$10,905.87
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,417.76 |
| Max. Negotiated Rate |
$10,469.64 |
| Rate for Payer: Aetna Commercial |
$8,397.52
|
| Rate for Payer: Anthem Medicaid |
$3,750.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,506.58
|
| Rate for Payer: Cash Price |
$5,452.94
|
| Rate for Payer: Cigna Commercial |
$9,051.87
|
| Rate for Payer: First Health Commercial |
$10,360.58
|
| Rate for Payer: Humana Commercial |
$9,269.99
|
| Rate for Payer: Humana KY Medicaid |
$3,750.53
|
| Rate for Payer: Kentucky WC Medicaid |
$3,788.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,942.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,048.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,271.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,825.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,597.17
|
| Rate for Payer: Ohio Health Group HMO |
$8,179.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,181.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,417.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,380.82
|
| Rate for Payer: PHCS Commercial |
$10,469.64
|
| Rate for Payer: United Healthcare All Payer |
$9,597.17
|
|
|
DELTA CER HEAD 12/14 32MM +5
|
Facility
|
IP
|
$9,356.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,216.39 |
| Max. Negotiated Rate |
$8,982.59 |
| Rate for Payer: Aetna Commercial |
$7,204.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,298.35
|
| Rate for Payer: Cash Price |
$4,678.43
|
| Rate for Payer: Cigna Commercial |
$7,766.19
|
| Rate for Payer: First Health Commercial |
$8,889.02
|
| Rate for Payer: Humana Commercial |
$7,953.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,672.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,905.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,234.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,017.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,871.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,216.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,900.63
|
| Rate for Payer: PHCS Commercial |
$8,982.59
|
| Rate for Payer: United Healthcare All Payer |
$8,234.04
|
|
|
DELTA CER HEAD 12/14 32MM +5
|
Facility
|
OP
|
$9,356.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,216.39 |
| Max. Negotiated Rate |
$8,982.59 |
| Rate for Payer: Aetna Commercial |
$7,204.78
|
| Rate for Payer: Anthem Medicaid |
$3,217.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,298.35
|
| Rate for Payer: Cash Price |
$4,678.43
|
| Rate for Payer: Cigna Commercial |
$7,766.19
|
| Rate for Payer: First Health Commercial |
$8,889.02
|
| Rate for Payer: Humana Commercial |
$7,953.33
|
| Rate for Payer: Humana KY Medicaid |
$3,217.82
|
| Rate for Payer: Kentucky WC Medicaid |
$3,250.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,672.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,905.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,282.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,234.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,017.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,871.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,216.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,900.63
|
| Rate for Payer: PHCS Commercial |
$8,982.59
|
| Rate for Payer: United Healthcare All Payer |
$8,234.04
|
|
|
DELTA CER HEAD 12/14 32MM +9
|
Facility
|
IP
|
$9,356.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,216.39 |
| Max. Negotiated Rate |
$8,982.59 |
| Rate for Payer: Aetna Commercial |
$7,204.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,298.35
|
| Rate for Payer: Cash Price |
$4,678.43
|
| Rate for Payer: Cigna Commercial |
$7,766.19
|
| Rate for Payer: First Health Commercial |
$8,889.02
|
| Rate for Payer: Humana Commercial |
$7,953.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,672.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,905.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,234.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,017.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,871.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,216.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,900.63
|
| Rate for Payer: PHCS Commercial |
$8,982.59
|
| Rate for Payer: United Healthcare All Payer |
$8,234.04
|
|
|
DELTA CER HEAD 12/14 32MM +9
|
Facility
|
OP
|
$9,356.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,216.39 |
| Max. Negotiated Rate |
$8,982.59 |
| Rate for Payer: Aetna Commercial |
$7,204.78
|
| Rate for Payer: Anthem Medicaid |
$3,217.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,298.35
|
| Rate for Payer: Cash Price |
$4,678.43
|
| Rate for Payer: Cigna Commercial |
$7,766.19
|
| Rate for Payer: First Health Commercial |
$8,889.02
|
| Rate for Payer: Humana Commercial |
$7,953.33
|
| Rate for Payer: Humana KY Medicaid |
$3,217.82
|
| Rate for Payer: Kentucky WC Medicaid |
$3,250.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,672.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,905.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,282.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,234.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,017.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,871.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,216.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,900.63
|
| Rate for Payer: PHCS Commercial |
$8,982.59
|
| Rate for Payer: United Healthcare All Payer |
$8,234.04
|
|
|
DELTA CER HEAD 12/14 36MM +12
|
Facility
|
IP
|
$9,264.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,204.34 |
| Max. Negotiated Rate |
$8,893.62 |
| Rate for Payer: Aetna Commercial |
$7,133.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,226.07
|
| Rate for Payer: Cash Price |
$4,632.09
|
| Rate for Payer: Cigna Commercial |
$7,689.28
|
| Rate for Payer: First Health Commercial |
$8,800.98
|
| Rate for Payer: Humana Commercial |
$7,874.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,596.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,836.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,779.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,152.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,948.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,852.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,204.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,871.90
|
| Rate for Payer: PHCS Commercial |
$8,893.62
|
| Rate for Payer: United Healthcare All Payer |
$8,152.49
|
|
|
DELTA CER HEAD 12/14 36MM +12
|
Facility
|
OP
|
$9,264.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,204.34 |
| Max. Negotiated Rate |
$8,893.62 |
| Rate for Payer: Aetna Commercial |
$7,133.43
|
| Rate for Payer: Anthem Medicaid |
$3,185.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,226.07
|
| Rate for Payer: Cash Price |
$4,632.09
|
| Rate for Payer: Cigna Commercial |
$7,689.28
|
| Rate for Payer: First Health Commercial |
$8,800.98
|
| Rate for Payer: Humana Commercial |
$7,874.56
|
| Rate for Payer: Humana KY Medicaid |
$3,185.95
|
| Rate for Payer: Kentucky WC Medicaid |
$3,218.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,596.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,836.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,779.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,249.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,152.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,948.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,852.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,204.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,871.90
|
| Rate for Payer: PHCS Commercial |
$8,893.62
|
| Rate for Payer: United Healthcare All Payer |
$8,152.49
|
|
|
DELTA CER HEAD 12/14 36MM +1.5
|
Facility
|
OP
|
$9,718.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,263.37 |
| Max. Negotiated Rate |
$9,329.48 |
| Rate for Payer: Aetna Commercial |
$7,483.02
|
| Rate for Payer: Anthem Medicaid |
$3,342.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,580.20
|
| Rate for Payer: Cash Price |
$4,859.10
|
| Rate for Payer: Cigna Commercial |
$8,066.11
|
| Rate for Payer: First Health Commercial |
$9,232.30
|
| Rate for Payer: Humana Commercial |
$8,260.48
|
| Rate for Payer: Humana KY Medicaid |
$3,342.09
|
| Rate for Payer: Kentucky WC Medicaid |
$3,376.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,968.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,172.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,915.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,409.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,552.02
|
| Rate for Payer: Ohio Health Group HMO |
$7,288.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,943.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,263.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,012.65
|
| Rate for Payer: PHCS Commercial |
$9,329.48
|
| Rate for Payer: United Healthcare All Payer |
$8,552.02
|
|
|
DELTA CER HEAD 12/14 36MM +1.5
|
Facility
|
IP
|
$9,718.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,263.37 |
| Max. Negotiated Rate |
$9,329.48 |
| Rate for Payer: Aetna Commercial |
$7,483.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,580.20
|
| Rate for Payer: Cash Price |
$4,859.10
|
| Rate for Payer: Cigna Commercial |
$8,066.11
|
| Rate for Payer: First Health Commercial |
$9,232.30
|
| Rate for Payer: Humana Commercial |
$8,260.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,968.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,172.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,915.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,552.02
|
| Rate for Payer: Ohio Health Group HMO |
$7,288.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,943.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,263.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,012.65
|
| Rate for Payer: PHCS Commercial |
$9,329.48
|
| Rate for Payer: United Healthcare All Payer |
$8,552.02
|
|
|
DELTA CER HEAD 12/14 36MM +5
|
Facility
|
IP
|
$7,696.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,000.59 |
| Max. Negotiated Rate |
$7,388.97 |
| Rate for Payer: Aetna Commercial |
$5,926.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,003.54
|
| Rate for Payer: Cash Price |
$3,848.42
|
| Rate for Payer: Cigna Commercial |
$6,388.38
|
| Rate for Payer: First Health Commercial |
$7,312.00
|
| Rate for Payer: Humana Commercial |
$6,542.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,311.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,680.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,309.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,773.22
|
| Rate for Payer: Ohio Health Group HMO |
$5,772.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,539.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,000.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,386.02
|
| Rate for Payer: PHCS Commercial |
$7,388.97
|
| Rate for Payer: United Healthcare All Payer |
$6,773.22
|
|
|
DELTA CER HEAD 12/14 36MM +5
|
Facility
|
OP
|
$7,696.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,000.59 |
| Max. Negotiated Rate |
$7,388.97 |
| Rate for Payer: Aetna Commercial |
$5,926.57
|
| Rate for Payer: Anthem Medicaid |
$2,646.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,003.54
|
| Rate for Payer: Cash Price |
$3,848.42
|
| Rate for Payer: Cigna Commercial |
$6,388.38
|
| Rate for Payer: First Health Commercial |
$7,312.00
|
| Rate for Payer: Humana Commercial |
$6,542.31
|
| Rate for Payer: Humana KY Medicaid |
$2,646.94
|
| Rate for Payer: Kentucky WC Medicaid |
$2,673.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,311.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,680.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,309.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,700.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,773.22
|
| Rate for Payer: Ohio Health Group HMO |
$5,772.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,539.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,000.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,386.02
|
| Rate for Payer: PHCS Commercial |
$7,388.97
|
| Rate for Payer: United Healthcare All Payer |
$6,773.22
|
|
|
DELTA CER HEAD 12/14 36MM +8.5
|
Facility
|
IP
|
$9,718.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,263.37 |
| Max. Negotiated Rate |
$9,329.48 |
| Rate for Payer: Aetna Commercial |
$7,483.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,580.20
|
| Rate for Payer: Cash Price |
$4,859.10
|
| Rate for Payer: Cigna Commercial |
$8,066.11
|
| Rate for Payer: First Health Commercial |
$9,232.30
|
| Rate for Payer: Humana Commercial |
$8,260.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,968.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,172.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,915.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,552.02
|
| Rate for Payer: Ohio Health Group HMO |
$7,288.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,943.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,263.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,012.65
|
| Rate for Payer: PHCS Commercial |
$9,329.48
|
| Rate for Payer: United Healthcare All Payer |
$8,552.02
|
|
|
DELTA CER HEAD 12/14 36MM +8.5
|
Facility
|
OP
|
$9,718.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,263.37 |
| Max. Negotiated Rate |
$9,329.48 |
| Rate for Payer: Aetna Commercial |
$7,483.02
|
| Rate for Payer: Anthem Medicaid |
$3,342.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,580.20
|
| Rate for Payer: Cash Price |
$4,859.10
|
| Rate for Payer: Cigna Commercial |
$8,066.11
|
| Rate for Payer: First Health Commercial |
$9,232.30
|
| Rate for Payer: Humana Commercial |
$8,260.48
|
| Rate for Payer: Humana KY Medicaid |
$3,342.09
|
| Rate for Payer: Kentucky WC Medicaid |
$3,376.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,968.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,172.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,915.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,409.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,552.02
|
| Rate for Payer: Ohio Health Group HMO |
$7,288.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,943.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,263.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,012.65
|
| Rate for Payer: PHCS Commercial |
$9,329.48
|
| Rate for Payer: United Healthcare All Payer |
$8,552.02
|
|
|
DELTA CER HEAD +3 36MM 11/13
|
Facility
|
OP
|
$9,783.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,271.91 |
| Max. Negotiated Rate |
$9,392.55 |
| Rate for Payer: Aetna Commercial |
$7,533.61
|
| Rate for Payer: Anthem Medicaid |
$3,364.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,631.45
|
| Rate for Payer: Cash Price |
$4,891.96
|
| Rate for Payer: Cigna Commercial |
$8,120.65
|
| Rate for Payer: First Health Commercial |
$9,294.71
|
| Rate for Payer: Humana Commercial |
$8,316.32
|
| Rate for Payer: Humana KY Medicaid |
$3,364.69
|
| Rate for Payer: Kentucky WC Medicaid |
$3,398.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,022.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,220.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,935.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,432.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,609.84
|
| Rate for Payer: Ohio Health Group HMO |
$7,337.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,956.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,271.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,033.01
|
| Rate for Payer: PHCS Commercial |
$9,392.55
|
| Rate for Payer: United Healthcare All Payer |
$8,609.84
|
|
|
DELTA CER HEAD +3 36MM 11/13
|
Facility
|
IP
|
$9,783.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,271.91 |
| Max. Negotiated Rate |
$9,392.55 |
| Rate for Payer: Aetna Commercial |
$7,533.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,631.45
|
| Rate for Payer: Cash Price |
$4,891.96
|
| Rate for Payer: Cigna Commercial |
$8,120.65
|
| Rate for Payer: First Health Commercial |
$9,294.71
|
| Rate for Payer: Humana Commercial |
$8,316.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,022.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,220.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,935.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,609.84
|
| Rate for Payer: Ohio Health Group HMO |
$7,337.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,956.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,271.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,033.01
|
| Rate for Payer: PHCS Commercial |
$9,392.55
|
| Rate for Payer: United Healthcare All Payer |
$8,609.84
|
|
|
DELTA CER HEAD +6 36MM 11/13
|
Facility
|
IP
|
$9,783.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,271.91 |
| Max. Negotiated Rate |
$9,392.55 |
| Rate for Payer: Aetna Commercial |
$7,533.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,631.45
|
| Rate for Payer: Cash Price |
$4,891.96
|
| Rate for Payer: Cigna Commercial |
$8,120.65
|
| Rate for Payer: First Health Commercial |
$9,294.71
|
| Rate for Payer: Humana Commercial |
$8,316.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,022.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,220.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,935.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,609.84
|
| Rate for Payer: Ohio Health Group HMO |
$7,337.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,956.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,271.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,033.01
|
| Rate for Payer: PHCS Commercial |
$9,392.55
|
| Rate for Payer: United Healthcare All Payer |
$8,609.84
|
|
|
DELTA CER HEAD +6 36MM 11/13
|
Facility
|
OP
|
$9,783.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,271.91 |
| Max. Negotiated Rate |
$9,392.55 |
| Rate for Payer: Aetna Commercial |
$7,533.61
|
| Rate for Payer: Anthem Medicaid |
$3,364.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,631.45
|
| Rate for Payer: Cash Price |
$4,891.96
|
| Rate for Payer: Cigna Commercial |
$8,120.65
|
| Rate for Payer: First Health Commercial |
$9,294.71
|
| Rate for Payer: Humana Commercial |
$8,316.32
|
| Rate for Payer: Humana KY Medicaid |
$3,364.69
|
| Rate for Payer: Kentucky WC Medicaid |
$3,398.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,022.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,220.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,935.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,432.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,609.84
|
| Rate for Payer: Ohio Health Group HMO |
$7,337.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,956.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,271.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,033.01
|
| Rate for Payer: PHCS Commercial |
$9,392.55
|
| Rate for Payer: United Healthcare All Payer |
$8,609.84
|
|
|
DELTA HEAD 12/14 S/+0 32MM
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
DELTA HEAD 12/14 S/+0 32MM
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
