|
DELTA TS CER HEAD 12/14 40MM +
|
Facility
|
IP
|
$11,683.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,518.83 |
| Max. Negotiated Rate |
$11,215.99 |
| Rate for Payer: Aetna Commercial |
$8,996.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,112.99
|
| Rate for Payer: Cash Price |
$5,841.66
|
| Rate for Payer: Cigna Commercial |
$9,697.16
|
| Rate for Payer: First Health Commercial |
$11,099.15
|
| Rate for Payer: Humana Commercial |
$9,930.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,580.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,622.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,505.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,281.32
|
| Rate for Payer: Ohio Health Group HMO |
$8,762.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,336.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,518.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,621.83
|
| Rate for Payer: PHCS Commercial |
$11,215.99
|
| Rate for Payer: United Healthcare All Payer |
$10,281.32
|
|
|
DELTA TS CER HEAD 12/14 44MM+5
|
Facility
|
IP
|
$15,468.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,010.84 |
| Max. Negotiated Rate |
$14,849.28 |
| Rate for Payer: Aetna Commercial |
$11,910.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,065.04
|
| Rate for Payer: Cash Price |
$7,734.00
|
| Rate for Payer: Cigna Commercial |
$12,838.44
|
| Rate for Payer: First Health Commercial |
$14,694.60
|
| Rate for Payer: Humana Commercial |
$13,147.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,683.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,415.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,640.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,611.84
|
| Rate for Payer: Ohio Health Group HMO |
$11,601.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,093.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,010.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,795.08
|
| Rate for Payer: PHCS Commercial |
$14,849.28
|
| Rate for Payer: United Healthcare All Payer |
$13,611.84
|
|
|
DELTA TS CER HEAD 12/14 44MM+5
|
Facility
|
OP
|
$15,468.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,010.84 |
| Max. Negotiated Rate |
$14,849.28 |
| Rate for Payer: Aetna Commercial |
$11,910.36
|
| Rate for Payer: Anthem Medicaid |
$5,319.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,065.04
|
| Rate for Payer: Cash Price |
$7,734.00
|
| Rate for Payer: Cigna Commercial |
$12,838.44
|
| Rate for Payer: First Health Commercial |
$14,694.60
|
| Rate for Payer: Humana Commercial |
$13,147.80
|
| Rate for Payer: Humana KY Medicaid |
$5,319.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,373.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,683.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,415.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,640.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,426.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,611.84
|
| Rate for Payer: Ohio Health Group HMO |
$11,601.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,093.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,010.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,795.08
|
| Rate for Payer: PHCS Commercial |
$14,849.28
|
| Rate for Payer: United Healthcare All Payer |
$13,611.84
|
|
|
DELTA TS CER. HED 12/14 32MM+5
|
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 TS CER. HED 12/14 32MM+5
|
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 TS CER. HED 12/14 32MM+9
|
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 TS CER. HED 12/14 32MM+9
|
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 TS CER HED 12/14 40MM+12
|
Facility
|
IP
|
$11,683.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,518.83 |
| Max. Negotiated Rate |
$11,215.99 |
| Rate for Payer: Aetna Commercial |
$8,996.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,112.99
|
| Rate for Payer: Cash Price |
$5,841.66
|
| Rate for Payer: Cigna Commercial |
$9,697.16
|
| Rate for Payer: First Health Commercial |
$11,099.15
|
| Rate for Payer: Humana Commercial |
$9,930.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,580.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,622.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,505.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,281.32
|
| Rate for Payer: Ohio Health Group HMO |
$8,762.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,336.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,518.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,621.83
|
| Rate for Payer: PHCS Commercial |
$11,215.99
|
| Rate for Payer: United Healthcare All Payer |
$10,281.32
|
|
|
DELTA TS CER HED 12/14 40MM+12
|
Facility
|
OP
|
$11,683.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,518.83 |
| Max. Negotiated Rate |
$11,215.99 |
| Rate for Payer: Aetna Commercial |
$8,996.16
|
| Rate for Payer: Anthem Medicaid |
$4,017.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,112.99
|
| Rate for Payer: Cash Price |
$5,841.66
|
| Rate for Payer: Cigna Commercial |
$9,697.16
|
| Rate for Payer: First Health Commercial |
$11,099.15
|
| Rate for Payer: Humana Commercial |
$9,930.82
|
| Rate for Payer: Humana KY Medicaid |
$4,017.89
|
| Rate for Payer: Kentucky WC Medicaid |
$4,058.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,580.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,622.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,505.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,098.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,281.32
|
| Rate for Payer: Ohio Health Group HMO |
$8,762.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,336.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,518.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,621.83
|
| Rate for Payer: PHCS Commercial |
$11,215.99
|
| Rate for Payer: United Healthcare All Payer |
$10,281.32
|
|
|
DELTA XTEND CTA HEAD 48*21MM
|
Facility
|
IP
|
$25,451.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,308.72 |
| Max. Negotiated Rate |
$24,433.63 |
| Rate for Payer: Aetna Commercial |
$19,597.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,852.33
|
| Rate for Payer: Cash Price |
$12,725.85
|
| Rate for Payer: Cigna Commercial |
$21,124.91
|
| Rate for Payer: First Health Commercial |
$24,179.12
|
| Rate for Payer: Humana Commercial |
$21,633.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,870.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,783.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,635.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,397.50
|
| Rate for Payer: Ohio Health Group HMO |
$19,088.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,090.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,308.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,890.03
|
| Rate for Payer: PHCS Commercial |
$24,433.63
|
| Rate for Payer: United Healthcare All Payer |
$22,397.50
|
|
|
DELTA XTEND CTA HEAD 48*21MM
|
Facility
|
OP
|
$25,451.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,308.72 |
| Max. Negotiated Rate |
$24,433.63 |
| Rate for Payer: Aetna Commercial |
$19,597.81
|
| Rate for Payer: Anthem Medicaid |
$8,752.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,852.33
|
| Rate for Payer: Cash Price |
$12,725.85
|
| Rate for Payer: Cigna Commercial |
$21,124.91
|
| Rate for Payer: First Health Commercial |
$24,179.12
|
| Rate for Payer: Humana Commercial |
$21,633.94
|
| Rate for Payer: Humana KY Medicaid |
$8,752.84
|
| Rate for Payer: Kentucky WC Medicaid |
$8,841.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,870.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,783.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,635.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,928.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,397.50
|
| Rate for Payer: Ohio Health Group HMO |
$19,088.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,090.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,308.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,890.03
|
| Rate for Payer: PHCS Commercial |
$24,433.63
|
| Rate for Payer: United Healthcare All Payer |
$22,397.50
|
|
|
DELTA XTEND CTA HEAD 48*26MM
|
Facility
|
IP
|
$23,531.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,059.13 |
| Max. Negotiated Rate |
$22,590.53 |
| Rate for Payer: Aetna Commercial |
$18,119.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,354.80
|
| Rate for Payer: Cash Price |
$11,765.90
|
| Rate for Payer: Cigna Commercial |
$19,531.39
|
| Rate for Payer: First Health Commercial |
$22,355.21
|
| Rate for Payer: Humana Commercial |
$20,002.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,296.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,366.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,059.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,707.98
|
| Rate for Payer: Ohio Health Group HMO |
$17,648.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,706.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,059.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,294.86
|
| Rate for Payer: PHCS Commercial |
$22,590.53
|
| Rate for Payer: United Healthcare All Payer |
$20,707.98
|
|
|
DELTA XTEND CTA HEAD 48*26MM
|
Facility
|
OP
|
$23,531.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,059.13 |
| Max. Negotiated Rate |
$22,590.53 |
| Rate for Payer: Aetna Commercial |
$18,119.49
|
| Rate for Payer: Anthem Medicaid |
$8,092.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,354.80
|
| Rate for Payer: Cash Price |
$11,765.90
|
| Rate for Payer: Cigna Commercial |
$19,531.39
|
| Rate for Payer: First Health Commercial |
$22,355.21
|
| Rate for Payer: Humana Commercial |
$20,002.03
|
| Rate for Payer: Humana KY Medicaid |
$8,092.59
|
| Rate for Payer: Kentucky WC Medicaid |
$8,174.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,296.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,366.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,059.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,254.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,707.98
|
| Rate for Payer: Ohio Health Group HMO |
$17,648.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,706.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,059.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,294.86
|
| Rate for Payer: PHCS Commercial |
$22,590.53
|
| Rate for Payer: United Healthcare All Payer |
$20,707.98
|
|
|
DELTA XTEND CTA HEAD 52*21MM
|
Facility
|
IP
|
$23,531.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,059.13 |
| Max. Negotiated Rate |
$22,590.53 |
| Rate for Payer: Aetna Commercial |
$18,119.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,354.80
|
| Rate for Payer: Cash Price |
$11,765.90
|
| Rate for Payer: Cigna Commercial |
$19,531.39
|
| Rate for Payer: First Health Commercial |
$22,355.21
|
| Rate for Payer: Humana Commercial |
$20,002.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,296.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,366.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,059.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,707.98
|
| Rate for Payer: Ohio Health Group HMO |
$17,648.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,706.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,059.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,294.86
|
| Rate for Payer: PHCS Commercial |
$22,590.53
|
| Rate for Payer: United Healthcare All Payer |
$20,707.98
|
|
|
DELTA XTEND CTA HEAD 52*21MM
|
Facility
|
OP
|
$23,531.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,059.13 |
| Max. Negotiated Rate |
$22,590.53 |
| Rate for Payer: Aetna Commercial |
$18,119.49
|
| Rate for Payer: Anthem Medicaid |
$8,092.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,354.80
|
| Rate for Payer: Cash Price |
$11,765.90
|
| Rate for Payer: Cigna Commercial |
$19,531.39
|
| Rate for Payer: First Health Commercial |
$22,355.21
|
| Rate for Payer: Humana Commercial |
$20,002.03
|
| Rate for Payer: Humana KY Medicaid |
$8,092.59
|
| Rate for Payer: Kentucky WC Medicaid |
$8,174.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,296.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,366.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,059.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,254.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,707.98
|
| Rate for Payer: Ohio Health Group HMO |
$17,648.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,706.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,059.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,294.86
|
| Rate for Payer: PHCS Commercial |
$22,590.53
|
| Rate for Payer: United Healthcare All Payer |
$20,707.98
|
|
|
DELTA XTEND CTA HEAD 52*26MM
|
Facility
|
IP
|
$15,756.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,048.28 |
| Max. Negotiated Rate |
$15,125.76 |
| Rate for Payer: Aetna Commercial |
$12,132.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,289.68
|
| Rate for Payer: Cash Price |
$7,878.00
|
| Rate for Payer: Cigna Commercial |
$13,077.48
|
| Rate for Payer: First Health Commercial |
$14,968.20
|
| Rate for Payer: Humana Commercial |
$13,392.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,919.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,627.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,726.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,865.28
|
| Rate for Payer: Ohio Health Group HMO |
$11,817.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,151.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,048.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,884.36
|
| Rate for Payer: PHCS Commercial |
$15,125.76
|
| Rate for Payer: United Healthcare All Payer |
$13,865.28
|
|
|
DELTA XTEND CTA HEAD 52*26MM
|
Facility
|
OP
|
$15,756.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,048.28 |
| Max. Negotiated Rate |
$15,125.76 |
| Rate for Payer: Aetna Commercial |
$12,132.12
|
| Rate for Payer: Anthem Medicaid |
$5,418.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,289.68
|
| Rate for Payer: Cash Price |
$7,878.00
|
| Rate for Payer: Cigna Commercial |
$13,077.48
|
| Rate for Payer: First Health Commercial |
$14,968.20
|
| Rate for Payer: Humana Commercial |
$13,392.60
|
| Rate for Payer: Humana KY Medicaid |
$5,418.49
|
| Rate for Payer: Kentucky WC Medicaid |
$5,473.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,919.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,627.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,726.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,527.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,865.28
|
| Rate for Payer: Ohio Health Group HMO |
$11,817.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,151.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,048.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,884.36
|
| Rate for Payer: PHCS Commercial |
$15,125.76
|
| Rate for Payer: United Healthcare All Payer |
$13,865.28
|
|
|
DELTA XTEND GUIDEWIRE 1.5MM
|
Facility
|
IP
|
$753.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.89 |
| Max. Negotiated Rate |
$722.88 |
| Rate for Payer: Aetna Commercial |
$579.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$587.34
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cigna Commercial |
$624.99
|
| Rate for Payer: First Health Commercial |
$715.35
|
| Rate for Payer: Humana Commercial |
$640.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$617.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$555.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$662.64
|
| Rate for Payer: Ohio Health Group HMO |
$564.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$233.43
|
| Rate for Payer: PHCS Commercial |
$722.88
|
| Rate for Payer: United Healthcare All Payer |
$662.64
|
|
|
DELTA XTEND GUIDEWIRE 1.5MM
|
Facility
|
OP
|
$753.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.89 |
| Max. Negotiated Rate |
$722.88 |
| Rate for Payer: Aetna Commercial |
$579.81
|
| Rate for Payer: Anthem Medicaid |
$258.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$587.34
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cigna Commercial |
$624.99
|
| Rate for Payer: First Health Commercial |
$715.35
|
| Rate for Payer: Humana Commercial |
$640.05
|
| Rate for Payer: Humana KY Medicaid |
$258.96
|
| Rate for Payer: Kentucky WC Medicaid |
$261.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$617.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$555.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$264.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$662.64
|
| Rate for Payer: Ohio Health Group HMO |
$564.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$233.43
|
| Rate for Payer: PHCS Commercial |
$722.88
|
| Rate for Payer: United Healthcare All Payer |
$662.64
|
|
|
DELTA XTEND HUM STEM D10 HA
|
Facility
|
IP
|
$16,101.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,093.21 |
| Max. Negotiated Rate |
$15,457.54 |
| Rate for Payer: Aetna Commercial |
$12,398.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,559.25
|
| Rate for Payer: Cash Price |
$8,050.80
|
| Rate for Payer: Cigna Commercial |
$13,364.33
|
| Rate for Payer: First Health Commercial |
$15,296.52
|
| Rate for Payer: Humana Commercial |
$13,686.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,203.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,882.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,830.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,169.41
|
| Rate for Payer: Ohio Health Group HMO |
$12,076.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,220.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,093.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,991.50
|
| Rate for Payer: PHCS Commercial |
$15,457.54
|
| Rate for Payer: United Healthcare All Payer |
$14,169.41
|
|
|
DELTA XTEND HUM STEM D10 HA
|
Facility
|
OP
|
$16,101.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,093.21 |
| Max. Negotiated Rate |
$15,457.54 |
| Rate for Payer: Aetna Commercial |
$12,398.23
|
| Rate for Payer: Anthem Medicaid |
$5,537.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,559.25
|
| Rate for Payer: Cash Price |
$8,050.80
|
| Rate for Payer: Cigna Commercial |
$13,364.33
|
| Rate for Payer: First Health Commercial |
$15,296.52
|
| Rate for Payer: Humana Commercial |
$13,686.36
|
| Rate for Payer: Humana KY Medicaid |
$5,537.34
|
| Rate for Payer: Kentucky WC Medicaid |
$5,593.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,203.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,882.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,830.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,648.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,169.41
|
| Rate for Payer: Ohio Health Group HMO |
$12,076.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,220.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,093.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,991.50
|
| Rate for Payer: PHCS Commercial |
$15,457.54
|
| Rate for Payer: United Healthcare All Payer |
$14,169.41
|
|
|
DELTA XTEND HUM STEM D12 HA
|
Facility
|
IP
|
$16,101.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,093.21 |
| Max. Negotiated Rate |
$15,457.54 |
| Rate for Payer: Aetna Commercial |
$12,398.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,559.25
|
| Rate for Payer: Cash Price |
$8,050.80
|
| Rate for Payer: Cigna Commercial |
$13,364.33
|
| Rate for Payer: First Health Commercial |
$15,296.52
|
| Rate for Payer: Humana Commercial |
$13,686.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,203.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,882.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,830.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,169.41
|
| Rate for Payer: Ohio Health Group HMO |
$12,076.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,220.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,093.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,991.50
|
| Rate for Payer: PHCS Commercial |
$15,457.54
|
| Rate for Payer: United Healthcare All Payer |
$14,169.41
|
|
|
DELTA XTEND HUM STEM D12 HA
|
Facility
|
OP
|
$16,101.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,093.21 |
| Max. Negotiated Rate |
$15,457.54 |
| Rate for Payer: Aetna Commercial |
$12,398.23
|
| Rate for Payer: Anthem Medicaid |
$5,537.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,559.25
|
| Rate for Payer: Cash Price |
$8,050.80
|
| Rate for Payer: Cigna Commercial |
$13,364.33
|
| Rate for Payer: First Health Commercial |
$15,296.52
|
| Rate for Payer: Humana Commercial |
$13,686.36
|
| Rate for Payer: Humana KY Medicaid |
$5,537.34
|
| Rate for Payer: Kentucky WC Medicaid |
$5,593.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,203.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,882.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,830.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,648.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,169.41
|
| Rate for Payer: Ohio Health Group HMO |
$12,076.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,220.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,093.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,991.50
|
| Rate for Payer: PHCS Commercial |
$15,457.54
|
| Rate for Payer: United Healthcare All Payer |
$14,169.41
|
|
|
DELTA XTEND HUM STEM D16 HA
|
Facility
|
OP
|
$16,101.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,093.21 |
| Max. Negotiated Rate |
$15,457.54 |
| Rate for Payer: Aetna Commercial |
$12,398.23
|
| Rate for Payer: Anthem Medicaid |
$5,537.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,559.25
|
| Rate for Payer: Cash Price |
$8,050.80
|
| Rate for Payer: Cigna Commercial |
$13,364.33
|
| Rate for Payer: First Health Commercial |
$15,296.52
|
| Rate for Payer: Humana Commercial |
$13,686.36
|
| Rate for Payer: Humana KY Medicaid |
$5,537.34
|
| Rate for Payer: Kentucky WC Medicaid |
$5,593.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,203.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,882.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,830.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,648.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,169.41
|
| Rate for Payer: Ohio Health Group HMO |
$12,076.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,220.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,093.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,991.50
|
| Rate for Payer: PHCS Commercial |
$15,457.54
|
| Rate for Payer: United Healthcare All Payer |
$14,169.41
|
|
|
DELTA XTEND HUM STEM D16 HA
|
Facility
|
IP
|
$16,101.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,093.21 |
| Max. Negotiated Rate |
$15,457.54 |
| Rate for Payer: Aetna Commercial |
$12,398.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,559.25
|
| Rate for Payer: Cash Price |
$8,050.80
|
| Rate for Payer: Cigna Commercial |
$13,364.33
|
| Rate for Payer: First Health Commercial |
$15,296.52
|
| Rate for Payer: Humana Commercial |
$13,686.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,203.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,882.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,830.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,169.41
|
| Rate for Payer: Ohio Health Group HMO |
$12,076.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,220.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,093.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,991.50
|
| Rate for Payer: PHCS Commercial |
$15,457.54
|
| Rate for Payer: United Healthcare All Payer |
$14,169.41
|
|
