|
DELTA XTEND HUM SZ 1 D10 LG
|
Facility
|
IP
|
$39,562.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,143.14 |
| Max. Negotiated Rate |
$37,980.10 |
| Rate for Payer: Aetna Commercial |
$30,463.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,858.83
|
| Rate for Payer: Cash Price |
$19,781.30
|
| Rate for Payer: Cigna Commercial |
$32,836.96
|
| Rate for Payer: First Health Commercial |
$37,584.47
|
| Rate for Payer: Humana Commercial |
$33,628.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,441.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,197.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,868.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,815.09
|
| Rate for Payer: Ohio Health Group HMO |
$29,671.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,912.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,143.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,264.41
|
| Rate for Payer: PHCS Commercial |
$37,980.10
|
| Rate for Payer: United Healthcare All Payer |
$34,815.09
|
|
|
DELTA XTEND HUM SZ 1 D10 LG
|
Facility
|
OP
|
$39,562.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,143.14 |
| Max. Negotiated Rate |
$37,980.10 |
| Rate for Payer: Aetna Commercial |
$30,463.20
|
| Rate for Payer: Anthem Medicaid |
$13,605.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30,858.83
|
| Rate for Payer: Cash Price |
$19,781.30
|
| Rate for Payer: Cigna Commercial |
$32,836.96
|
| Rate for Payer: First Health Commercial |
$37,584.47
|
| Rate for Payer: Humana Commercial |
$33,628.21
|
| Rate for Payer: Humana KY Medicaid |
$13,605.58
|
| Rate for Payer: Kentucky WC Medicaid |
$13,744.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,441.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,197.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,868.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,878.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$34,815.09
|
| Rate for Payer: Ohio Health Group HMO |
$29,671.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,912.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,143.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,264.41
|
| Rate for Payer: PHCS Commercial |
$37,980.10
|
| Rate for Payer: United Healthcare All Payer |
$34,815.09
|
|
|
DELTA XTEND HUM SZ 1 D12 LG
|
Facility
|
OP
|
$36,941.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,802.45 |
| Max. Negotiated Rate |
$35,464.22 |
| Rate for Payer: Aetna Commercial |
$28,445.26
|
| Rate for Payer: Anthem Medicaid |
$12,704.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,814.68
|
| Rate for Payer: Cash Price |
$18,470.95
|
| Rate for Payer: Cigna Commercial |
$30,661.78
|
| Rate for Payer: First Health Commercial |
$35,094.80
|
| Rate for Payer: Humana Commercial |
$31,400.62
|
| Rate for Payer: Humana KY Medicaid |
$12,704.32
|
| Rate for Payer: Kentucky WC Medicaid |
$12,833.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,292.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,263.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,082.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,959.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,508.87
|
| Rate for Payer: Ohio Health Group HMO |
$27,706.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,388.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,802.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,451.99
|
| Rate for Payer: PHCS Commercial |
$35,464.22
|
| Rate for Payer: United Healthcare All Payer |
$32,508.87
|
|
|
DELTA XTEND HUM SZ 1 D12 LG
|
Facility
|
IP
|
$36,941.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,802.45 |
| Max. Negotiated Rate |
$35,464.22 |
| Rate for Payer: Aetna Commercial |
$28,445.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,814.68
|
| Rate for Payer: Cash Price |
$18,470.95
|
| Rate for Payer: Cigna Commercial |
$30,661.78
|
| Rate for Payer: First Health Commercial |
$35,094.80
|
| Rate for Payer: Humana Commercial |
$31,400.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30,292.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,263.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,082.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$32,508.87
|
| Rate for Payer: Ohio Health Group HMO |
$27,706.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,388.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,802.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,451.99
|
| Rate for Payer: PHCS Commercial |
$35,464.22
|
| Rate for Payer: United Healthcare All Payer |
$32,508.87
|
|
|
DELTA XTEND HUM SZ 1 D14 LG
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
DELTA XTEND HUM SZ 1 D14 LG
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
DELTA XTEND HUM SZ 1 D8 LG
|
Facility
|
IP
|
$24,663.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,206.23 |
| Max. Negotiated Rate |
$23,676.77 |
| Rate for Payer: Aetna Commercial |
$18,990.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,237.37
|
| Rate for Payer: Cash Price |
$12,331.65
|
| Rate for Payer: Cigna Commercial |
$20,470.54
|
| Rate for Payer: First Health Commercial |
$23,430.14
|
| Rate for Payer: Humana Commercial |
$20,963.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,223.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,201.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,398.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,703.70
|
| Rate for Payer: Ohio Health Group HMO |
$18,497.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,932.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,206.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,645.62
|
| Rate for Payer: PHCS Commercial |
$23,676.77
|
| Rate for Payer: United Healthcare All Payer |
$21,703.70
|
|
|
DELTA XTEND HUM SZ 1 D8 LG
|
Facility
|
OP
|
$24,663.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,206.23 |
| Max. Negotiated Rate |
$23,676.77 |
| Rate for Payer: Aetna Commercial |
$18,990.74
|
| Rate for Payer: Anthem Medicaid |
$8,481.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,237.37
|
| Rate for Payer: Cash Price |
$12,331.65
|
| Rate for Payer: Cigna Commercial |
$20,470.54
|
| Rate for Payer: First Health Commercial |
$23,430.14
|
| Rate for Payer: Humana Commercial |
$20,963.80
|
| Rate for Payer: Humana KY Medicaid |
$8,481.71
|
| Rate for Payer: Kentucky WC Medicaid |
$8,568.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,223.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,201.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,398.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,651.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,703.70
|
| Rate for Payer: Ohio Health Group HMO |
$18,497.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,932.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,206.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,645.62
|
| Rate for Payer: PHCS Commercial |
$23,676.77
|
| Rate for Payer: United Healthcare All Payer |
$21,703.70
|
|
|
DELTA XTEND HUM SZ 2 D10 LG
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
DELTA XTEND HUM SZ 2 D10 LG
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
DELTA XTEND HUM SZ 2 D14 LG
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
DELTA XTEND HUM SZ 2 D14 LG
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
DELTA XTEND MOD CENT EPI 2 HA
|
Facility
|
IP
|
$27,930.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,630.91 |
| Max. Negotiated Rate |
$26,812.85 |
| Rate for Payer: Aetna Commercial |
$21,506.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,785.44
|
| Rate for Payer: Cash Price |
$13,965.02
|
| Rate for Payer: Cigna Commercial |
$23,181.94
|
| Rate for Payer: First Health Commercial |
$26,533.55
|
| Rate for Payer: Humana Commercial |
$23,740.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,902.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,612.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,379.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,578.44
|
| Rate for Payer: Ohio Health Group HMO |
$20,947.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,586.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,630.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,658.32
|
| Rate for Payer: PHCS Commercial |
$26,812.85
|
| Rate for Payer: United Healthcare All Payer |
$24,578.44
|
|
|
DELTA XTEND MOD CENT EPI 2 HA
|
Facility
|
OP
|
$27,930.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,630.91 |
| Max. Negotiated Rate |
$26,812.85 |
| Rate for Payer: Aetna Commercial |
$21,506.14
|
| Rate for Payer: Anthem Medicaid |
$9,605.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,785.44
|
| Rate for Payer: Cash Price |
$13,965.02
|
| Rate for Payer: Cigna Commercial |
$23,181.94
|
| Rate for Payer: First Health Commercial |
$26,533.55
|
| Rate for Payer: Humana Commercial |
$23,740.54
|
| Rate for Payer: Humana KY Medicaid |
$9,605.14
|
| Rate for Payer: Kentucky WC Medicaid |
$9,702.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,902.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,612.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,379.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,797.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,578.44
|
| Rate for Payer: Ohio Health Group HMO |
$20,947.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,586.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,630.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,658.32
|
| Rate for Payer: PHCS Commercial |
$26,812.85
|
| Rate for Payer: United Healthcare All Payer |
$24,578.44
|
|
|
DELTA XTEND MOD EPI 1 ECC LT H
|
Facility
|
IP
|
$27,930.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,630.91 |
| Max. Negotiated Rate |
$26,812.85 |
| Rate for Payer: Aetna Commercial |
$21,506.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,785.44
|
| Rate for Payer: Cash Price |
$13,965.02
|
| Rate for Payer: Cigna Commercial |
$23,181.94
|
| Rate for Payer: First Health Commercial |
$26,533.55
|
| Rate for Payer: Humana Commercial |
$23,740.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,902.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,612.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,379.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,578.44
|
| Rate for Payer: Ohio Health Group HMO |
$20,947.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,586.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,630.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,658.32
|
| Rate for Payer: PHCS Commercial |
$26,812.85
|
| Rate for Payer: United Healthcare All Payer |
$24,578.44
|
|
|
DELTA XTEND MOD EPI 1 ECC LT H
|
Facility
|
OP
|
$27,930.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,630.91 |
| Max. Negotiated Rate |
$26,812.85 |
| Rate for Payer: Aetna Commercial |
$21,506.14
|
| Rate for Payer: Anthem Medicaid |
$9,605.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,785.44
|
| Rate for Payer: Cash Price |
$13,965.02
|
| Rate for Payer: Cigna Commercial |
$23,181.94
|
| Rate for Payer: First Health Commercial |
$26,533.55
|
| Rate for Payer: Humana Commercial |
$23,740.54
|
| Rate for Payer: Humana KY Medicaid |
$9,605.14
|
| Rate for Payer: Kentucky WC Medicaid |
$9,702.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,902.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,612.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,379.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,797.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,578.44
|
| Rate for Payer: Ohio Health Group HMO |
$20,947.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,586.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,630.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,658.32
|
| Rate for Payer: PHCS Commercial |
$26,812.85
|
| Rate for Payer: United Healthcare All Payer |
$24,578.44
|
|
|
DELTA XTEND MOD EPI 1 ECC RT H
|
Facility
|
OP
|
$27,930.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,630.91 |
| Max. Negotiated Rate |
$26,812.85 |
| Rate for Payer: Aetna Commercial |
$21,506.14
|
| Rate for Payer: Anthem Medicaid |
$9,605.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,785.44
|
| Rate for Payer: Cash Price |
$13,965.02
|
| Rate for Payer: Cigna Commercial |
$23,181.94
|
| Rate for Payer: First Health Commercial |
$26,533.55
|
| Rate for Payer: Humana Commercial |
$23,740.54
|
| Rate for Payer: Humana KY Medicaid |
$9,605.14
|
| Rate for Payer: Kentucky WC Medicaid |
$9,702.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,902.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,612.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,379.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,797.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,578.44
|
| Rate for Payer: Ohio Health Group HMO |
$20,947.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,586.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,630.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,658.32
|
| Rate for Payer: PHCS Commercial |
$26,812.85
|
| Rate for Payer: United Healthcare All Payer |
$24,578.44
|
|
|
DELTA XTEND MOD EPI 1 ECC RT H
|
Facility
|
IP
|
$27,930.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,630.91 |
| Max. Negotiated Rate |
$26,812.85 |
| Rate for Payer: Aetna Commercial |
$21,506.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,785.44
|
| Rate for Payer: Cash Price |
$13,965.02
|
| Rate for Payer: Cigna Commercial |
$23,181.94
|
| Rate for Payer: First Health Commercial |
$26,533.55
|
| Rate for Payer: Humana Commercial |
$23,740.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,902.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,612.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,379.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,578.44
|
| Rate for Payer: Ohio Health Group HMO |
$20,947.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,586.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,630.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,658.32
|
| Rate for Payer: PHCS Commercial |
$26,812.85
|
| Rate for Payer: United Healthcare All Payer |
$24,578.44
|
|
|
DELTA XTEND MODEPI 2 ECC LT HA
|
Facility
|
OP
|
$25,754.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,348.10 |
| Max. Negotiated Rate |
$24,724.46 |
| Rate for Payer: Aetna Commercial |
$19,831.08
|
| Rate for Payer: Anthem Medicaid |
$8,857.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,088.63
|
| Rate for Payer: Cash Price |
$12,877.33
|
| Rate for Payer: Cigna Commercial |
$21,376.36
|
| Rate for Payer: First Health Commercial |
$24,466.92
|
| Rate for Payer: Humana Commercial |
$21,891.45
|
| Rate for Payer: Humana KY Medicaid |
$8,857.02
|
| Rate for Payer: Kentucky WC Medicaid |
$8,947.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,118.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,006.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,726.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,034.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,664.09
|
| Rate for Payer: Ohio Health Group HMO |
$19,315.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,150.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,348.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,983.94
|
| Rate for Payer: PHCS Commercial |
$24,724.46
|
| Rate for Payer: United Healthcare All Payer |
$22,664.09
|
|
|
DELTA XTEND MODEPI 2 ECC LT HA
|
Facility
|
IP
|
$25,754.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,348.10 |
| Max. Negotiated Rate |
$24,724.46 |
| Rate for Payer: Aetna Commercial |
$19,831.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,088.63
|
| Rate for Payer: Cash Price |
$12,877.33
|
| Rate for Payer: Cigna Commercial |
$21,376.36
|
| Rate for Payer: First Health Commercial |
$24,466.92
|
| Rate for Payer: Humana Commercial |
$21,891.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,118.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,006.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,726.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,664.09
|
| Rate for Payer: Ohio Health Group HMO |
$19,315.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,150.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,348.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,983.94
|
| Rate for Payer: PHCS Commercial |
$24,724.46
|
| Rate for Payer: United Healthcare All Payer |
$22,664.09
|
|
|
DELTA XTEND MODEPI 2 ECC RT HA
|
Facility
|
IP
|
$26,594.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,457.24 |
| Max. Negotiated Rate |
$25,530.38 |
| Rate for Payer: Aetna Commercial |
$20,477.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,743.44
|
| Rate for Payer: Cash Price |
$13,297.08
|
| Rate for Payer: Cigna Commercial |
$22,073.14
|
| Rate for Payer: First Health Commercial |
$25,264.44
|
| Rate for Payer: Humana Commercial |
$22,605.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,807.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,626.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,978.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,402.85
|
| Rate for Payer: Ohio Health Group HMO |
$19,945.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,318.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,457.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,244.19
|
| Rate for Payer: PHCS Commercial |
$25,530.38
|
| Rate for Payer: United Healthcare All Payer |
$23,402.85
|
|
|
DELTA XTEND MODEPI 2 ECC RT HA
|
Facility
|
OP
|
$26,594.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,457.24 |
| Max. Negotiated Rate |
$25,530.38 |
| Rate for Payer: Aetna Commercial |
$20,477.50
|
| Rate for Payer: Anthem Medicaid |
$9,145.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,743.44
|
| Rate for Payer: Cash Price |
$13,297.08
|
| Rate for Payer: Cigna Commercial |
$22,073.14
|
| Rate for Payer: First Health Commercial |
$25,264.44
|
| Rate for Payer: Humana Commercial |
$22,605.03
|
| Rate for Payer: Humana KY Medicaid |
$9,145.73
|
| Rate for Payer: Kentucky WC Medicaid |
$9,238.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,807.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,626.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,978.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,329.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,402.85
|
| Rate for Payer: Ohio Health Group HMO |
$19,945.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,318.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,457.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,244.19
|
| Rate for Payer: PHCS Commercial |
$25,530.38
|
| Rate for Payer: United Healthcare All Payer |
$23,402.85
|
|
|
DELTA XTEND SZ 1
|
Facility
|
IP
|
$27,930.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,630.91 |
| Max. Negotiated Rate |
$26,812.85 |
| Rate for Payer: Aetna Commercial |
$21,506.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,785.44
|
| Rate for Payer: Cash Price |
$13,965.02
|
| Rate for Payer: Cigna Commercial |
$23,181.94
|
| Rate for Payer: First Health Commercial |
$26,533.55
|
| Rate for Payer: Humana Commercial |
$23,740.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,902.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,612.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,379.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,578.44
|
| Rate for Payer: Ohio Health Group HMO |
$20,947.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,586.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,630.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,658.32
|
| Rate for Payer: PHCS Commercial |
$26,812.85
|
| Rate for Payer: United Healthcare All Payer |
$24,578.44
|
|
|
DELTA XTEND SZ 1
|
Facility
|
OP
|
$27,930.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,630.91 |
| Max. Negotiated Rate |
$26,812.85 |
| Rate for Payer: Aetna Commercial |
$21,506.14
|
| Rate for Payer: Anthem Medicaid |
$9,605.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,785.44
|
| Rate for Payer: Cash Price |
$13,965.02
|
| Rate for Payer: Cigna Commercial |
$23,181.94
|
| Rate for Payer: First Health Commercial |
$26,533.55
|
| Rate for Payer: Humana Commercial |
$23,740.54
|
| Rate for Payer: Humana KY Medicaid |
$9,605.14
|
| Rate for Payer: Kentucky WC Medicaid |
$9,702.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,902.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,612.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,379.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,797.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,578.44
|
| Rate for Payer: Ohio Health Group HMO |
$20,947.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,586.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,630.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,658.32
|
| Rate for Payer: PHCS Commercial |
$26,812.85
|
| Rate for Payer: United Healthcare All Payer |
$24,578.44
|
|
|
DELTOID LIGMNT RECON IMP SYS
|
Facility
|
OP
|
$9,935.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,291.65 |
| Max. Negotiated Rate |
$9,538.32 |
| Rate for Payer: Aetna Commercial |
$7,650.53
|
| Rate for Payer: Anthem Medicaid |
$3,416.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.88
|
| Rate for Payer: Cash Price |
$4,967.88
|
| Rate for Payer: Cigna Commercial |
$8,246.67
|
| Rate for Payer: First Health Commercial |
$9,438.96
|
| Rate for Payer: Humana Commercial |
$8,445.39
|
| Rate for Payer: Humana KY Medicaid |
$3,416.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,451.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,147.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,485.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,743.46
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,987.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,291.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,080.08
|
| Rate for Payer: PHCS Commercial |
$9,538.32
|
| Rate for Payer: United Healthcare All Payer |
$8,743.46
|
|
