|
DELTA CER HEAD 12/14 32MM +1.0
|
Facility
|
IP
|
$11,147.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,344.26 |
| Max. Negotiated Rate |
$10,701.65 |
| Rate for Payer: Aetna Commercial |
$8,583.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,695.09
|
| Rate for Payer: Cash Price |
$5,573.77
|
| Rate for Payer: Cigna Commercial |
$9,252.47
|
| Rate for Payer: First Health Commercial |
$10,590.17
|
| Rate for Payer: Humana Commercial |
$9,475.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,140.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,226.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,344.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,809.84
|
| Rate for Payer: Ohio Health Group HMO |
$8,360.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,918.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,698.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,691.81
|
| Rate for Payer: PHCS Commercial |
$10,701.65
|
| Rate for Payer: United Healthcare All Payer |
$9,809.84
|
|
|
DELTA CER HEAD 12/14 32MM +5
|
Facility
|
IP
|
$9,556.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,867.06 |
| Max. Negotiated Rate |
$9,174.59 |
| Rate for Payer: Aetna Commercial |
$7,358.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,454.35
|
| Rate for Payer: Cash Price |
$4,778.43
|
| Rate for Payer: Cigna Commercial |
$7,932.19
|
| Rate for Payer: First Health Commercial |
$9,079.02
|
| Rate for Payer: Humana Commercial |
$8,123.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,836.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,052.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,867.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,410.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,167.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,645.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,314.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,594.23
|
| Rate for Payer: PHCS Commercial |
$9,174.59
|
| Rate for Payer: United Healthcare All Payer |
$8,410.04
|
|
|
DELTA CER HEAD 12/14 32MM +5
|
Facility
|
OP
|
$9,556.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,867.06 |
| Max. Negotiated Rate |
$9,174.59 |
| Rate for Payer: Aetna Commercial |
$7,358.78
|
| Rate for Payer: Anthem Medicaid |
$3,286.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,454.35
|
| Rate for Payer: Cash Price |
$4,778.43
|
| Rate for Payer: Cigna Commercial |
$7,932.19
|
| Rate for Payer: First Health Commercial |
$9,079.02
|
| Rate for Payer: Humana Commercial |
$8,123.33
|
| Rate for Payer: Humana KY Medicaid |
$3,286.60
|
| Rate for Payer: Kentucky WC Medicaid |
$3,320.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,836.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,052.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,867.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,352.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,410.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,167.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,645.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,314.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,594.23
|
| Rate for Payer: PHCS Commercial |
$9,174.59
|
| Rate for Payer: United Healthcare All Payer |
$8,410.04
|
|
|
DELTA CER HEAD 12/14 32MM +9
|
Facility
|
OP
|
$9,556.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,867.06 |
| Max. Negotiated Rate |
$9,174.59 |
| Rate for Payer: Aetna Commercial |
$7,358.78
|
| Rate for Payer: Anthem Medicaid |
$3,286.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,454.35
|
| Rate for Payer: Cash Price |
$4,778.43
|
| Rate for Payer: Cigna Commercial |
$7,932.19
|
| Rate for Payer: First Health Commercial |
$9,079.02
|
| Rate for Payer: Humana Commercial |
$8,123.33
|
| Rate for Payer: Humana KY Medicaid |
$3,286.60
|
| Rate for Payer: Kentucky WC Medicaid |
$3,320.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,836.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,052.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,867.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,352.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,410.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,167.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,645.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,314.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,594.23
|
| Rate for Payer: PHCS Commercial |
$9,174.59
|
| Rate for Payer: United Healthcare All Payer |
$8,410.04
|
|
|
DELTA CER HEAD 12/14 32MM +9
|
Facility
|
IP
|
$9,556.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,867.06 |
| Max. Negotiated Rate |
$9,174.59 |
| Rate for Payer: Aetna Commercial |
$7,358.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,454.35
|
| Rate for Payer: Cash Price |
$4,778.43
|
| Rate for Payer: Cigna Commercial |
$7,932.19
|
| Rate for Payer: First Health Commercial |
$9,079.02
|
| Rate for Payer: Humana Commercial |
$8,123.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,836.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,052.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,867.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,410.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,167.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,645.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,314.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,594.23
|
| Rate for Payer: PHCS Commercial |
$9,174.59
|
| Rate for Payer: United Healthcare All Payer |
$8,410.04
|
|
|
DELTA CER HEAD 12/14 36MM +12
|
Facility
|
IP
|
$9,464.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,839.26 |
| Max. Negotiated Rate |
$9,085.62 |
| Rate for Payer: Aetna Commercial |
$7,287.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,382.07
|
| Rate for Payer: Cash Price |
$4,732.09
|
| Rate for Payer: Cigna Commercial |
$7,855.28
|
| Rate for Payer: First Health Commercial |
$8,990.98
|
| Rate for Payer: Humana Commercial |
$8,044.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,760.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,984.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,839.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,328.49
|
| Rate for Payer: Ohio Health Group HMO |
$7,098.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,571.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,233.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,530.29
|
| Rate for Payer: PHCS Commercial |
$9,085.62
|
| Rate for Payer: United Healthcare All Payer |
$8,328.49
|
|
|
DELTA CER HEAD 12/14 36MM +12
|
Facility
|
OP
|
$9,464.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,839.26 |
| Max. Negotiated Rate |
$9,085.62 |
| Rate for Payer: Aetna Commercial |
$7,287.43
|
| Rate for Payer: Anthem Medicaid |
$3,254.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,382.07
|
| Rate for Payer: Cash Price |
$4,732.09
|
| Rate for Payer: Cigna Commercial |
$7,855.28
|
| Rate for Payer: First Health Commercial |
$8,990.98
|
| Rate for Payer: Humana Commercial |
$8,044.56
|
| Rate for Payer: Humana KY Medicaid |
$3,254.73
|
| Rate for Payer: Kentucky WC Medicaid |
$3,287.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,760.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,984.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,839.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,320.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,328.49
|
| Rate for Payer: Ohio Health Group HMO |
$7,098.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,571.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,233.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,530.29
|
| Rate for Payer: PHCS Commercial |
$9,085.62
|
| Rate for Payer: United Healthcare All Payer |
$8,328.49
|
|
|
DELTA CER HEAD 12/14 36MM +1.5
|
Facility
|
OP
|
$9,918.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,975.46 |
| Max. Negotiated Rate |
$9,521.48 |
| Rate for Payer: Aetna Commercial |
$7,637.02
|
| Rate for Payer: Anthem Medicaid |
$3,410.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,736.20
|
| Rate for Payer: Cash Price |
$4,959.10
|
| Rate for Payer: Cigna Commercial |
$8,232.11
|
| Rate for Payer: First Health Commercial |
$9,422.30
|
| Rate for Payer: Humana Commercial |
$8,430.48
|
| Rate for Payer: Humana KY Medicaid |
$3,410.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,445.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,132.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,319.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,479.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,728.02
|
| Rate for Payer: Ohio Health Group HMO |
$7,438.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,934.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,628.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,843.56
|
| Rate for Payer: PHCS Commercial |
$9,521.48
|
| Rate for Payer: United Healthcare All Payer |
$8,728.02
|
|
|
DELTA CER HEAD 12/14 36MM +1.5
|
Facility
|
IP
|
$9,918.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,975.46 |
| Max. Negotiated Rate |
$9,521.48 |
| Rate for Payer: Aetna Commercial |
$7,637.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,736.20
|
| Rate for Payer: Cash Price |
$4,959.10
|
| Rate for Payer: Cigna Commercial |
$8,232.11
|
| Rate for Payer: First Health Commercial |
$9,422.30
|
| Rate for Payer: Humana Commercial |
$8,430.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,132.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,319.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,728.02
|
| Rate for Payer: Ohio Health Group HMO |
$7,438.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,934.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,628.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,843.56
|
| Rate for Payer: PHCS Commercial |
$9,521.48
|
| Rate for Payer: United Healthcare All Payer |
$8,728.02
|
|
|
DELTA CER HEAD 12/14 36MM +5
|
Facility
|
IP
|
$7,896.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,369.05 |
| Max. Negotiated Rate |
$7,580.97 |
| Rate for Payer: Aetna Commercial |
$6,080.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,159.54
|
| Rate for Payer: Cash Price |
$3,948.42
|
| Rate for Payer: Cigna Commercial |
$6,554.38
|
| Rate for Payer: First Health Commercial |
$7,502.00
|
| Rate for Payer: Humana Commercial |
$6,712.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,475.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,827.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,369.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,949.22
|
| Rate for Payer: Ohio Health Group HMO |
$5,922.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,317.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,870.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,448.82
|
| Rate for Payer: PHCS Commercial |
$7,580.97
|
| Rate for Payer: United Healthcare All Payer |
$6,949.22
|
|
|
DELTA CER HEAD 12/14 36MM +5
|
Facility
|
OP
|
$7,896.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,369.05 |
| Max. Negotiated Rate |
$7,580.97 |
| Rate for Payer: Aetna Commercial |
$6,080.57
|
| Rate for Payer: Anthem Medicaid |
$2,715.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,159.54
|
| Rate for Payer: Cash Price |
$3,948.42
|
| Rate for Payer: Cigna Commercial |
$6,554.38
|
| Rate for Payer: First Health Commercial |
$7,502.00
|
| Rate for Payer: Humana Commercial |
$6,712.31
|
| Rate for Payer: Humana KY Medicaid |
$2,715.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,743.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,475.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,827.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,369.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,770.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,949.22
|
| Rate for Payer: Ohio Health Group HMO |
$5,922.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,317.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,870.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,448.82
|
| Rate for Payer: PHCS Commercial |
$7,580.97
|
| Rate for Payer: United Healthcare All Payer |
$6,949.22
|
|
|
DELTA CER HEAD 12/14 36MM +8.5
|
Facility
|
OP
|
$9,918.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,975.46 |
| Max. Negotiated Rate |
$9,521.48 |
| Rate for Payer: Aetna Commercial |
$7,637.02
|
| Rate for Payer: Anthem Medicaid |
$3,410.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,736.20
|
| Rate for Payer: Cash Price |
$4,959.10
|
| Rate for Payer: Cigna Commercial |
$8,232.11
|
| Rate for Payer: First Health Commercial |
$9,422.30
|
| Rate for Payer: Humana Commercial |
$8,430.48
|
| Rate for Payer: Humana KY Medicaid |
$3,410.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,445.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,132.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,319.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,479.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,728.02
|
| Rate for Payer: Ohio Health Group HMO |
$7,438.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,934.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,628.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,843.56
|
| Rate for Payer: PHCS Commercial |
$9,521.48
|
| Rate for Payer: United Healthcare All Payer |
$8,728.02
|
|
|
DELTA CER HEAD 12/14 36MM +8.5
|
Facility
|
IP
|
$9,918.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,975.46 |
| Max. Negotiated Rate |
$9,521.48 |
| Rate for Payer: Aetna Commercial |
$7,637.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,736.20
|
| Rate for Payer: Cash Price |
$4,959.10
|
| Rate for Payer: Cigna Commercial |
$8,232.11
|
| Rate for Payer: First Health Commercial |
$9,422.30
|
| Rate for Payer: Humana Commercial |
$8,430.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,132.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,319.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,728.02
|
| Rate for Payer: Ohio Health Group HMO |
$7,438.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,934.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,628.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,843.56
|
| Rate for Payer: PHCS Commercial |
$9,521.48
|
| Rate for Payer: United Healthcare All Payer |
$8,728.02
|
|
|
DELTA CER HEAD +3 36MM 11/13
|
Facility
|
IP
|
$9,983.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,995.17 |
| Max. Negotiated Rate |
$9,584.55 |
| Rate for Payer: Aetna Commercial |
$7,687.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,787.45
|
| Rate for Payer: Cash Price |
$4,991.96
|
| Rate for Payer: Cigna Commercial |
$8,286.65
|
| Rate for Payer: First Health Commercial |
$9,484.71
|
| Rate for Payer: Humana Commercial |
$8,486.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,186.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,368.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,995.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,785.84
|
| Rate for Payer: Ohio Health Group HMO |
$7,487.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,987.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,686.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,888.90
|
| Rate for Payer: PHCS Commercial |
$9,584.55
|
| Rate for Payer: United Healthcare All Payer |
$8,785.84
|
|
|
DELTA CER HEAD +3 36MM 11/13
|
Facility
|
OP
|
$9,983.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,995.17 |
| Max. Negotiated Rate |
$9,584.55 |
| Rate for Payer: Aetna Commercial |
$7,687.61
|
| Rate for Payer: Anthem Medicaid |
$3,433.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,787.45
|
| Rate for Payer: Cash Price |
$4,991.96
|
| Rate for Payer: Cigna Commercial |
$8,286.65
|
| Rate for Payer: First Health Commercial |
$9,484.71
|
| Rate for Payer: Humana Commercial |
$8,486.32
|
| Rate for Payer: Humana KY Medicaid |
$3,433.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,468.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,186.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,368.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,995.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,502.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,785.84
|
| Rate for Payer: Ohio Health Group HMO |
$7,487.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,987.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,686.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,888.90
|
| Rate for Payer: PHCS Commercial |
$9,584.55
|
| Rate for Payer: United Healthcare All Payer |
$8,785.84
|
|
|
DELTA CER HEAD +6 36MM 11/13
|
Facility
|
IP
|
$9,983.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,995.17 |
| Max. Negotiated Rate |
$9,584.55 |
| Rate for Payer: Aetna Commercial |
$7,687.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,787.45
|
| Rate for Payer: Cash Price |
$4,991.96
|
| Rate for Payer: Cigna Commercial |
$8,286.65
|
| Rate for Payer: First Health Commercial |
$9,484.71
|
| Rate for Payer: Humana Commercial |
$8,486.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,186.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,368.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,995.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,785.84
|
| Rate for Payer: Ohio Health Group HMO |
$7,487.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,987.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,686.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,888.90
|
| Rate for Payer: PHCS Commercial |
$9,584.55
|
| Rate for Payer: United Healthcare All Payer |
$8,785.84
|
|
|
DELTA CER HEAD +6 36MM 11/13
|
Facility
|
OP
|
$9,983.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,995.17 |
| Max. Negotiated Rate |
$9,584.55 |
| Rate for Payer: Aetna Commercial |
$7,687.61
|
| Rate for Payer: Anthem Medicaid |
$3,433.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,787.45
|
| Rate for Payer: Cash Price |
$4,991.96
|
| Rate for Payer: Cigna Commercial |
$8,286.65
|
| Rate for Payer: First Health Commercial |
$9,484.71
|
| Rate for Payer: Humana Commercial |
$8,486.32
|
| Rate for Payer: Humana KY Medicaid |
$3,433.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,468.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,186.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,368.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,995.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,502.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,785.84
|
| Rate for Payer: Ohio Health Group HMO |
$7,487.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,987.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,686.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,888.90
|
| Rate for Payer: PHCS Commercial |
$9,584.55
|
| Rate for Payer: United Healthcare All Payer |
$8,785.84
|
|
|
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 |
$1,500.00 |
| 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 |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| 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 |
$1,500.00 |
| 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 |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
DELTA HEAD 12/14 XL/+12 36MM
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| 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 |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
DELTA HEAD 12/14 XL/+12 36MM
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| 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 |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
DELTA HUMERAL STEM DIA 14
|
Facility
|
IP
|
$16,632.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,989.66 |
| Max. Negotiated Rate |
$15,966.91 |
| Rate for Payer: Aetna Commercial |
$12,806.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,973.12
|
| Rate for Payer: Cash Price |
$8,316.10
|
| Rate for Payer: Cigna Commercial |
$13,804.73
|
| Rate for Payer: First Health Commercial |
$15,800.59
|
| Rate for Payer: Humana Commercial |
$14,137.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,638.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,274.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,989.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,636.34
|
| Rate for Payer: Ohio Health Group HMO |
$12,474.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,305.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,470.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,476.22
|
| Rate for Payer: PHCS Commercial |
$15,966.91
|
| Rate for Payer: United Healthcare All Payer |
$14,636.34
|
|
|
DELTA HUMERAL STEM DIA 14
|
Facility
|
OP
|
$16,632.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,989.66 |
| Max. Negotiated Rate |
$15,966.91 |
| Rate for Payer: Aetna Commercial |
$12,806.79
|
| Rate for Payer: Anthem Medicaid |
$5,719.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,973.12
|
| Rate for Payer: Cash Price |
$8,316.10
|
| Rate for Payer: Cigna Commercial |
$13,804.73
|
| Rate for Payer: First Health Commercial |
$15,800.59
|
| Rate for Payer: Humana Commercial |
$14,137.37
|
| Rate for Payer: Humana KY Medicaid |
$5,719.81
|
| Rate for Payer: Kentucky WC Medicaid |
$5,778.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,638.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,274.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,989.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,834.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,636.34
|
| Rate for Payer: Ohio Health Group HMO |
$12,474.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,305.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,470.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,476.22
|
| Rate for Payer: PHCS Commercial |
$15,966.91
|
| Rate for Payer: United Healthcare All Payer |
$14,636.34
|
|
|
DELTA PREMIERON HUM CUP SZ 38
|
Facility
|
IP
|
$12,792.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,837.73 |
| Max. Negotiated Rate |
$12,280.74 |
| Rate for Payer: Aetna Commercial |
$9,850.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,978.10
|
| Rate for Payer: Cash Price |
$6,396.22
|
| Rate for Payer: Cigna Commercial |
$10,617.73
|
| Rate for Payer: First Health Commercial |
$12,152.82
|
| Rate for Payer: Humana Commercial |
$10,873.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,489.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,440.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,257.35
|
| Rate for Payer: Ohio Health Group HMO |
$9,594.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,233.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,129.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,826.78
|
| Rate for Payer: PHCS Commercial |
$12,280.74
|
| Rate for Payer: United Healthcare All Payer |
$11,257.35
|
|
|
DELTA PREMIERON HUM CUP SZ 38
|
Facility
|
OP
|
$12,792.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,837.73 |
| Max. Negotiated Rate |
$12,280.74 |
| Rate for Payer: Aetna Commercial |
$9,850.18
|
| Rate for Payer: Anthem Medicaid |
$4,399.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,978.10
|
| Rate for Payer: Cash Price |
$6,396.22
|
| Rate for Payer: Cigna Commercial |
$10,617.73
|
| Rate for Payer: First Health Commercial |
$12,152.82
|
| Rate for Payer: Humana Commercial |
$10,873.57
|
| Rate for Payer: Humana KY Medicaid |
$4,399.32
|
| Rate for Payer: Kentucky WC Medicaid |
$4,444.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,489.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,440.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,487.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,257.35
|
| Rate for Payer: Ohio Health Group HMO |
$9,594.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,233.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,129.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,826.78
|
| Rate for Payer: PHCS Commercial |
$12,280.74
|
| Rate for Payer: United Healthcare All Payer |
$11,257.35
|
|
