|
DELTA PREMIERON HUM CUP SZ 42
|
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
|
|
|
DELTA PREMIERON HUM CUP SZ 42
|
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 SZ42+3
|
Facility
|
OP
|
$12,656.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,796.99 |
| Max. Negotiated Rate |
$12,150.38 |
| Rate for Payer: Aetna Commercial |
$9,745.62
|
| Rate for Payer: Anthem Medicaid |
$4,352.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,872.19
|
| Rate for Payer: Cash Price |
$6,328.32
|
| Rate for Payer: Cigna Commercial |
$10,505.02
|
| Rate for Payer: First Health Commercial |
$12,023.82
|
| Rate for Payer: Humana Commercial |
$10,758.15
|
| Rate for Payer: Humana KY Medicaid |
$4,352.62
|
| Rate for Payer: Kentucky WC Medicaid |
$4,396.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,378.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,340.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,796.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,439.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,137.85
|
| Rate for Payer: Ohio Health Group HMO |
$9,492.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,125.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,011.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,733.09
|
| Rate for Payer: PHCS Commercial |
$12,150.38
|
| Rate for Payer: United Healthcare All Payer |
$11,137.85
|
|
|
DELTA PREMIERON HUM CUP SZ42+3
|
Facility
|
IP
|
$12,656.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,796.99 |
| Max. Negotiated Rate |
$12,150.38 |
| Rate for Payer: Aetna Commercial |
$9,745.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,872.19
|
| Rate for Payer: Cash Price |
$6,328.32
|
| Rate for Payer: Cigna Commercial |
$10,505.02
|
| Rate for Payer: First Health Commercial |
$12,023.82
|
| Rate for Payer: Humana Commercial |
$10,758.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,378.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,340.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,796.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,137.85
|
| Rate for Payer: Ohio Health Group HMO |
$9,492.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,125.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,011.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,733.09
|
| Rate for Payer: PHCS Commercial |
$12,150.38
|
| Rate for Payer: United Healthcare All Payer |
$11,137.85
|
|
|
DELTA TS CER HEAD 12/14 28MM12
|
Facility
|
OP
|
$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 Medicaid |
$3,833.64
|
| 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: Humana KY Medicaid |
$3,833.64
|
| Rate for Payer: Kentucky WC Medicaid |
$3,872.66
|
| 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: Molina Healthcare Medicaid |
$3,910.56
|
| 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 TS CER HEAD 12/14 28MM12
|
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 TS CER HEAD 12/14 36MM +
|
Facility
|
OP
|
$20,016.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,004.89 |
| Max. Negotiated Rate |
$19,215.66 |
| Rate for Payer: Aetna Commercial |
$15,412.56
|
| Rate for Payer: Anthem Medicaid |
$6,883.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,612.72
|
| Rate for Payer: Cash Price |
$10,008.16
|
| Rate for Payer: Cigna Commercial |
$16,613.54
|
| Rate for Payer: First Health Commercial |
$19,015.49
|
| Rate for Payer: Humana Commercial |
$17,013.86
|
| Rate for Payer: Humana KY Medicaid |
$6,883.61
|
| Rate for Payer: Kentucky WC Medicaid |
$6,953.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,413.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,772.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,004.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,021.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,614.35
|
| Rate for Payer: Ohio Health Group HMO |
$15,012.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,013.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,414.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,811.25
|
| Rate for Payer: PHCS Commercial |
$19,215.66
|
| Rate for Payer: United Healthcare All Payer |
$17,614.35
|
|
|
DELTA TS CER HEAD 12/14 36MM +
|
Facility
|
IP
|
$20,016.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,004.89 |
| Max. Negotiated Rate |
$19,215.66 |
| Rate for Payer: Aetna Commercial |
$15,412.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,612.72
|
| Rate for Payer: Cash Price |
$10,008.16
|
| Rate for Payer: Cigna Commercial |
$16,613.54
|
| Rate for Payer: First Health Commercial |
$19,015.49
|
| Rate for Payer: Humana Commercial |
$17,013.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,413.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,772.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,004.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,614.35
|
| Rate for Payer: Ohio Health Group HMO |
$15,012.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,013.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,414.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,811.25
|
| Rate for Payer: PHCS Commercial |
$19,215.66
|
| Rate for Payer: United Healthcare All Payer |
$17,614.35
|
|
|
DELTA TS CER HEAD 12/14 36MM12
|
Facility
|
IP
|
$21,826.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,547.88 |
| Max. Negotiated Rate |
$20,953.20 |
| Rate for Payer: Aetna Commercial |
$16,806.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,024.47
|
| Rate for Payer: Cash Price |
$10,913.12
|
| Rate for Payer: Cigna Commercial |
$18,115.79
|
| Rate for Payer: First Health Commercial |
$20,734.94
|
| Rate for Payer: Humana Commercial |
$18,552.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,897.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,107.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,547.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,207.10
|
| Rate for Payer: Ohio Health Group HMO |
$16,369.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,461.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,988.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,060.11
|
| Rate for Payer: PHCS Commercial |
$20,953.20
|
| Rate for Payer: United Healthcare All Payer |
$19,207.10
|
|
|
DELTA TS CER HEAD 12/14 36MM12
|
Facility
|
OP
|
$21,826.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,547.88 |
| Max. Negotiated Rate |
$20,953.20 |
| Rate for Payer: Aetna Commercial |
$16,806.21
|
| Rate for Payer: Anthem Medicaid |
$7,506.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,024.47
|
| Rate for Payer: Cash Price |
$10,913.12
|
| Rate for Payer: Cigna Commercial |
$18,115.79
|
| Rate for Payer: First Health Commercial |
$20,734.94
|
| Rate for Payer: Humana Commercial |
$18,552.31
|
| Rate for Payer: Humana KY Medicaid |
$7,506.05
|
| Rate for Payer: Kentucky WC Medicaid |
$7,582.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,897.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,107.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,547.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,656.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,207.10
|
| Rate for Payer: Ohio Health Group HMO |
$16,369.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,461.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,988.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,060.11
|
| Rate for Payer: PHCS Commercial |
$20,953.20
|
| Rate for Payer: United Healthcare All Payer |
$19,207.10
|
|
|
DELTA TS CER HEAD 12/14 36MM 8
|
Facility
|
IP
|
$20,016.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,004.89 |
| Max. Negotiated Rate |
$19,215.66 |
| Rate for Payer: Aetna Commercial |
$15,412.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,612.72
|
| Rate for Payer: Cash Price |
$10,008.16
|
| Rate for Payer: Cigna Commercial |
$16,613.54
|
| Rate for Payer: First Health Commercial |
$19,015.49
|
| Rate for Payer: Humana Commercial |
$17,013.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,413.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,772.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,004.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,614.35
|
| Rate for Payer: Ohio Health Group HMO |
$15,012.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,013.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,414.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,811.25
|
| Rate for Payer: PHCS Commercial |
$19,215.66
|
| Rate for Payer: United Healthcare All Payer |
$17,614.35
|
|
|
DELTA TS CER HEAD 12/14 36MM 8
|
Facility
|
OP
|
$20,016.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,004.89 |
| Max. Negotiated Rate |
$19,215.66 |
| Rate for Payer: Aetna Commercial |
$15,412.56
|
| Rate for Payer: Anthem Medicaid |
$6,883.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,612.72
|
| Rate for Payer: Cash Price |
$10,008.16
|
| Rate for Payer: Cigna Commercial |
$16,613.54
|
| Rate for Payer: First Health Commercial |
$19,015.49
|
| Rate for Payer: Humana Commercial |
$17,013.86
|
| Rate for Payer: Humana KY Medicaid |
$6,883.61
|
| Rate for Payer: Kentucky WC Medicaid |
$6,953.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,413.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,772.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,004.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,021.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,614.35
|
| Rate for Payer: Ohio Health Group HMO |
$15,012.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,013.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,414.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,811.25
|
| Rate for Payer: PHCS Commercial |
$19,215.66
|
| Rate for Payer: United Healthcare All Payer |
$17,614.35
|
|
|
DELTA TS CER HEAD 12/14 40M +1
|
Facility
|
IP
|
$11,929.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,578.78 |
| Max. Negotiated Rate |
$11,452.09 |
| Rate for Payer: Aetna Commercial |
$9,185.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,304.82
|
| Rate for Payer: Cash Price |
$5,964.63
|
| Rate for Payer: Cigna Commercial |
$9,901.29
|
| Rate for Payer: First Health Commercial |
$11,332.80
|
| Rate for Payer: Humana Commercial |
$10,139.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,781.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,803.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,578.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,497.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,946.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,543.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,378.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,231.19
|
| Rate for Payer: PHCS Commercial |
$11,452.09
|
| Rate for Payer: United Healthcare All Payer |
$10,497.75
|
|
|
DELTA TS CER HEAD 12/14 40M +1
|
Facility
|
OP
|
$11,929.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,578.78 |
| Max. Negotiated Rate |
$11,452.09 |
| Rate for Payer: Aetna Commercial |
$9,185.53
|
| Rate for Payer: Anthem Medicaid |
$4,102.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,304.82
|
| Rate for Payer: Cash Price |
$5,964.63
|
| Rate for Payer: Cigna Commercial |
$9,901.29
|
| Rate for Payer: First Health Commercial |
$11,332.80
|
| Rate for Payer: Humana Commercial |
$10,139.87
|
| Rate for Payer: Humana KY Medicaid |
$4,102.47
|
| Rate for Payer: Kentucky WC Medicaid |
$4,144.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,781.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,803.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,578.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,184.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,497.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,946.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,543.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,378.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,231.19
|
| Rate for Payer: PHCS Commercial |
$11,452.09
|
| Rate for Payer: United Healthcare All Payer |
$10,497.75
|
|
|
DELTA TS CER HEAD 12/14 40M +8
|
Facility
|
OP
|
$11,929.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,578.78 |
| Max. Negotiated Rate |
$11,452.09 |
| Rate for Payer: Aetna Commercial |
$9,185.53
|
| Rate for Payer: Anthem Medicaid |
$4,102.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,304.82
|
| Rate for Payer: Cash Price |
$5,964.63
|
| Rate for Payer: Cigna Commercial |
$9,901.29
|
| Rate for Payer: First Health Commercial |
$11,332.80
|
| Rate for Payer: Humana Commercial |
$10,139.87
|
| Rate for Payer: Humana KY Medicaid |
$4,102.47
|
| Rate for Payer: Kentucky WC Medicaid |
$4,144.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,781.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,803.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,578.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,184.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,497.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,946.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,543.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,378.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,231.19
|
| Rate for Payer: PHCS Commercial |
$11,452.09
|
| Rate for Payer: United Healthcare All Payer |
$10,497.75
|
|
|
DELTA TS CER HEAD 12/14 40M +8
|
Facility
|
IP
|
$11,929.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,578.78 |
| Max. Negotiated Rate |
$11,452.09 |
| Rate for Payer: Aetna Commercial |
$9,185.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,304.82
|
| Rate for Payer: Cash Price |
$5,964.63
|
| Rate for Payer: Cigna Commercial |
$9,901.29
|
| Rate for Payer: First Health Commercial |
$11,332.80
|
| Rate for Payer: Humana Commercial |
$10,139.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,781.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,803.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,578.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,497.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,946.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,543.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,378.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,231.19
|
| Rate for Payer: PHCS Commercial |
$11,452.09
|
| Rate for Payer: United Healthcare All Payer |
$10,497.75
|
|
|
DELTA TS CER HEAD 12/14 40MM +
|
Facility
|
IP
|
$21,036.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,311.06 |
| Max. Negotiated Rate |
$20,195.40 |
| Rate for Payer: Aetna Commercial |
$16,198.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,408.77
|
| Rate for Payer: Cash Price |
$10,518.44
|
| Rate for Payer: Cigna Commercial |
$17,460.61
|
| Rate for Payer: First Health Commercial |
$19,985.04
|
| Rate for Payer: Humana Commercial |
$17,881.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,250.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,525.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,311.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,512.45
|
| Rate for Payer: Ohio Health Group HMO |
$15,777.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,829.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,302.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,515.45
|
| Rate for Payer: PHCS Commercial |
$20,195.40
|
| Rate for Payer: United Healthcare All Payer |
$18,512.45
|
|
|
DELTA TS CER HEAD 12/14 40MM +
|
Facility
|
OP
|
$21,036.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,311.06 |
| Max. Negotiated Rate |
$20,195.40 |
| Rate for Payer: Aetna Commercial |
$16,198.40
|
| Rate for Payer: Anthem Medicaid |
$7,234.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,408.77
|
| Rate for Payer: Cash Price |
$10,518.44
|
| Rate for Payer: Cigna Commercial |
$17,460.61
|
| Rate for Payer: First Health Commercial |
$19,985.04
|
| Rate for Payer: Humana Commercial |
$17,881.35
|
| Rate for Payer: Humana KY Medicaid |
$7,234.58
|
| Rate for Payer: Kentucky WC Medicaid |
$7,308.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,250.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,525.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,311.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,379.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,512.45
|
| Rate for Payer: Ohio Health Group HMO |
$15,777.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,829.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,302.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,515.45
|
| Rate for Payer: PHCS Commercial |
$20,195.40
|
| Rate for Payer: United Healthcare All Payer |
$18,512.45
|
|
|
DELTA TS CER HEAD 12/14 44MM+5
|
Facility
|
IP
|
$15,981.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,794.30 |
| Max. Negotiated Rate |
$15,341.76 |
| Rate for Payer: Aetna Commercial |
$12,305.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,465.18
|
| Rate for Payer: Cash Price |
$7,990.50
|
| Rate for Payer: Cigna Commercial |
$13,264.23
|
| Rate for Payer: First Health Commercial |
$15,181.95
|
| Rate for Payer: Humana Commercial |
$13,583.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,104.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,793.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,794.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,063.28
|
| Rate for Payer: Ohio Health Group HMO |
$11,985.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,784.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,903.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,026.89
|
| Rate for Payer: PHCS Commercial |
$15,341.76
|
| Rate for Payer: United Healthcare All Payer |
$14,063.28
|
|
|
DELTA TS CER HEAD 12/14 44MM+5
|
Facility
|
OP
|
$15,981.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,794.30 |
| Max. Negotiated Rate |
$15,341.76 |
| Rate for Payer: Aetna Commercial |
$12,305.37
|
| Rate for Payer: Anthem Medicaid |
$5,495.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,465.18
|
| Rate for Payer: Cash Price |
$7,990.50
|
| Rate for Payer: Cigna Commercial |
$13,264.23
|
| Rate for Payer: First Health Commercial |
$15,181.95
|
| Rate for Payer: Humana Commercial |
$13,583.85
|
| Rate for Payer: Humana KY Medicaid |
$5,495.87
|
| Rate for Payer: Kentucky WC Medicaid |
$5,551.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,104.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,793.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,794.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,606.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,063.28
|
| Rate for Payer: Ohio Health Group HMO |
$11,985.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,784.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,903.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,026.89
|
| Rate for Payer: PHCS Commercial |
$15,341.76
|
| Rate for Payer: United Healthcare All Payer |
$14,063.28
|
|
|
DELTA TS CER. HED 12/14 32MM+5
|
Facility
|
OP
|
$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 Medicaid |
$3,833.64
|
| 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: Humana KY Medicaid |
$3,833.64
|
| Rate for Payer: Kentucky WC Medicaid |
$3,872.66
|
| 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: Molina Healthcare Medicaid |
$3,910.56
|
| 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 TS CER. HED 12/14 32MM+5
|
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 TS CER. HED 12/14 32MM+9
|
Facility
|
OP
|
$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 Medicaid |
$3,833.64
|
| 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: Humana KY Medicaid |
$3,833.64
|
| Rate for Payer: Kentucky WC Medicaid |
$3,872.66
|
| 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: Molina Healthcare Medicaid |
$3,910.56
|
| 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 TS CER. HED 12/14 32MM+9
|
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 TS CER HED 12/14 40MM+12
|
Facility
|
IP
|
$11,929.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,578.78 |
| Max. Negotiated Rate |
$11,452.09 |
| Rate for Payer: Aetna Commercial |
$9,185.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,304.82
|
| Rate for Payer: Cash Price |
$5,964.63
|
| Rate for Payer: Cigna Commercial |
$9,901.29
|
| Rate for Payer: First Health Commercial |
$11,332.80
|
| Rate for Payer: Humana Commercial |
$10,139.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,781.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,803.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,578.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,497.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,946.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,543.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,378.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,231.19
|
| Rate for Payer: PHCS Commercial |
$11,452.09
|
| Rate for Payer: United Healthcare All Payer |
$10,497.75
|
|
