|
DELTA TS CER HED 12/14 40MM+12
|
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 XTEND CTA HEAD 48*21MM
|
Facility
|
OP
|
$26,217.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,865.25 |
| Max. Negotiated Rate |
$25,168.80 |
| Rate for Payer: Aetna Commercial |
$20,187.47
|
| Rate for Payer: Anthem Medicaid |
$9,016.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,449.65
|
| Rate for Payer: Cash Price |
$13,108.75
|
| Rate for Payer: Cigna Commercial |
$21,760.53
|
| Rate for Payer: First Health Commercial |
$24,906.62
|
| Rate for Payer: Humana Commercial |
$22,284.88
|
| Rate for Payer: Humana KY Medicaid |
$9,016.20
|
| Rate for Payer: Kentucky WC Medicaid |
$9,107.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,498.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,348.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,865.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,197.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,071.40
|
| Rate for Payer: Ohio Health Group HMO |
$19,663.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,974.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,809.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,090.08
|
| Rate for Payer: PHCS Commercial |
$25,168.80
|
| Rate for Payer: United Healthcare All Payer |
$23,071.40
|
|
|
DELTA XTEND CTA HEAD 48*21MM
|
Facility
|
IP
|
$26,217.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,865.25 |
| Max. Negotiated Rate |
$25,168.80 |
| Rate for Payer: Aetna Commercial |
$20,187.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,449.65
|
| Rate for Payer: Cash Price |
$13,108.75
|
| Rate for Payer: Cigna Commercial |
$21,760.53
|
| Rate for Payer: First Health Commercial |
$24,906.62
|
| Rate for Payer: Humana Commercial |
$22,284.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,498.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,348.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,865.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,071.40
|
| Rate for Payer: Ohio Health Group HMO |
$19,663.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,974.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,809.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,090.08
|
| Rate for Payer: PHCS Commercial |
$25,168.80
|
| Rate for Payer: United Healthcare All Payer |
$23,071.40
|
|
|
DELTA XTEND CTA HEAD 48*26MM
|
Facility
|
IP
|
$24,245.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,273.50 |
| Max. Negotiated Rate |
$23,275.20 |
| Rate for Payer: Aetna Commercial |
$18,668.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,911.10
|
| Rate for Payer: Cash Price |
$12,122.50
|
| Rate for Payer: Cigna Commercial |
$20,123.35
|
| Rate for Payer: First Health Commercial |
$23,032.75
|
| Rate for Payer: Humana Commercial |
$20,608.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,880.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,892.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,273.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,335.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,183.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,396.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,093.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,729.05
|
| Rate for Payer: PHCS Commercial |
$23,275.20
|
| Rate for Payer: United Healthcare All Payer |
$21,335.60
|
|
|
DELTA XTEND CTA HEAD 48*26MM
|
Facility
|
OP
|
$24,245.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,273.50 |
| Max. Negotiated Rate |
$23,275.20 |
| Rate for Payer: Aetna Commercial |
$18,668.65
|
| Rate for Payer: Anthem Medicaid |
$8,337.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,911.10
|
| Rate for Payer: Cash Price |
$12,122.50
|
| Rate for Payer: Cigna Commercial |
$20,123.35
|
| Rate for Payer: First Health Commercial |
$23,032.75
|
| Rate for Payer: Humana Commercial |
$20,608.25
|
| Rate for Payer: Humana KY Medicaid |
$8,337.86
|
| Rate for Payer: Kentucky WC Medicaid |
$8,422.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,880.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,892.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,273.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,505.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,335.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,183.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,396.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,093.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,729.05
|
| Rate for Payer: PHCS Commercial |
$23,275.20
|
| Rate for Payer: United Healthcare All Payer |
$21,335.60
|
|
|
DELTA XTEND CTA HEAD 52*21MM
|
Facility
|
IP
|
$24,245.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,273.50 |
| Max. Negotiated Rate |
$23,275.20 |
| Rate for Payer: Aetna Commercial |
$18,668.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,911.10
|
| Rate for Payer: Cash Price |
$12,122.50
|
| Rate for Payer: Cigna Commercial |
$20,123.35
|
| Rate for Payer: First Health Commercial |
$23,032.75
|
| Rate for Payer: Humana Commercial |
$20,608.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,880.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,892.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,273.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,335.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,183.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,396.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,093.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,729.05
|
| Rate for Payer: PHCS Commercial |
$23,275.20
|
| Rate for Payer: United Healthcare All Payer |
$21,335.60
|
|
|
DELTA XTEND CTA HEAD 52*21MM
|
Facility
|
OP
|
$24,245.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,273.50 |
| Max. Negotiated Rate |
$23,275.20 |
| Rate for Payer: Aetna Commercial |
$18,668.65
|
| Rate for Payer: Anthem Medicaid |
$8,337.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,911.10
|
| Rate for Payer: Cash Price |
$12,122.50
|
| Rate for Payer: Cigna Commercial |
$20,123.35
|
| Rate for Payer: First Health Commercial |
$23,032.75
|
| Rate for Payer: Humana Commercial |
$20,608.25
|
| Rate for Payer: Humana KY Medicaid |
$8,337.86
|
| Rate for Payer: Kentucky WC Medicaid |
$8,422.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,880.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,892.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,273.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,505.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,335.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,183.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,396.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,093.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,729.05
|
| Rate for Payer: PHCS Commercial |
$23,275.20
|
| Rate for Payer: United Healthcare All Payer |
$21,335.60
|
|
|
DELTA XTEND CTA HEAD 52*26MM
|
Facility
|
OP
|
$16,277.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,883.10 |
| Max. Negotiated Rate |
$15,625.92 |
| Rate for Payer: Aetna Commercial |
$12,533.29
|
| Rate for Payer: Anthem Medicaid |
$5,597.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,696.06
|
| Rate for Payer: Cash Price |
$8,138.50
|
| Rate for Payer: Cigna Commercial |
$13,509.91
|
| Rate for Payer: First Health Commercial |
$15,463.15
|
| Rate for Payer: Humana Commercial |
$13,835.45
|
| Rate for Payer: Humana KY Medicaid |
$5,597.66
|
| Rate for Payer: Kentucky WC Medicaid |
$5,654.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,347.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,012.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,883.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,709.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,323.76
|
| Rate for Payer: Ohio Health Group HMO |
$12,207.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,021.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,160.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,231.13
|
| Rate for Payer: PHCS Commercial |
$15,625.92
|
| Rate for Payer: United Healthcare All Payer |
$14,323.76
|
|
|
DELTA XTEND CTA HEAD 52*26MM
|
Facility
|
IP
|
$16,277.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,883.10 |
| Max. Negotiated Rate |
$15,625.92 |
| Rate for Payer: Aetna Commercial |
$12,533.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,696.06
|
| Rate for Payer: Cash Price |
$8,138.50
|
| Rate for Payer: Cigna Commercial |
$13,509.91
|
| Rate for Payer: First Health Commercial |
$15,463.15
|
| Rate for Payer: Humana Commercial |
$13,835.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,347.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,012.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,883.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,323.76
|
| Rate for Payer: Ohio Health Group HMO |
$12,207.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,021.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,160.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,231.13
|
| Rate for Payer: PHCS Commercial |
$15,625.92
|
| Rate for Payer: United Healthcare All Payer |
$14,323.76
|
|
|
DELTA XTEND GUIDEWIRE 1.5MM
|
Facility
|
OP
|
$770.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$739.20 |
| Rate for Payer: Aetna Commercial |
$592.90
|
| Rate for Payer: Anthem Medicaid |
$264.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$600.60
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cigna Commercial |
$639.10
|
| Rate for Payer: First Health Commercial |
$731.50
|
| Rate for Payer: Humana Commercial |
$654.50
|
| Rate for Payer: Humana KY Medicaid |
$264.80
|
| Rate for Payer: Kentucky WC Medicaid |
$267.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$631.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$568.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$231.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$270.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$677.60
|
| Rate for Payer: Ohio Health Group HMO |
$577.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$616.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$531.30
|
| Rate for Payer: PHCS Commercial |
$739.20
|
| Rate for Payer: United Healthcare All Payer |
$677.60
|
|
|
DELTA XTEND GUIDEWIRE 1.5MM
|
Facility
|
IP
|
$770.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$739.20 |
| Rate for Payer: Aetna Commercial |
$592.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$600.60
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cigna Commercial |
$639.10
|
| Rate for Payer: First Health Commercial |
$731.50
|
| Rate for Payer: Humana Commercial |
$654.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$631.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$568.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$231.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$677.60
|
| Rate for Payer: Ohio Health Group HMO |
$577.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$616.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$531.30
|
| Rate for Payer: PHCS Commercial |
$739.20
|
| Rate for Payer: United Healthcare All Payer |
$677.60
|
|
|
DELTA XTEND HUM STEM D10 HA
|
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 XTEND HUM STEM D10 HA
|
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 XTEND HUM STEM D12 HA
|
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 XTEND HUM STEM D12 HA
|
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 XTEND HUM STEM D16 HA
|
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 XTEND HUM STEM D16 HA
|
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 XTEND HUM SZ 1 D10 LG
|
Facility
|
IP
|
$40,715.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,214.50 |
| Max. Negotiated Rate |
$39,086.40 |
| Rate for Payer: Aetna Commercial |
$31,350.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,757.70
|
| Rate for Payer: Cash Price |
$20,357.50
|
| Rate for Payer: Cigna Commercial |
$33,793.45
|
| Rate for Payer: First Health Commercial |
$38,679.25
|
| Rate for Payer: Humana Commercial |
$34,607.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,386.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,047.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,214.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,829.20
|
| Rate for Payer: Ohio Health Group HMO |
$30,536.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,572.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,422.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,093.35
|
| Rate for Payer: PHCS Commercial |
$39,086.40
|
| Rate for Payer: United Healthcare All Payer |
$35,829.20
|
|
|
DELTA XTEND HUM SZ 1 D10 LG
|
Facility
|
OP
|
$40,715.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,214.50 |
| Max. Negotiated Rate |
$39,086.40 |
| Rate for Payer: Aetna Commercial |
$31,350.55
|
| Rate for Payer: Anthem Medicaid |
$14,001.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,757.70
|
| Rate for Payer: Cash Price |
$20,357.50
|
| Rate for Payer: Cigna Commercial |
$33,793.45
|
| Rate for Payer: First Health Commercial |
$38,679.25
|
| Rate for Payer: Humana Commercial |
$34,607.75
|
| Rate for Payer: Humana KY Medicaid |
$14,001.89
|
| Rate for Payer: Kentucky WC Medicaid |
$14,144.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,386.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,047.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,214.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,282.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,829.20
|
| Rate for Payer: Ohio Health Group HMO |
$30,536.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32,572.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,422.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,093.35
|
| Rate for Payer: PHCS Commercial |
$39,086.40
|
| Rate for Payer: United Healthcare All Payer |
$35,829.20
|
|
|
DELTA XTEND HUM SZ 1 D12 LG
|
Facility
|
OP
|
$38,022.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,406.75 |
| Max. Negotiated Rate |
$36,501.60 |
| Rate for Payer: Aetna Commercial |
$29,277.33
|
| Rate for Payer: Anthem Medicaid |
$13,075.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,657.55
|
| Rate for Payer: Cash Price |
$19,011.25
|
| Rate for Payer: Cigna Commercial |
$31,558.67
|
| Rate for Payer: First Health Commercial |
$36,121.38
|
| Rate for Payer: Humana Commercial |
$32,319.12
|
| Rate for Payer: Humana KY Medicaid |
$13,075.94
|
| Rate for Payer: Kentucky WC Medicaid |
$13,209.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,178.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,060.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,406.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,338.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,459.80
|
| Rate for Payer: Ohio Health Group HMO |
$28,516.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,418.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,079.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,235.53
|
| Rate for Payer: PHCS Commercial |
$36,501.60
|
| Rate for Payer: United Healthcare All Payer |
$33,459.80
|
|
|
DELTA XTEND HUM SZ 1 D12 LG
|
Facility
|
IP
|
$38,022.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,406.75 |
| Max. Negotiated Rate |
$36,501.60 |
| Rate for Payer: Aetna Commercial |
$29,277.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,657.55
|
| Rate for Payer: Cash Price |
$19,011.25
|
| Rate for Payer: Cigna Commercial |
$31,558.67
|
| Rate for Payer: First Health Commercial |
$36,121.38
|
| Rate for Payer: Humana Commercial |
$32,319.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,178.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28,060.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,406.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,459.80
|
| Rate for Payer: Ohio Health Group HMO |
$28,516.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,418.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33,079.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,235.53
|
| Rate for Payer: PHCS Commercial |
$36,501.60
|
| Rate for Payer: United Healthcare All Payer |
$33,459.80
|
|
|
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 |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| 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 |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| 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
|
$25,407.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,622.25 |
| Max. Negotiated Rate |
$24,391.20 |
| Rate for Payer: Aetna Commercial |
$19,563.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,817.85
|
| Rate for Payer: Cash Price |
$12,703.75
|
| Rate for Payer: Cigna Commercial |
$21,088.22
|
| Rate for Payer: First Health Commercial |
$24,137.12
|
| Rate for Payer: Humana Commercial |
$21,596.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,834.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,750.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,622.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,358.60
|
| Rate for Payer: Ohio Health Group HMO |
$19,055.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,326.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,104.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,531.17
|
| Rate for Payer: PHCS Commercial |
$24,391.20
|
| Rate for Payer: United Healthcare All Payer |
$22,358.60
|
|
|
DELTA XTEND HUM SZ 1 D8 LG
|
Facility
|
OP
|
$25,407.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,622.25 |
| Max. Negotiated Rate |
$24,391.20 |
| Rate for Payer: Aetna Commercial |
$19,563.78
|
| Rate for Payer: Anthem Medicaid |
$8,737.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,817.85
|
| Rate for Payer: Cash Price |
$12,703.75
|
| Rate for Payer: Cigna Commercial |
$21,088.22
|
| Rate for Payer: First Health Commercial |
$24,137.12
|
| Rate for Payer: Humana Commercial |
$21,596.38
|
| Rate for Payer: Humana KY Medicaid |
$8,737.64
|
| Rate for Payer: Kentucky WC Medicaid |
$8,826.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,834.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,750.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,622.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,912.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,358.60
|
| Rate for Payer: Ohio Health Group HMO |
$19,055.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,326.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,104.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,531.17
|
| Rate for Payer: PHCS Commercial |
$24,391.20
|
| Rate for Payer: United Healthcare All Payer |
$22,358.60
|
|
