|
ALTRX +4 10D LNR 36 X 60
|
Facility
|
IP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
|
ALTRX +4 10D LNR 36 X 60
|
Facility
|
OP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem Medicaid |
$4,485.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Humana KY Medicaid |
$4,485.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,530.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,575.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
|
ALTRX +4 10D LNR 36 X 62
|
Facility
|
OP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem Medicaid |
$4,485.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Humana KY Medicaid |
$4,485.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,530.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,575.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
|
ALTRX +4 10D LNR 36 X 62
|
Facility
|
IP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
|
ALTRX +4 10D LNR 36 X 64
|
Facility
|
IP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
|
ALTRX +4 10D LNR 36 X 64
|
Facility
|
OP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem Medicaid |
$4,485.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Humana KY Medicaid |
$4,485.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,530.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,575.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
|
ALTRX +4 10D LNR 36 X 66
|
Facility
|
IP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
|
ALTRX +4 10D LNR 36 X 66
|
Facility
|
OP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem Medicaid |
$4,485.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Humana KY Medicaid |
$4,485.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,530.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,575.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
|
ALTRX +4NEUT LNR 32 X 48
|
Facility
|
IP
|
$11,444.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,433.45 |
| Max. Negotiated Rate |
$10,987.03 |
| Rate for Payer: Aetna Commercial |
$8,812.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,926.96
|
| Rate for Payer: Cash Price |
$5,722.41
|
| Rate for Payer: Cigna Commercial |
$9,499.20
|
| Rate for Payer: First Health Commercial |
$10,872.58
|
| Rate for Payer: Humana Commercial |
$9,728.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,384.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,446.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,433.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,071.44
|
| Rate for Payer: Ohio Health Group HMO |
$8,583.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,155.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,956.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,896.93
|
| Rate for Payer: PHCS Commercial |
$10,987.03
|
| Rate for Payer: United Healthcare All Payer |
$10,071.44
|
|
|
ALTRX +4NEUT LNR 32 X 48
|
Facility
|
OP
|
$11,444.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,433.45 |
| Max. Negotiated Rate |
$10,987.03 |
| Rate for Payer: Aetna Commercial |
$8,812.51
|
| Rate for Payer: Anthem Medicaid |
$3,935.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,926.96
|
| Rate for Payer: Cash Price |
$5,722.41
|
| Rate for Payer: Cigna Commercial |
$9,499.20
|
| Rate for Payer: First Health Commercial |
$10,872.58
|
| Rate for Payer: Humana Commercial |
$9,728.10
|
| Rate for Payer: Humana KY Medicaid |
$3,935.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,975.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,384.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,446.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,433.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,014.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,071.44
|
| Rate for Payer: Ohio Health Group HMO |
$8,583.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,155.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,956.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,896.93
|
| Rate for Payer: PHCS Commercial |
$10,987.03
|
| Rate for Payer: United Healthcare All Payer |
$10,071.44
|
|
|
ALTRX +4NEUT LNR 32 X 50
|
Facility
|
IP
|
$12,381.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,714.42 |
| Max. Negotiated Rate |
$11,886.14 |
| Rate for Payer: Aetna Commercial |
$9,533.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,657.49
|
| Rate for Payer: Cash Price |
$6,190.70
|
| Rate for Payer: Cigna Commercial |
$10,276.56
|
| Rate for Payer: First Health Commercial |
$11,762.33
|
| Rate for Payer: Humana Commercial |
$10,524.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,137.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,714.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,895.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,286.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,905.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,771.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,543.17
|
| Rate for Payer: PHCS Commercial |
$11,886.14
|
| Rate for Payer: United Healthcare All Payer |
$10,895.63
|
|
|
ALTRX +4NEUT LNR 32 X 50
|
Facility
|
OP
|
$12,381.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,714.42 |
| Max. Negotiated Rate |
$11,886.14 |
| Rate for Payer: Aetna Commercial |
$9,533.68
|
| Rate for Payer: Anthem Medicaid |
$4,257.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,657.49
|
| Rate for Payer: Cash Price |
$6,190.70
|
| Rate for Payer: Cigna Commercial |
$10,276.56
|
| Rate for Payer: First Health Commercial |
$11,762.33
|
| Rate for Payer: Humana Commercial |
$10,524.19
|
| Rate for Payer: Humana KY Medicaid |
$4,257.96
|
| Rate for Payer: Kentucky WC Medicaid |
$4,301.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,152.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,137.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,714.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,343.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,895.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,286.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,905.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,771.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,543.17
|
| Rate for Payer: PHCS Commercial |
$11,886.14
|
| Rate for Payer: United Healthcare All Payer |
$10,895.63
|
|
|
ALTRX +4NEUT LNR 32 X 52
|
Facility
|
OP
|
$11,243.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,373.11 |
| Max. Negotiated Rate |
$10,793.95 |
| Rate for Payer: Aetna Commercial |
$8,657.65
|
| Rate for Payer: Anthem Medicaid |
$3,866.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,770.09
|
| Rate for Payer: Cash Price |
$5,621.85
|
| Rate for Payer: Cigna Commercial |
$9,332.27
|
| Rate for Payer: First Health Commercial |
$10,681.51
|
| Rate for Payer: Humana Commercial |
$9,557.15
|
| Rate for Payer: Humana KY Medicaid |
$3,866.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,906.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,219.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,297.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,373.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,944.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,894.46
|
| Rate for Payer: Ohio Health Group HMO |
$8,432.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,994.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,782.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,758.15
|
| Rate for Payer: PHCS Commercial |
$10,793.95
|
| Rate for Payer: United Healthcare All Payer |
$9,894.46
|
|
|
ALTRX +4NEUT LNR 32 X 52
|
Facility
|
IP
|
$11,243.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,373.11 |
| Max. Negotiated Rate |
$10,793.95 |
| Rate for Payer: Aetna Commercial |
$8,657.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,770.09
|
| Rate for Payer: Cash Price |
$5,621.85
|
| Rate for Payer: Cigna Commercial |
$9,332.27
|
| Rate for Payer: First Health Commercial |
$10,681.51
|
| Rate for Payer: Humana Commercial |
$9,557.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,219.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,297.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,373.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,894.46
|
| Rate for Payer: Ohio Health Group HMO |
$8,432.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,994.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,782.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,758.15
|
| Rate for Payer: PHCS Commercial |
$10,793.95
|
| Rate for Payer: United Healthcare All Payer |
$9,894.46
|
|
|
ALTRX +4NEUT LNR 32 X 54
|
Facility
|
OP
|
$11,243.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,373.11 |
| Max. Negotiated Rate |
$10,793.95 |
| Rate for Payer: Aetna Commercial |
$8,657.65
|
| Rate for Payer: Anthem Medicaid |
$3,866.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,770.09
|
| Rate for Payer: Cash Price |
$5,621.85
|
| Rate for Payer: Cigna Commercial |
$9,332.27
|
| Rate for Payer: First Health Commercial |
$10,681.51
|
| Rate for Payer: Humana Commercial |
$9,557.15
|
| Rate for Payer: Humana KY Medicaid |
$3,866.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,906.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,219.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,297.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,373.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,944.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,894.46
|
| Rate for Payer: Ohio Health Group HMO |
$8,432.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,994.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,782.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,758.15
|
| Rate for Payer: PHCS Commercial |
$10,793.95
|
| Rate for Payer: United Healthcare All Payer |
$9,894.46
|
|
|
ALTRX +4NEUT LNR 32 X 54
|
Facility
|
IP
|
$11,243.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,373.11 |
| Max. Negotiated Rate |
$10,793.95 |
| Rate for Payer: Aetna Commercial |
$8,657.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,770.09
|
| Rate for Payer: Cash Price |
$5,621.85
|
| Rate for Payer: Cigna Commercial |
$9,332.27
|
| Rate for Payer: First Health Commercial |
$10,681.51
|
| Rate for Payer: Humana Commercial |
$9,557.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,219.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,297.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,373.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,894.46
|
| Rate for Payer: Ohio Health Group HMO |
$8,432.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,994.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,782.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,758.15
|
| Rate for Payer: PHCS Commercial |
$10,793.95
|
| Rate for Payer: United Healthcare All Payer |
$9,894.46
|
|
|
ALTRX +4 NEUT LNR 36 X 52
|
Facility
|
IP
|
$11,444.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,433.45 |
| Max. Negotiated Rate |
$10,987.03 |
| Rate for Payer: Aetna Commercial |
$8,812.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,926.96
|
| Rate for Payer: Cash Price |
$5,722.41
|
| Rate for Payer: Cigna Commercial |
$9,499.20
|
| Rate for Payer: First Health Commercial |
$10,872.58
|
| Rate for Payer: Humana Commercial |
$9,728.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,384.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,446.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,433.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,071.44
|
| Rate for Payer: Ohio Health Group HMO |
$8,583.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,155.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,956.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,896.93
|
| Rate for Payer: PHCS Commercial |
$10,987.03
|
| Rate for Payer: United Healthcare All Payer |
$10,071.44
|
|
|
ALTRX +4 NEUT LNR 36 X 52
|
Facility
|
OP
|
$11,444.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,433.45 |
| Max. Negotiated Rate |
$10,987.03 |
| Rate for Payer: Aetna Commercial |
$8,812.51
|
| Rate for Payer: Anthem Medicaid |
$3,935.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,926.96
|
| Rate for Payer: Cash Price |
$5,722.41
|
| Rate for Payer: Cigna Commercial |
$9,499.20
|
| Rate for Payer: First Health Commercial |
$10,872.58
|
| Rate for Payer: Humana Commercial |
$9,728.10
|
| Rate for Payer: Humana KY Medicaid |
$3,935.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,975.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,384.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,446.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,433.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,014.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,071.44
|
| Rate for Payer: Ohio Health Group HMO |
$8,583.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,155.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,956.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,896.93
|
| Rate for Payer: PHCS Commercial |
$10,987.03
|
| Rate for Payer: United Healthcare All Payer |
$10,071.44
|
|
|
ALTRX +4 NEUT LNR 36 X 54
|
Facility
|
OP
|
$11,444.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,433.45 |
| Max. Negotiated Rate |
$10,987.03 |
| Rate for Payer: Aetna Commercial |
$8,812.51
|
| Rate for Payer: Anthem Medicaid |
$3,935.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,926.96
|
| Rate for Payer: Cash Price |
$5,722.41
|
| Rate for Payer: Cigna Commercial |
$9,499.20
|
| Rate for Payer: First Health Commercial |
$10,872.58
|
| Rate for Payer: Humana Commercial |
$9,728.10
|
| Rate for Payer: Humana KY Medicaid |
$3,935.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,975.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,384.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,446.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,433.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,014.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,071.44
|
| Rate for Payer: Ohio Health Group HMO |
$8,583.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,155.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,956.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,896.93
|
| Rate for Payer: PHCS Commercial |
$10,987.03
|
| Rate for Payer: United Healthcare All Payer |
$10,071.44
|
|
|
ALTRX +4 NEUT LNR 36 X 54
|
Facility
|
IP
|
$11,444.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,433.45 |
| Max. Negotiated Rate |
$10,987.03 |
| Rate for Payer: Aetna Commercial |
$8,812.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,926.96
|
| Rate for Payer: Cash Price |
$5,722.41
|
| Rate for Payer: Cigna Commercial |
$9,499.20
|
| Rate for Payer: First Health Commercial |
$10,872.58
|
| Rate for Payer: Humana Commercial |
$9,728.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,384.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,446.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,433.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,071.44
|
| Rate for Payer: Ohio Health Group HMO |
$8,583.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,155.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,956.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,896.93
|
| Rate for Payer: PHCS Commercial |
$10,987.03
|
| Rate for Payer: United Healthcare All Payer |
$10,071.44
|
|
|
ALTRX +4 NEUT LNR 36 X 58
|
Facility
|
OP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem Medicaid |
$4,485.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Humana KY Medicaid |
$4,485.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,530.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,575.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
|
ALTRX +4 NEUT LNR 36 X 58
|
Facility
|
IP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
|
ALTRX +4 NEUT LNR 36 X 60
|
Facility
|
IP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
|
ALTRX +4 NEUT LNR 36 X 60
|
Facility
|
OP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem Medicaid |
$4,485.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Humana KY Medicaid |
$4,485.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,530.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,575.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
|
ALTRX +4 NEUT LNR 36 X 62
|
Facility
|
OP
|
$13,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,912.60 |
| Max. Negotiated Rate |
$12,520.32 |
| Rate for Payer: Aetna Commercial |
$10,042.34
|
| Rate for Payer: Anthem Medicaid |
$4,485.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,172.76
|
| Rate for Payer: Cash Price |
$6,521.00
|
| Rate for Payer: Cigna Commercial |
$10,824.86
|
| Rate for Payer: First Health Commercial |
$12,389.90
|
| Rate for Payer: Humana Commercial |
$11,085.70
|
| Rate for Payer: Humana KY Medicaid |
$4,485.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,530.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,694.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,625.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,575.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,476.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,433.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,346.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,998.98
|
| Rate for Payer: PHCS Commercial |
$12,520.32
|
| Rate for Payer: United Healthcare All Payer |
$11,476.96
|
|
