|
ALTRX +4 NEUT LNR 36 X 52
|
Facility
|
OP
|
$11,201.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.20 |
| Max. Negotiated Rate |
$10,753.46 |
| Rate for Payer: Aetna Commercial |
$8,625.17
|
| Rate for Payer: Anthem Medicaid |
$3,852.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,737.19
|
| Rate for Payer: Cash Price |
$5,600.76
|
| Rate for Payer: Cigna Commercial |
$9,297.26
|
| Rate for Payer: First Health Commercial |
$10,641.44
|
| Rate for Payer: Humana Commercial |
$9,521.29
|
| Rate for Payer: Humana KY Medicaid |
$3,852.20
|
| Rate for Payer: Kentucky WC Medicaid |
$3,891.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,185.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,266.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,360.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,929.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,857.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,401.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,240.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,456.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,472.47
|
| Rate for Payer: PHCS Commercial |
$10,753.46
|
| Rate for Payer: United Healthcare All Payer |
$9,857.34
|
|
|
ALTRX +4 NEUT LNR 36 X 52
|
Facility
|
IP
|
$11,201.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.20 |
| Max. Negotiated Rate |
$10,753.46 |
| Rate for Payer: Aetna Commercial |
$8,625.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,737.19
|
| Rate for Payer: Cash Price |
$5,600.76
|
| Rate for Payer: Cigna Commercial |
$9,297.26
|
| Rate for Payer: First Health Commercial |
$10,641.44
|
| Rate for Payer: Humana Commercial |
$9,521.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,185.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,266.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,360.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,857.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,401.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,240.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,456.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,472.47
|
| Rate for Payer: PHCS Commercial |
$10,753.46
|
| Rate for Payer: United Healthcare All Payer |
$9,857.34
|
|
|
ALTRX +4 NEUT LNR 36 X 54
|
Facility
|
OP
|
$11,201.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.20 |
| Max. Negotiated Rate |
$10,753.46 |
| Rate for Payer: Aetna Commercial |
$8,625.17
|
| Rate for Payer: Anthem Medicaid |
$3,852.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,737.19
|
| Rate for Payer: Cash Price |
$5,600.76
|
| Rate for Payer: Cigna Commercial |
$9,297.26
|
| Rate for Payer: First Health Commercial |
$10,641.44
|
| Rate for Payer: Humana Commercial |
$9,521.29
|
| Rate for Payer: Humana KY Medicaid |
$3,852.20
|
| Rate for Payer: Kentucky WC Medicaid |
$3,891.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,185.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,266.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,360.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,929.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,857.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,401.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,240.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,456.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,472.47
|
| Rate for Payer: PHCS Commercial |
$10,753.46
|
| Rate for Payer: United Healthcare All Payer |
$9,857.34
|
|
|
ALTRX +4 NEUT LNR 36 X 54
|
Facility
|
IP
|
$11,201.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.20 |
| Max. Negotiated Rate |
$10,753.46 |
| Rate for Payer: Aetna Commercial |
$8,625.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,737.19
|
| Rate for Payer: Cash Price |
$5,600.76
|
| Rate for Payer: Cigna Commercial |
$9,297.26
|
| Rate for Payer: First Health Commercial |
$10,641.44
|
| Rate for Payer: Humana Commercial |
$9,521.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,185.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,266.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,360.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,857.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,401.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,240.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,456.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,472.47
|
| Rate for Payer: PHCS Commercial |
$10,753.46
|
| Rate for Payer: United Healthcare All Payer |
$9,857.34
|
|
|
ALTRX +4 NEUT LNR 36 X 58
|
Facility
|
IP
|
$12,790.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.70 |
| Max. Negotiated Rate |
$12,278.40 |
| Rate for Payer: Aetna Commercial |
$9,848.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,976.20
|
| Rate for Payer: Cash Price |
$6,395.00
|
| Rate for Payer: Cigna Commercial |
$10,615.70
|
| Rate for Payer: First Health Commercial |
$12,150.50
|
| Rate for Payer: Humana Commercial |
$10,871.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,487.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,439.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,255.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,964.90
|
| Rate for Payer: PHCS Commercial |
$12,278.40
|
| Rate for Payer: United Healthcare All Payer |
$11,255.20
|
|
|
ALTRX +4 NEUT LNR 36 X 58
|
Facility
|
OP
|
$12,790.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.70 |
| Max. Negotiated Rate |
$12,278.40 |
| Rate for Payer: Aetna Commercial |
$9,848.30
|
| Rate for Payer: Anthem Medicaid |
$4,398.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,976.20
|
| Rate for Payer: Cash Price |
$6,395.00
|
| Rate for Payer: Cigna Commercial |
$10,615.70
|
| Rate for Payer: First Health Commercial |
$12,150.50
|
| Rate for Payer: Humana Commercial |
$10,871.50
|
| Rate for Payer: Humana KY Medicaid |
$4,398.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4,443.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,487.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,439.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,486.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,255.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,964.90
|
| Rate for Payer: PHCS Commercial |
$12,278.40
|
| Rate for Payer: United Healthcare All Payer |
$11,255.20
|
|
|
ALTRX +4 NEUT LNR 36 X 60
|
Facility
|
IP
|
$12,790.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.70 |
| Max. Negotiated Rate |
$12,278.40 |
| Rate for Payer: Aetna Commercial |
$9,848.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,976.20
|
| Rate for Payer: Cash Price |
$6,395.00
|
| Rate for Payer: Cigna Commercial |
$10,615.70
|
| Rate for Payer: First Health Commercial |
$12,150.50
|
| Rate for Payer: Humana Commercial |
$10,871.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,487.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,439.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,255.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,964.90
|
| Rate for Payer: PHCS Commercial |
$12,278.40
|
| Rate for Payer: United Healthcare All Payer |
$11,255.20
|
|
|
ALTRX +4 NEUT LNR 36 X 60
|
Facility
|
OP
|
$12,790.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.70 |
| Max. Negotiated Rate |
$12,278.40 |
| Rate for Payer: Aetna Commercial |
$9,848.30
|
| Rate for Payer: Anthem Medicaid |
$4,398.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,976.20
|
| Rate for Payer: Cash Price |
$6,395.00
|
| Rate for Payer: Cigna Commercial |
$10,615.70
|
| Rate for Payer: First Health Commercial |
$12,150.50
|
| Rate for Payer: Humana Commercial |
$10,871.50
|
| Rate for Payer: Humana KY Medicaid |
$4,398.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4,443.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,487.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,439.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,486.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,255.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,964.90
|
| Rate for Payer: PHCS Commercial |
$12,278.40
|
| Rate for Payer: United Healthcare All Payer |
$11,255.20
|
|
|
ALTRX +4 NEUT LNR 36 X 62
|
Facility
|
IP
|
$12,790.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.70 |
| Max. Negotiated Rate |
$12,278.40 |
| Rate for Payer: Aetna Commercial |
$9,848.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,976.20
|
| Rate for Payer: Cash Price |
$6,395.00
|
| Rate for Payer: Cigna Commercial |
$10,615.70
|
| Rate for Payer: First Health Commercial |
$12,150.50
|
| Rate for Payer: Humana Commercial |
$10,871.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,487.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,439.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,255.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,964.90
|
| Rate for Payer: PHCS Commercial |
$12,278.40
|
| Rate for Payer: United Healthcare All Payer |
$11,255.20
|
|
|
ALTRX +4 NEUT LNR 36 X 62
|
Facility
|
OP
|
$12,790.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.70 |
| Max. Negotiated Rate |
$12,278.40 |
| Rate for Payer: Aetna Commercial |
$9,848.30
|
| Rate for Payer: Anthem Medicaid |
$4,398.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,976.20
|
| Rate for Payer: Cash Price |
$6,395.00
|
| Rate for Payer: Cigna Commercial |
$10,615.70
|
| Rate for Payer: First Health Commercial |
$12,150.50
|
| Rate for Payer: Humana Commercial |
$10,871.50
|
| Rate for Payer: Humana KY Medicaid |
$4,398.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4,443.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,487.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,439.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,486.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,255.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,964.90
|
| Rate for Payer: PHCS Commercial |
$12,278.40
|
| Rate for Payer: United Healthcare All Payer |
$11,255.20
|
|
|
ALTRX +4 NEUT LNR 36 X 64
|
Facility
|
IP
|
$12,790.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.70 |
| Max. Negotiated Rate |
$12,278.40 |
| Rate for Payer: Aetna Commercial |
$9,848.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,976.20
|
| Rate for Payer: Cash Price |
$6,395.00
|
| Rate for Payer: Cigna Commercial |
$10,615.70
|
| Rate for Payer: First Health Commercial |
$12,150.50
|
| Rate for Payer: Humana Commercial |
$10,871.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,487.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,439.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,255.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,964.90
|
| Rate for Payer: PHCS Commercial |
$12,278.40
|
| Rate for Payer: United Healthcare All Payer |
$11,255.20
|
|
|
ALTRX +4 NEUT LNR 36 X 64
|
Facility
|
OP
|
$12,790.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.70 |
| Max. Negotiated Rate |
$12,278.40 |
| Rate for Payer: Aetna Commercial |
$9,848.30
|
| Rate for Payer: Anthem Medicaid |
$4,398.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,976.20
|
| Rate for Payer: Cash Price |
$6,395.00
|
| Rate for Payer: Cigna Commercial |
$10,615.70
|
| Rate for Payer: First Health Commercial |
$12,150.50
|
| Rate for Payer: Humana Commercial |
$10,871.50
|
| Rate for Payer: Humana KY Medicaid |
$4,398.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4,443.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,487.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,439.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,486.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,255.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,964.90
|
| Rate for Payer: PHCS Commercial |
$12,278.40
|
| Rate for Payer: United Healthcare All Payer |
$11,255.20
|
|
|
ALTRX +4 NEUT LNR 36 X 66
|
Facility
|
IP
|
$12,790.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.70 |
| Max. Negotiated Rate |
$12,278.40 |
| Rate for Payer: Aetna Commercial |
$9,848.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,976.20
|
| Rate for Payer: Cash Price |
$6,395.00
|
| Rate for Payer: Cigna Commercial |
$10,615.70
|
| Rate for Payer: First Health Commercial |
$12,150.50
|
| Rate for Payer: Humana Commercial |
$10,871.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,487.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,439.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,255.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,964.90
|
| Rate for Payer: PHCS Commercial |
$12,278.40
|
| Rate for Payer: United Healthcare All Payer |
$11,255.20
|
|
|
ALTRX +4 NEUT LNR 36 X 66
|
Facility
|
OP
|
$12,790.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.70 |
| Max. Negotiated Rate |
$12,278.40 |
| Rate for Payer: Aetna Commercial |
$9,848.30
|
| Rate for Payer: Anthem Medicaid |
$4,398.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,976.20
|
| Rate for Payer: Cash Price |
$6,395.00
|
| Rate for Payer: Cigna Commercial |
$10,615.70
|
| Rate for Payer: First Health Commercial |
$12,150.50
|
| Rate for Payer: Humana Commercial |
$10,871.50
|
| Rate for Payer: Humana KY Medicaid |
$4,398.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4,443.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,487.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,439.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,837.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,486.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,255.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,558.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,662.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,964.90
|
| Rate for Payer: PHCS Commercial |
$12,278.40
|
| Rate for Payer: United Healthcare All Payer |
$11,255.20
|
|
|
ALTRX LIP LNR 32 X 52
|
Facility
|
OP
|
$9,881.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,284.53 |
| Max. Negotiated Rate |
$9,485.76 |
| Rate for Payer: Aetna Commercial |
$7,608.37
|
| Rate for Payer: Anthem Medicaid |
$3,398.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,707.18
|
| Rate for Payer: Cash Price |
$4,940.50
|
| Rate for Payer: Cigna Commercial |
$8,201.23
|
| Rate for Payer: First Health Commercial |
$9,386.95
|
| Rate for Payer: Humana Commercial |
$8,398.85
|
| Rate for Payer: Humana KY Medicaid |
$3,398.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,432.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,102.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,292.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,964.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,466.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,695.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,410.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,976.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,284.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,063.11
|
| Rate for Payer: PHCS Commercial |
$9,485.76
|
| Rate for Payer: United Healthcare All Payer |
$8,695.28
|
|
|
ALTRX LIP LNR 32 X 52
|
Facility
|
IP
|
$9,881.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,284.53 |
| Max. Negotiated Rate |
$9,485.76 |
| Rate for Payer: Aetna Commercial |
$7,608.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,707.18
|
| Rate for Payer: Cash Price |
$4,940.50
|
| Rate for Payer: Cigna Commercial |
$8,201.23
|
| Rate for Payer: First Health Commercial |
$9,386.95
|
| Rate for Payer: Humana Commercial |
$8,398.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,102.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,292.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,964.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,695.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,410.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,976.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,284.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,063.11
|
| Rate for Payer: PHCS Commercial |
$9,485.76
|
| Rate for Payer: United Healthcare All Payer |
$8,695.28
|
|
|
ALTRX LIP LNR 32 X 54
|
Facility
|
OP
|
$9,881.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,284.53 |
| Max. Negotiated Rate |
$9,485.76 |
| Rate for Payer: Aetna Commercial |
$7,608.37
|
| Rate for Payer: Anthem Medicaid |
$3,398.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,707.18
|
| Rate for Payer: Cash Price |
$4,940.50
|
| Rate for Payer: Cigna Commercial |
$8,201.23
|
| Rate for Payer: First Health Commercial |
$9,386.95
|
| Rate for Payer: Humana Commercial |
$8,398.85
|
| Rate for Payer: Humana KY Medicaid |
$3,398.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,432.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,102.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,292.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,964.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,466.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,695.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,410.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,976.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,284.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,063.11
|
| Rate for Payer: PHCS Commercial |
$9,485.76
|
| Rate for Payer: United Healthcare All Payer |
$8,695.28
|
|
|
ALTRX LIP LNR 32 X 54
|
Facility
|
IP
|
$9,881.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,284.53 |
| Max. Negotiated Rate |
$9,485.76 |
| Rate for Payer: Aetna Commercial |
$7,608.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,707.18
|
| Rate for Payer: Cash Price |
$4,940.50
|
| Rate for Payer: Cigna Commercial |
$8,201.23
|
| Rate for Payer: First Health Commercial |
$9,386.95
|
| Rate for Payer: Humana Commercial |
$8,398.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,102.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,292.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,964.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,695.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,410.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,976.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,284.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,063.11
|
| Rate for Payer: PHCS Commercial |
$9,485.76
|
| Rate for Payer: United Healthcare All Payer |
$8,695.28
|
|
|
ALTRX LIP LNR 32 X 56
|
Facility
|
IP
|
$9,881.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,284.53 |
| Max. Negotiated Rate |
$9,485.76 |
| Rate for Payer: Aetna Commercial |
$7,608.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,707.18
|
| Rate for Payer: Cash Price |
$4,940.50
|
| Rate for Payer: Cigna Commercial |
$8,201.23
|
| Rate for Payer: First Health Commercial |
$9,386.95
|
| Rate for Payer: Humana Commercial |
$8,398.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,102.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,292.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,964.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,695.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,410.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,976.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,284.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,063.11
|
| Rate for Payer: PHCS Commercial |
$9,485.76
|
| Rate for Payer: United Healthcare All Payer |
$8,695.28
|
|
|
ALTRX LIP LNR 32 X 56
|
Facility
|
OP
|
$9,881.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,284.53 |
| Max. Negotiated Rate |
$9,485.76 |
| Rate for Payer: Aetna Commercial |
$7,608.37
|
| Rate for Payer: Anthem Medicaid |
$3,398.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,707.18
|
| Rate for Payer: Cash Price |
$4,940.50
|
| Rate for Payer: Cigna Commercial |
$8,201.23
|
| Rate for Payer: First Health Commercial |
$9,386.95
|
| Rate for Payer: Humana Commercial |
$8,398.85
|
| Rate for Payer: Humana KY Medicaid |
$3,398.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,432.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,102.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,292.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,964.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,466.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,695.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,410.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,976.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,284.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,063.11
|
| Rate for Payer: PHCS Commercial |
$9,485.76
|
| Rate for Payer: United Healthcare All Payer |
$8,695.28
|
|
|
ALTRX LIP LNR 32 X 58
|
Facility
|
IP
|
$9,881.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,284.53 |
| Max. Negotiated Rate |
$9,485.76 |
| Rate for Payer: Aetna Commercial |
$7,608.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,707.18
|
| Rate for Payer: Cash Price |
$4,940.50
|
| Rate for Payer: Cigna Commercial |
$8,201.23
|
| Rate for Payer: First Health Commercial |
$9,386.95
|
| Rate for Payer: Humana Commercial |
$8,398.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,102.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,292.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,964.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,695.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,410.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,976.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,284.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,063.11
|
| Rate for Payer: PHCS Commercial |
$9,485.76
|
| Rate for Payer: United Healthcare All Payer |
$8,695.28
|
|
|
ALTRX LIP LNR 32 X 58
|
Facility
|
OP
|
$9,881.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,284.53 |
| Max. Negotiated Rate |
$9,485.76 |
| Rate for Payer: Aetna Commercial |
$7,608.37
|
| Rate for Payer: Anthem Medicaid |
$3,398.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,707.18
|
| Rate for Payer: Cash Price |
$4,940.50
|
| Rate for Payer: Cigna Commercial |
$8,201.23
|
| Rate for Payer: First Health Commercial |
$9,386.95
|
| Rate for Payer: Humana Commercial |
$8,398.85
|
| Rate for Payer: Humana KY Medicaid |
$3,398.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,432.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,102.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,292.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,964.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,466.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,695.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,410.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,976.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,284.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,063.11
|
| Rate for Payer: PHCS Commercial |
$9,485.76
|
| Rate for Payer: United Healthcare All Payer |
$8,695.28
|
|
|
ALTRX LIP LNR 32 X 60
|
Facility
|
OP
|
$9,881.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,284.53 |
| Max. Negotiated Rate |
$9,485.76 |
| Rate for Payer: Aetna Commercial |
$7,608.37
|
| Rate for Payer: Anthem Medicaid |
$3,398.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,707.18
|
| Rate for Payer: Cash Price |
$4,940.50
|
| Rate for Payer: Cigna Commercial |
$8,201.23
|
| Rate for Payer: First Health Commercial |
$9,386.95
|
| Rate for Payer: Humana Commercial |
$8,398.85
|
| Rate for Payer: Humana KY Medicaid |
$3,398.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,432.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,102.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,292.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,964.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,466.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,695.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,410.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,976.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,284.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,063.11
|
| Rate for Payer: PHCS Commercial |
$9,485.76
|
| Rate for Payer: United Healthcare All Payer |
$8,695.28
|
|
|
ALTRX LIP LNR 32 X 60
|
Facility
|
IP
|
$9,881.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,284.53 |
| Max. Negotiated Rate |
$9,485.76 |
| Rate for Payer: Aetna Commercial |
$7,608.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,707.18
|
| Rate for Payer: Cash Price |
$4,940.50
|
| Rate for Payer: Cigna Commercial |
$8,201.23
|
| Rate for Payer: First Health Commercial |
$9,386.95
|
| Rate for Payer: Humana Commercial |
$8,398.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,102.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,292.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,964.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,695.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,410.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,976.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,284.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,063.11
|
| Rate for Payer: PHCS Commercial |
$9,485.76
|
| Rate for Payer: United Healthcare All Payer |
$8,695.28
|
|
|
ALTRX LIP LNR 32 X 62
|
Facility
|
IP
|
$9,881.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,284.53 |
| Max. Negotiated Rate |
$9,485.76 |
| Rate for Payer: Aetna Commercial |
$7,608.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,707.18
|
| Rate for Payer: Cash Price |
$4,940.50
|
| Rate for Payer: Cigna Commercial |
$8,201.23
|
| Rate for Payer: First Health Commercial |
$9,386.95
|
| Rate for Payer: Humana Commercial |
$8,398.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,102.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,292.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,964.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,695.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,410.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,976.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,284.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,063.11
|
| Rate for Payer: PHCS Commercial |
$9,485.76
|
| Rate for Payer: United Healthcare All Payer |
$8,695.28
|
|
