|
ALTRX +4 NEUT 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 NEUT 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 NEUT 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 NEUT 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 +4 NEUT 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 LIP LNR 32 X 52
|
Facility
|
IP
|
$10,081.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,024.30 |
| Max. Negotiated Rate |
$9,677.76 |
| Rate for Payer: Aetna Commercial |
$7,762.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.18
|
| Rate for Payer: Cash Price |
$5,040.50
|
| Rate for Payer: Cigna Commercial |
$8,367.23
|
| Rate for Payer: First Health Commercial |
$9,576.95
|
| Rate for Payer: Humana Commercial |
$8,568.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,266.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,439.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,560.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,064.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,770.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,955.89
|
| Rate for Payer: PHCS Commercial |
$9,677.76
|
| Rate for Payer: United Healthcare All Payer |
$8,871.28
|
|
|
ALTRX LIP LNR 32 X 52
|
Facility
|
OP
|
$10,081.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,024.30 |
| Max. Negotiated Rate |
$9,677.76 |
| Rate for Payer: Aetna Commercial |
$7,762.37
|
| Rate for Payer: Anthem Medicaid |
$3,466.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.18
|
| Rate for Payer: Cash Price |
$5,040.50
|
| Rate for Payer: Cigna Commercial |
$8,367.23
|
| Rate for Payer: First Health Commercial |
$9,576.95
|
| Rate for Payer: Humana Commercial |
$8,568.85
|
| Rate for Payer: Humana KY Medicaid |
$3,466.86
|
| Rate for Payer: Kentucky WC Medicaid |
$3,502.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,266.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,439.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,536.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,560.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,064.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,770.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,955.89
|
| Rate for Payer: PHCS Commercial |
$9,677.76
|
| Rate for Payer: United Healthcare All Payer |
$8,871.28
|
|
|
ALTRX LIP LNR 32 X 54
|
Facility
|
IP
|
$10,081.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,024.30 |
| Max. Negotiated Rate |
$9,677.76 |
| Rate for Payer: Aetna Commercial |
$7,762.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.18
|
| Rate for Payer: Cash Price |
$5,040.50
|
| Rate for Payer: Cigna Commercial |
$8,367.23
|
| Rate for Payer: First Health Commercial |
$9,576.95
|
| Rate for Payer: Humana Commercial |
$8,568.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,266.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,439.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,560.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,064.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,770.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,955.89
|
| Rate for Payer: PHCS Commercial |
$9,677.76
|
| Rate for Payer: United Healthcare All Payer |
$8,871.28
|
|
|
ALTRX LIP LNR 32 X 54
|
Facility
|
OP
|
$10,081.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,024.30 |
| Max. Negotiated Rate |
$9,677.76 |
| Rate for Payer: Aetna Commercial |
$7,762.37
|
| Rate for Payer: Anthem Medicaid |
$3,466.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.18
|
| Rate for Payer: Cash Price |
$5,040.50
|
| Rate for Payer: Cigna Commercial |
$8,367.23
|
| Rate for Payer: First Health Commercial |
$9,576.95
|
| Rate for Payer: Humana Commercial |
$8,568.85
|
| Rate for Payer: Humana KY Medicaid |
$3,466.86
|
| Rate for Payer: Kentucky WC Medicaid |
$3,502.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,266.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,439.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,536.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,560.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,064.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,770.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,955.89
|
| Rate for Payer: PHCS Commercial |
$9,677.76
|
| Rate for Payer: United Healthcare All Payer |
$8,871.28
|
|
|
ALTRX LIP LNR 32 X 56
|
Facility
|
OP
|
$10,081.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,024.30 |
| Max. Negotiated Rate |
$9,677.76 |
| Rate for Payer: Aetna Commercial |
$7,762.37
|
| Rate for Payer: Anthem Medicaid |
$3,466.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.18
|
| Rate for Payer: Cash Price |
$5,040.50
|
| Rate for Payer: Cigna Commercial |
$8,367.23
|
| Rate for Payer: First Health Commercial |
$9,576.95
|
| Rate for Payer: Humana Commercial |
$8,568.85
|
| Rate for Payer: Humana KY Medicaid |
$3,466.86
|
| Rate for Payer: Kentucky WC Medicaid |
$3,502.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,266.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,439.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,536.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,560.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,064.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,770.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,955.89
|
| Rate for Payer: PHCS Commercial |
$9,677.76
|
| Rate for Payer: United Healthcare All Payer |
$8,871.28
|
|
|
ALTRX LIP LNR 32 X 56
|
Facility
|
IP
|
$10,081.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,024.30 |
| Max. Negotiated Rate |
$9,677.76 |
| Rate for Payer: Aetna Commercial |
$7,762.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.18
|
| Rate for Payer: Cash Price |
$5,040.50
|
| Rate for Payer: Cigna Commercial |
$8,367.23
|
| Rate for Payer: First Health Commercial |
$9,576.95
|
| Rate for Payer: Humana Commercial |
$8,568.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,266.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,439.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,560.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,064.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,770.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,955.89
|
| Rate for Payer: PHCS Commercial |
$9,677.76
|
| Rate for Payer: United Healthcare All Payer |
$8,871.28
|
|
|
ALTRX LIP LNR 32 X 58
|
Facility
|
OP
|
$10,081.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,024.30 |
| Max. Negotiated Rate |
$9,677.76 |
| Rate for Payer: Aetna Commercial |
$7,762.37
|
| Rate for Payer: Anthem Medicaid |
$3,466.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.18
|
| Rate for Payer: Cash Price |
$5,040.50
|
| Rate for Payer: Cigna Commercial |
$8,367.23
|
| Rate for Payer: First Health Commercial |
$9,576.95
|
| Rate for Payer: Humana Commercial |
$8,568.85
|
| Rate for Payer: Humana KY Medicaid |
$3,466.86
|
| Rate for Payer: Kentucky WC Medicaid |
$3,502.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,266.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,439.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,536.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,560.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,064.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,770.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,955.89
|
| Rate for Payer: PHCS Commercial |
$9,677.76
|
| Rate for Payer: United Healthcare All Payer |
$8,871.28
|
|
|
ALTRX LIP LNR 32 X 58
|
Facility
|
IP
|
$10,081.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,024.30 |
| Max. Negotiated Rate |
$9,677.76 |
| Rate for Payer: Aetna Commercial |
$7,762.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.18
|
| Rate for Payer: Cash Price |
$5,040.50
|
| Rate for Payer: Cigna Commercial |
$8,367.23
|
| Rate for Payer: First Health Commercial |
$9,576.95
|
| Rate for Payer: Humana Commercial |
$8,568.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,266.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,439.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,560.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,064.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,770.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,955.89
|
| Rate for Payer: PHCS Commercial |
$9,677.76
|
| Rate for Payer: United Healthcare All Payer |
$8,871.28
|
|
|
ALTRX LIP LNR 32 X 60
|
Facility
|
OP
|
$10,081.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,024.30 |
| Max. Negotiated Rate |
$9,677.76 |
| Rate for Payer: Aetna Commercial |
$7,762.37
|
| Rate for Payer: Anthem Medicaid |
$3,466.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.18
|
| Rate for Payer: Cash Price |
$5,040.50
|
| Rate for Payer: Cigna Commercial |
$8,367.23
|
| Rate for Payer: First Health Commercial |
$9,576.95
|
| Rate for Payer: Humana Commercial |
$8,568.85
|
| Rate for Payer: Humana KY Medicaid |
$3,466.86
|
| Rate for Payer: Kentucky WC Medicaid |
$3,502.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,266.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,439.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,536.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,560.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,064.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,770.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,955.89
|
| Rate for Payer: PHCS Commercial |
$9,677.76
|
| Rate for Payer: United Healthcare All Payer |
$8,871.28
|
|
|
ALTRX LIP LNR 32 X 60
|
Facility
|
IP
|
$10,081.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,024.30 |
| Max. Negotiated Rate |
$9,677.76 |
| Rate for Payer: Aetna Commercial |
$7,762.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.18
|
| Rate for Payer: Cash Price |
$5,040.50
|
| Rate for Payer: Cigna Commercial |
$8,367.23
|
| Rate for Payer: First Health Commercial |
$9,576.95
|
| Rate for Payer: Humana Commercial |
$8,568.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,266.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,439.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,560.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,064.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,770.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,955.89
|
| Rate for Payer: PHCS Commercial |
$9,677.76
|
| Rate for Payer: United Healthcare All Payer |
$8,871.28
|
|
|
ALTRX LIP LNR 32 X 62
|
Facility
|
IP
|
$10,081.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,024.30 |
| Max. Negotiated Rate |
$9,677.76 |
| Rate for Payer: Aetna Commercial |
$7,762.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.18
|
| Rate for Payer: Cash Price |
$5,040.50
|
| Rate for Payer: Cigna Commercial |
$8,367.23
|
| Rate for Payer: First Health Commercial |
$9,576.95
|
| Rate for Payer: Humana Commercial |
$8,568.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,266.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,439.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,560.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,064.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,770.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,955.89
|
| Rate for Payer: PHCS Commercial |
$9,677.76
|
| Rate for Payer: United Healthcare All Payer |
$8,871.28
|
|
|
ALTRX LIP LNR 32 X 62
|
Facility
|
OP
|
$10,081.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,024.30 |
| Max. Negotiated Rate |
$9,677.76 |
| Rate for Payer: Aetna Commercial |
$7,762.37
|
| Rate for Payer: Anthem Medicaid |
$3,466.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.18
|
| Rate for Payer: Cash Price |
$5,040.50
|
| Rate for Payer: Cigna Commercial |
$8,367.23
|
| Rate for Payer: First Health Commercial |
$9,576.95
|
| Rate for Payer: Humana Commercial |
$8,568.85
|
| Rate for Payer: Humana KY Medicaid |
$3,466.86
|
| Rate for Payer: Kentucky WC Medicaid |
$3,502.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,266.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,439.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,536.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,560.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,064.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,770.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,955.89
|
| Rate for Payer: PHCS Commercial |
$9,677.76
|
| Rate for Payer: United Healthcare All Payer |
$8,871.28
|
|
|
ALTRX LIP LNR 32 X 64
|
Facility
|
IP
|
$10,081.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,024.30 |
| Max. Negotiated Rate |
$9,677.76 |
| Rate for Payer: Aetna Commercial |
$7,762.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.18
|
| Rate for Payer: Cash Price |
$5,040.50
|
| Rate for Payer: Cigna Commercial |
$8,367.23
|
| Rate for Payer: First Health Commercial |
$9,576.95
|
| Rate for Payer: Humana Commercial |
$8,568.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,266.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,439.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,560.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,064.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,770.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,955.89
|
| Rate for Payer: PHCS Commercial |
$9,677.76
|
| Rate for Payer: United Healthcare All Payer |
$8,871.28
|
|
|
ALTRX LIP LNR 32 X 64
|
Facility
|
OP
|
$10,081.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,024.30 |
| Max. Negotiated Rate |
$9,677.76 |
| Rate for Payer: Aetna Commercial |
$7,762.37
|
| Rate for Payer: Anthem Medicaid |
$3,466.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.18
|
| Rate for Payer: Cash Price |
$5,040.50
|
| Rate for Payer: Cigna Commercial |
$8,367.23
|
| Rate for Payer: First Health Commercial |
$9,576.95
|
| Rate for Payer: Humana Commercial |
$8,568.85
|
| Rate for Payer: Humana KY Medicaid |
$3,466.86
|
| Rate for Payer: Kentucky WC Medicaid |
$3,502.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,266.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,439.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,536.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,560.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,064.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,770.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,955.89
|
| Rate for Payer: PHCS Commercial |
$9,677.76
|
| Rate for Payer: United Healthcare All Payer |
$8,871.28
|
|
|
ALTRX LIP LNR 32 X 66
|
Facility
|
IP
|
$10,081.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,024.30 |
| Max. Negotiated Rate |
$9,677.76 |
| Rate for Payer: Aetna Commercial |
$7,762.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.18
|
| Rate for Payer: Cash Price |
$5,040.50
|
| Rate for Payer: Cigna Commercial |
$8,367.23
|
| Rate for Payer: First Health Commercial |
$9,576.95
|
| Rate for Payer: Humana Commercial |
$8,568.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,266.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,439.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,560.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,064.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,770.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,955.89
|
| Rate for Payer: PHCS Commercial |
$9,677.76
|
| Rate for Payer: United Healthcare All Payer |
$8,871.28
|
|
|
ALTRX LIP LNR 32 X 66
|
Facility
|
OP
|
$10,081.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,024.30 |
| Max. Negotiated Rate |
$9,677.76 |
| Rate for Payer: Aetna Commercial |
$7,762.37
|
| Rate for Payer: Anthem Medicaid |
$3,466.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.18
|
| Rate for Payer: Cash Price |
$5,040.50
|
| Rate for Payer: Cigna Commercial |
$8,367.23
|
| Rate for Payer: First Health Commercial |
$9,576.95
|
| Rate for Payer: Humana Commercial |
$8,568.85
|
| Rate for Payer: Humana KY Medicaid |
$3,466.86
|
| Rate for Payer: Kentucky WC Medicaid |
$3,502.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,266.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,439.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,536.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,560.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,064.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,770.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,955.89
|
| Rate for Payer: PHCS Commercial |
$9,677.76
|
| Rate for Payer: United Healthcare All Payer |
$8,871.28
|
|
|
ALTRX NEUT LNR 32 X 50
|
Facility
|
OP
|
$9,971.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,991.45 |
| Max. Negotiated Rate |
$9,572.64 |
| Rate for Payer: Aetna Commercial |
$7,678.06
|
| Rate for Payer: Anthem Medicaid |
$3,429.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,777.77
|
| Rate for Payer: Cash Price |
$4,985.75
|
| Rate for Payer: Cigna Commercial |
$8,276.34
|
| Rate for Payer: First Health Commercial |
$9,472.92
|
| Rate for Payer: Humana Commercial |
$8,475.77
|
| Rate for Payer: Humana KY Medicaid |
$3,429.20
|
| Rate for Payer: Kentucky WC Medicaid |
$3,464.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,176.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,358.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,991.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,498.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,774.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,478.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,977.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,675.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,880.34
|
| Rate for Payer: PHCS Commercial |
$9,572.64
|
| Rate for Payer: United Healthcare All Payer |
$8,774.92
|
|
|
ALTRX NEUT LNR 32 X 50
|
Facility
|
IP
|
$9,971.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,991.45 |
| Max. Negotiated Rate |
$9,572.64 |
| Rate for Payer: Aetna Commercial |
$7,678.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,777.77
|
| Rate for Payer: Cash Price |
$4,985.75
|
| Rate for Payer: Cigna Commercial |
$8,276.34
|
| Rate for Payer: First Health Commercial |
$9,472.92
|
| Rate for Payer: Humana Commercial |
$8,475.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,176.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,358.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,991.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,774.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,478.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,977.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,675.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,880.34
|
| Rate for Payer: PHCS Commercial |
$9,572.64
|
| Rate for Payer: United Healthcare All Payer |
$8,774.92
|
|
|
ALTRX NEUT LNR 32 X 54
|
Facility
|
IP
|
$9,971.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,991.45 |
| Max. Negotiated Rate |
$9,572.64 |
| Rate for Payer: Aetna Commercial |
$7,678.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,777.77
|
| Rate for Payer: Cash Price |
$4,985.75
|
| Rate for Payer: Cigna Commercial |
$8,276.34
|
| Rate for Payer: First Health Commercial |
$9,472.92
|
| Rate for Payer: Humana Commercial |
$8,475.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,176.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,358.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,991.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,774.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,478.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,977.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,675.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,880.34
|
| Rate for Payer: PHCS Commercial |
$9,572.64
|
| Rate for Payer: United Healthcare All Payer |
$8,774.92
|
|
|
ALTRX NEUT LNR 32 X 54
|
Facility
|
OP
|
$9,971.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,991.45 |
| Max. Negotiated Rate |
$9,572.64 |
| Rate for Payer: Aetna Commercial |
$7,678.06
|
| Rate for Payer: Anthem Medicaid |
$3,429.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,777.77
|
| Rate for Payer: Cash Price |
$4,985.75
|
| Rate for Payer: Cigna Commercial |
$8,276.34
|
| Rate for Payer: First Health Commercial |
$9,472.92
|
| Rate for Payer: Humana Commercial |
$8,475.77
|
| Rate for Payer: Humana KY Medicaid |
$3,429.20
|
| Rate for Payer: Kentucky WC Medicaid |
$3,464.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,176.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,358.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,991.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,498.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,774.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,478.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,977.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,675.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,880.34
|
| Rate for Payer: PHCS Commercial |
$9,572.64
|
| Rate for Payer: United Healthcare All Payer |
$8,774.92
|
|
