|
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
|
|
|
ALTRX LIP LNR 32 X 64
|
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 64
|
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 66
|
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 66
|
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 NEUT LNR 32 X 50
|
Facility
|
IP
|
$9,771.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,270.30 |
| Max. Negotiated Rate |
$9,380.64 |
| Rate for Payer: Aetna Commercial |
$7,524.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,621.77
|
| Rate for Payer: Cash Price |
$4,885.75
|
| Rate for Payer: Cigna Commercial |
$8,110.34
|
| Rate for Payer: First Health Commercial |
$9,282.92
|
| Rate for Payer: Humana Commercial |
$8,305.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,012.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,211.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,931.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,598.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,328.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,954.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,270.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,029.16
|
| Rate for Payer: PHCS Commercial |
$9,380.64
|
| Rate for Payer: United Healthcare All Payer |
$8,598.92
|
|
|
ALTRX NEUT LNR 32 X 50
|
Facility
|
OP
|
$9,771.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,270.30 |
| Max. Negotiated Rate |
$9,380.64 |
| Rate for Payer: Aetna Commercial |
$7,524.06
|
| Rate for Payer: Anthem Medicaid |
$3,360.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,621.77
|
| Rate for Payer: Cash Price |
$4,885.75
|
| Rate for Payer: Cigna Commercial |
$8,110.34
|
| Rate for Payer: First Health Commercial |
$9,282.92
|
| Rate for Payer: Humana Commercial |
$8,305.78
|
| Rate for Payer: Humana KY Medicaid |
$3,360.42
|
| Rate for Payer: Kentucky WC Medicaid |
$3,394.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,012.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,211.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,931.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,427.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,598.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,328.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,954.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,270.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,029.16
|
| Rate for Payer: PHCS Commercial |
$9,380.64
|
| Rate for Payer: United Healthcare All Payer |
$8,598.92
|
|
|
ALTRX NEUT LNR 32 X 54
|
Facility
|
IP
|
$9,771.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,270.30 |
| Max. Negotiated Rate |
$9,380.64 |
| Rate for Payer: Aetna Commercial |
$7,524.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,621.77
|
| Rate for Payer: Cash Price |
$4,885.75
|
| Rate for Payer: Cigna Commercial |
$8,110.34
|
| Rate for Payer: First Health Commercial |
$9,282.92
|
| Rate for Payer: Humana Commercial |
$8,305.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,012.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,211.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,931.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,598.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,328.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,954.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,270.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,029.16
|
| Rate for Payer: PHCS Commercial |
$9,380.64
|
| Rate for Payer: United Healthcare All Payer |
$8,598.92
|
|
|
ALTRX NEUT LNR 32 X 54
|
Facility
|
OP
|
$9,771.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,270.30 |
| Max. Negotiated Rate |
$9,380.64 |
| Rate for Payer: Aetna Commercial |
$7,524.06
|
| Rate for Payer: Anthem Medicaid |
$3,360.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,621.77
|
| Rate for Payer: Cash Price |
$4,885.75
|
| Rate for Payer: Cigna Commercial |
$8,110.34
|
| Rate for Payer: First Health Commercial |
$9,282.92
|
| Rate for Payer: Humana Commercial |
$8,305.78
|
| Rate for Payer: Humana KY Medicaid |
$3,360.42
|
| Rate for Payer: Kentucky WC Medicaid |
$3,394.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,012.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,211.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,931.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,427.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,598.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,328.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,954.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,270.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,029.16
|
| Rate for Payer: PHCS Commercial |
$9,380.64
|
| Rate for Payer: United Healthcare All Payer |
$8,598.92
|
|
|
ALTRX NEUT LNR 32 X 56
|
Facility
|
IP
|
$9,771.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,270.30 |
| Max. Negotiated Rate |
$9,380.64 |
| Rate for Payer: Aetna Commercial |
$7,524.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,621.77
|
| Rate for Payer: Cash Price |
$4,885.75
|
| Rate for Payer: Cigna Commercial |
$8,110.34
|
| Rate for Payer: First Health Commercial |
$9,282.92
|
| Rate for Payer: Humana Commercial |
$8,305.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,012.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,211.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,931.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,598.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,328.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,954.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,270.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,029.16
|
| Rate for Payer: PHCS Commercial |
$9,380.64
|
| Rate for Payer: United Healthcare All Payer |
$8,598.92
|
|
|
ALTRX NEUT LNR 32 X 56
|
Facility
|
OP
|
$9,771.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,270.30 |
| Max. Negotiated Rate |
$9,380.64 |
| Rate for Payer: Aetna Commercial |
$7,524.06
|
| Rate for Payer: Anthem Medicaid |
$3,360.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,621.77
|
| Rate for Payer: Cash Price |
$4,885.75
|
| Rate for Payer: Cigna Commercial |
$8,110.34
|
| Rate for Payer: First Health Commercial |
$9,282.92
|
| Rate for Payer: Humana Commercial |
$8,305.78
|
| Rate for Payer: Humana KY Medicaid |
$3,360.42
|
| Rate for Payer: Kentucky WC Medicaid |
$3,394.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,012.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,211.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,931.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,427.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,598.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,328.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,954.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,270.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,029.16
|
| Rate for Payer: PHCS Commercial |
$9,380.64
|
| Rate for Payer: United Healthcare All Payer |
$8,598.92
|
|
|
ALTRX NEUT LNR 32 X 58
|
Facility
|
IP
|
$9,771.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,270.30 |
| Max. Negotiated Rate |
$9,380.64 |
| Rate for Payer: Aetna Commercial |
$7,524.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,621.77
|
| Rate for Payer: Cash Price |
$4,885.75
|
| Rate for Payer: Cigna Commercial |
$8,110.34
|
| Rate for Payer: First Health Commercial |
$9,282.92
|
| Rate for Payer: Humana Commercial |
$8,305.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,012.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,211.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,931.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,598.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,328.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,954.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,270.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,029.16
|
| Rate for Payer: PHCS Commercial |
$9,380.64
|
| Rate for Payer: United Healthcare All Payer |
$8,598.92
|
|
|
ALTRX NEUT LNR 32 X 58
|
Facility
|
OP
|
$9,771.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,270.30 |
| Max. Negotiated Rate |
$9,380.64 |
| Rate for Payer: Aetna Commercial |
$7,524.06
|
| Rate for Payer: Anthem Medicaid |
$3,360.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,621.77
|
| Rate for Payer: Cash Price |
$4,885.75
|
| Rate for Payer: Cigna Commercial |
$8,110.34
|
| Rate for Payer: First Health Commercial |
$9,282.92
|
| Rate for Payer: Humana Commercial |
$8,305.78
|
| Rate for Payer: Humana KY Medicaid |
$3,360.42
|
| Rate for Payer: Kentucky WC Medicaid |
$3,394.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,012.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,211.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,931.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,427.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,598.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,328.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,954.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,270.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,029.16
|
| Rate for Payer: PHCS Commercial |
$9,380.64
|
| Rate for Payer: United Healthcare All Payer |
$8,598.92
|
|
|
ALTRX NEUT LNR 36 X 52
|
Facility
|
OP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$604.50 |
| Max. Negotiated Rate |
$4,464.00 |
| Rate for Payer: Aetna Commercial |
$3,580.50
|
| Rate for Payer: Anthem Medicaid |
$1,599.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,627.00
|
| Rate for Payer: Cash Price |
$2,325.00
|
| Rate for Payer: Cigna Commercial |
$3,859.50
|
| Rate for Payer: First Health Commercial |
$4,417.50
|
| Rate for Payer: Humana Commercial |
$3,952.50
|
| Rate for Payer: Humana KY Medicaid |
$1,599.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,615.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,813.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,431.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,395.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,631.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,092.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$930.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$604.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,441.50
|
| Rate for Payer: PHCS Commercial |
$4,464.00
|
| Rate for Payer: United Healthcare All Payer |
$4,092.00
|
|
|
ALTRX NEUT LNR 36 X 52
|
Facility
|
IP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$604.50 |
| Max. Negotiated Rate |
$4,464.00 |
| Rate for Payer: Aetna Commercial |
$3,580.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,627.00
|
| Rate for Payer: Cash Price |
$2,325.00
|
| Rate for Payer: Cigna Commercial |
$3,859.50
|
| Rate for Payer: First Health Commercial |
$4,417.50
|
| Rate for Payer: Humana Commercial |
$3,952.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,813.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,431.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,395.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,092.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$930.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$604.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,441.50
|
| Rate for Payer: PHCS Commercial |
$4,464.00
|
| Rate for Payer: United Healthcare All Payer |
$4,092.00
|
|
|
ALTRX 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 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 NEUT LNR 36 X 56
|
Facility
|
IP
|
$11,914.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.82 |
| Max. Negotiated Rate |
$11,437.44 |
| Rate for Payer: Aetna Commercial |
$9,173.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,292.92
|
| Rate for Payer: Cash Price |
$5,957.00
|
| Rate for Payer: Cigna Commercial |
$9,888.62
|
| Rate for Payer: First Health Commercial |
$11,318.30
|
| Rate for Payer: Humana Commercial |
$10,126.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,769.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,792.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,574.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,484.32
|
| Rate for Payer: Ohio Health Group HMO |
$8,935.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,382.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,548.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,693.34
|
| Rate for Payer: PHCS Commercial |
$11,437.44
|
| Rate for Payer: United Healthcare All Payer |
$10,484.32
|
|
|
ALTRX NEUT LNR 36 X 56
|
Facility
|
OP
|
$11,914.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.82 |
| Max. Negotiated Rate |
$11,437.44 |
| Rate for Payer: Aetna Commercial |
$9,173.78
|
| Rate for Payer: Anthem Medicaid |
$4,097.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,292.92
|
| Rate for Payer: Cash Price |
$5,957.00
|
| Rate for Payer: Cigna Commercial |
$9,888.62
|
| Rate for Payer: First Health Commercial |
$11,318.30
|
| Rate for Payer: Humana Commercial |
$10,126.90
|
| Rate for Payer: Humana KY Medicaid |
$4,097.22
|
| Rate for Payer: Kentucky WC Medicaid |
$4,138.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,769.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,792.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,574.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,179.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,484.32
|
| Rate for Payer: Ohio Health Group HMO |
$8,935.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,382.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,548.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,693.34
|
| Rate for Payer: PHCS Commercial |
$11,437.44
|
| Rate for Payer: United Healthcare All Payer |
$10,484.32
|
|
|
ALTRX NEUT LNR 36 X 58
|
Facility
|
IP
|
$11,914.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.82 |
| Max. Negotiated Rate |
$11,437.44 |
| Rate for Payer: Aetna Commercial |
$9,173.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,292.92
|
| Rate for Payer: Cash Price |
$5,957.00
|
| Rate for Payer: Cigna Commercial |
$9,888.62
|
| Rate for Payer: First Health Commercial |
$11,318.30
|
| Rate for Payer: Humana Commercial |
$10,126.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,769.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,792.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,574.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,484.32
|
| Rate for Payer: Ohio Health Group HMO |
$8,935.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,382.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,548.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,693.34
|
| Rate for Payer: PHCS Commercial |
$11,437.44
|
| Rate for Payer: United Healthcare All Payer |
$10,484.32
|
|
|
ALTRX NEUT LNR 36 X 58
|
Facility
|
OP
|
$11,914.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.82 |
| Max. Negotiated Rate |
$11,437.44 |
| Rate for Payer: Aetna Commercial |
$9,173.78
|
| Rate for Payer: Anthem Medicaid |
$4,097.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,292.92
|
| Rate for Payer: Cash Price |
$5,957.00
|
| Rate for Payer: Cigna Commercial |
$9,888.62
|
| Rate for Payer: First Health Commercial |
$11,318.30
|
| Rate for Payer: Humana Commercial |
$10,126.90
|
| Rate for Payer: Humana KY Medicaid |
$4,097.22
|
| Rate for Payer: Kentucky WC Medicaid |
$4,138.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,769.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,792.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,574.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,179.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,484.32
|
| Rate for Payer: Ohio Health Group HMO |
$8,935.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,382.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,548.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,693.34
|
| Rate for Payer: PHCS Commercial |
$11,437.44
|
| Rate for Payer: United Healthcare All Payer |
$10,484.32
|
|
|
ALTRX NEUT LNR 36 X 60
|
Facility
|
OP
|
$11,914.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.82 |
| Max. Negotiated Rate |
$11,437.44 |
| Rate for Payer: Aetna Commercial |
$9,173.78
|
| Rate for Payer: Anthem Medicaid |
$4,097.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,292.92
|
| Rate for Payer: Cash Price |
$5,957.00
|
| Rate for Payer: Cigna Commercial |
$9,888.62
|
| Rate for Payer: First Health Commercial |
$11,318.30
|
| Rate for Payer: Humana Commercial |
$10,126.90
|
| Rate for Payer: Humana KY Medicaid |
$4,097.22
|
| Rate for Payer: Kentucky WC Medicaid |
$4,138.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,769.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,792.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,574.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,179.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,484.32
|
| Rate for Payer: Ohio Health Group HMO |
$8,935.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,382.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,548.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,693.34
|
| Rate for Payer: PHCS Commercial |
$11,437.44
|
| Rate for Payer: United Healthcare All Payer |
$10,484.32
|
|
|
ALTRX NEUT LNR 36 X 60
|
Facility
|
IP
|
$11,914.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.82 |
| Max. Negotiated Rate |
$11,437.44 |
| Rate for Payer: Aetna Commercial |
$9,173.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,292.92
|
| Rate for Payer: Cash Price |
$5,957.00
|
| Rate for Payer: Cigna Commercial |
$9,888.62
|
| Rate for Payer: First Health Commercial |
$11,318.30
|
| Rate for Payer: Humana Commercial |
$10,126.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,769.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,792.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,574.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,484.32
|
| Rate for Payer: Ohio Health Group HMO |
$8,935.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,382.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,548.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,693.34
|
| Rate for Payer: PHCS Commercial |
$11,437.44
|
| Rate for Payer: United Healthcare All Payer |
$10,484.32
|
|
|
ALTRX NEUT LNR 36 X 62
|
Facility
|
OP
|
$11,914.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.82 |
| Max. Negotiated Rate |
$11,437.44 |
| Rate for Payer: Aetna Commercial |
$9,173.78
|
| Rate for Payer: Anthem Medicaid |
$4,097.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,292.92
|
| Rate for Payer: Cash Price |
$5,957.00
|
| Rate for Payer: Cigna Commercial |
$9,888.62
|
| Rate for Payer: First Health Commercial |
$11,318.30
|
| Rate for Payer: Humana Commercial |
$10,126.90
|
| Rate for Payer: Humana KY Medicaid |
$4,097.22
|
| Rate for Payer: Kentucky WC Medicaid |
$4,138.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,769.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,792.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,574.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,179.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,484.32
|
| Rate for Payer: Ohio Health Group HMO |
$8,935.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,382.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,548.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,693.34
|
| Rate for Payer: PHCS Commercial |
$11,437.44
|
| Rate for Payer: United Healthcare All Payer |
$10,484.32
|
|
|
ALTRX NEUT LNR 36 X 62
|
Facility
|
IP
|
$11,914.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.82 |
| Max. Negotiated Rate |
$11,437.44 |
| Rate for Payer: Aetna Commercial |
$9,173.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,292.92
|
| Rate for Payer: Cash Price |
$5,957.00
|
| Rate for Payer: Cigna Commercial |
$9,888.62
|
| Rate for Payer: First Health Commercial |
$11,318.30
|
| Rate for Payer: Humana Commercial |
$10,126.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,769.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,792.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,574.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,484.32
|
| Rate for Payer: Ohio Health Group HMO |
$8,935.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,382.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,548.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,693.34
|
| Rate for Payer: PHCS Commercial |
$11,437.44
|
| Rate for Payer: United Healthcare All Payer |
$10,484.32
|
|
