|
ALTRX NEUT LNR 32 X 56
|
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 56
|
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 58
|
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 58
|
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 36 X 52
|
Facility
|
OP
|
$4,625.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.50 |
| Max. Negotiated Rate |
$4,440.00 |
| Rate for Payer: Aetna Commercial |
$3,561.25
|
| Rate for Payer: Anthem Medicaid |
$1,590.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,607.50
|
| Rate for Payer: Cash Price |
$2,312.50
|
| Rate for Payer: Cigna Commercial |
$3,838.75
|
| Rate for Payer: First Health Commercial |
$4,393.75
|
| Rate for Payer: Humana Commercial |
$3,931.25
|
| Rate for Payer: Humana KY Medicaid |
$1,590.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,606.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,792.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,413.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,387.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,622.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,070.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,468.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,023.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,191.25
|
| Rate for Payer: PHCS Commercial |
$4,440.00
|
| Rate for Payer: United Healthcare All Payer |
$4,070.00
|
|
|
ALTRX NEUT LNR 36 X 52
|
Facility
|
IP
|
$4,625.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.50 |
| Max. Negotiated Rate |
$4,440.00 |
| Rate for Payer: Aetna Commercial |
$3,561.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,607.50
|
| Rate for Payer: Cash Price |
$2,312.50
|
| Rate for Payer: Cigna Commercial |
$3,838.75
|
| Rate for Payer: First Health Commercial |
$4,393.75
|
| Rate for Payer: Humana Commercial |
$3,931.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,792.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,413.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,387.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,070.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,468.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,023.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,191.25
|
| Rate for Payer: PHCS Commercial |
$4,440.00
|
| Rate for Payer: United Healthcare All Payer |
$4,070.00
|
|
|
ALTRX NEUT LNR 36 X 54
|
Facility
|
IP
|
$11,444.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,433.45 |
| Max. Negotiated Rate |
$10,987.03 |
| Rate for Payer: Aetna Commercial |
$8,812.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,926.96
|
| Rate for Payer: Cash Price |
$5,722.41
|
| Rate for Payer: Cigna Commercial |
$9,499.20
|
| Rate for Payer: First Health Commercial |
$10,872.58
|
| Rate for Payer: Humana Commercial |
$9,728.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,384.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,446.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,433.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,071.44
|
| Rate for Payer: Ohio Health Group HMO |
$8,583.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,155.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,956.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,896.93
|
| Rate for Payer: PHCS Commercial |
$10,987.03
|
| Rate for Payer: United Healthcare All Payer |
$10,071.44
|
|
|
ALTRX NEUT LNR 36 X 54
|
Facility
|
OP
|
$11,444.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,433.45 |
| Max. Negotiated Rate |
$10,987.03 |
| Rate for Payer: Aetna Commercial |
$8,812.51
|
| Rate for Payer: Anthem Medicaid |
$3,935.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,926.96
|
| Rate for Payer: Cash Price |
$5,722.41
|
| Rate for Payer: Cigna Commercial |
$9,499.20
|
| Rate for Payer: First Health Commercial |
$10,872.58
|
| Rate for Payer: Humana Commercial |
$9,728.10
|
| Rate for Payer: Humana KY Medicaid |
$3,935.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,975.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,384.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,446.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,433.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,014.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,071.44
|
| Rate for Payer: Ohio Health Group HMO |
$8,583.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,155.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,956.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,896.93
|
| Rate for Payer: PHCS Commercial |
$10,987.03
|
| Rate for Payer: United Healthcare All Payer |
$10,071.44
|
|
|
ALTRX NEUT LNR 36 X 56
|
Facility
|
OP
|
$12,161.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,648.36 |
| Max. Negotiated Rate |
$11,674.75 |
| Rate for Payer: Aetna Commercial |
$9,364.12
|
| Rate for Payer: Anthem Medicaid |
$4,182.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,485.74
|
| Rate for Payer: Cash Price |
$6,080.60
|
| Rate for Payer: Cigna Commercial |
$10,093.80
|
| Rate for Payer: First Health Commercial |
$11,553.14
|
| Rate for Payer: Humana Commercial |
$10,337.02
|
| Rate for Payer: Humana KY Medicaid |
$4,182.24
|
| Rate for Payer: Kentucky WC Medicaid |
$4,224.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,972.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,974.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,648.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,266.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,701.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,120.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,728.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,580.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,391.23
|
| Rate for Payer: PHCS Commercial |
$11,674.75
|
| Rate for Payer: United Healthcare All Payer |
$10,701.86
|
|
|
ALTRX NEUT LNR 36 X 56
|
Facility
|
IP
|
$12,161.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,648.36 |
| Max. Negotiated Rate |
$11,674.75 |
| Rate for Payer: Aetna Commercial |
$9,364.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,485.74
|
| Rate for Payer: Cash Price |
$6,080.60
|
| Rate for Payer: Cigna Commercial |
$10,093.80
|
| Rate for Payer: First Health Commercial |
$11,553.14
|
| Rate for Payer: Humana Commercial |
$10,337.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,972.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,974.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,648.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,701.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,120.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,728.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,580.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,391.23
|
| Rate for Payer: PHCS Commercial |
$11,674.75
|
| Rate for Payer: United Healthcare All Payer |
$10,701.86
|
|
|
ALTRX NEUT LNR 36 X 58
|
Facility
|
OP
|
$12,161.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,648.36 |
| Max. Negotiated Rate |
$11,674.75 |
| Rate for Payer: Aetna Commercial |
$9,364.12
|
| Rate for Payer: Anthem Medicaid |
$4,182.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,485.74
|
| Rate for Payer: Cash Price |
$6,080.60
|
| Rate for Payer: Cigna Commercial |
$10,093.80
|
| Rate for Payer: First Health Commercial |
$11,553.14
|
| Rate for Payer: Humana Commercial |
$10,337.02
|
| Rate for Payer: Humana KY Medicaid |
$4,182.24
|
| Rate for Payer: Kentucky WC Medicaid |
$4,224.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,972.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,974.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,648.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,266.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,701.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,120.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,728.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,580.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,391.23
|
| Rate for Payer: PHCS Commercial |
$11,674.75
|
| Rate for Payer: United Healthcare All Payer |
$10,701.86
|
|
|
ALTRX NEUT LNR 36 X 58
|
Facility
|
IP
|
$12,161.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,648.36 |
| Max. Negotiated Rate |
$11,674.75 |
| Rate for Payer: Aetna Commercial |
$9,364.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,485.74
|
| Rate for Payer: Cash Price |
$6,080.60
|
| Rate for Payer: Cigna Commercial |
$10,093.80
|
| Rate for Payer: First Health Commercial |
$11,553.14
|
| Rate for Payer: Humana Commercial |
$10,337.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,972.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,974.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,648.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,701.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,120.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,728.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,580.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,391.23
|
| Rate for Payer: PHCS Commercial |
$11,674.75
|
| Rate for Payer: United Healthcare All Payer |
$10,701.86
|
|
|
ALTRX NEUT LNR 36 X 60
|
Facility
|
OP
|
$12,161.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,648.36 |
| Max. Negotiated Rate |
$11,674.75 |
| Rate for Payer: Aetna Commercial |
$9,364.12
|
| Rate for Payer: Anthem Medicaid |
$4,182.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,485.74
|
| Rate for Payer: Cash Price |
$6,080.60
|
| Rate for Payer: Cigna Commercial |
$10,093.80
|
| Rate for Payer: First Health Commercial |
$11,553.14
|
| Rate for Payer: Humana Commercial |
$10,337.02
|
| Rate for Payer: Humana KY Medicaid |
$4,182.24
|
| Rate for Payer: Kentucky WC Medicaid |
$4,224.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,972.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,974.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,648.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,266.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,701.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,120.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,728.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,580.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,391.23
|
| Rate for Payer: PHCS Commercial |
$11,674.75
|
| Rate for Payer: United Healthcare All Payer |
$10,701.86
|
|
|
ALTRX NEUT LNR 36 X 60
|
Facility
|
IP
|
$12,161.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,648.36 |
| Max. Negotiated Rate |
$11,674.75 |
| Rate for Payer: Aetna Commercial |
$9,364.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,485.74
|
| Rate for Payer: Cash Price |
$6,080.60
|
| Rate for Payer: Cigna Commercial |
$10,093.80
|
| Rate for Payer: First Health Commercial |
$11,553.14
|
| Rate for Payer: Humana Commercial |
$10,337.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,972.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,974.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,648.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,701.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,120.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,728.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,580.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,391.23
|
| Rate for Payer: PHCS Commercial |
$11,674.75
|
| Rate for Payer: United Healthcare All Payer |
$10,701.86
|
|
|
ALTRX NEUT LNR 36 X 62
|
Facility
|
OP
|
$12,161.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,648.36 |
| Max. Negotiated Rate |
$11,674.75 |
| Rate for Payer: Aetna Commercial |
$9,364.12
|
| Rate for Payer: Anthem Medicaid |
$4,182.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,485.74
|
| Rate for Payer: Cash Price |
$6,080.60
|
| Rate for Payer: Cigna Commercial |
$10,093.80
|
| Rate for Payer: First Health Commercial |
$11,553.14
|
| Rate for Payer: Humana Commercial |
$10,337.02
|
| Rate for Payer: Humana KY Medicaid |
$4,182.24
|
| Rate for Payer: Kentucky WC Medicaid |
$4,224.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,972.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,974.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,648.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,266.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,701.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,120.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,728.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,580.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,391.23
|
| Rate for Payer: PHCS Commercial |
$11,674.75
|
| Rate for Payer: United Healthcare All Payer |
$10,701.86
|
|
|
ALTRX NEUT LNR 36 X 62
|
Facility
|
IP
|
$12,161.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,648.36 |
| Max. Negotiated Rate |
$11,674.75 |
| Rate for Payer: Aetna Commercial |
$9,364.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,485.74
|
| Rate for Payer: Cash Price |
$6,080.60
|
| Rate for Payer: Cigna Commercial |
$10,093.80
|
| Rate for Payer: First Health Commercial |
$11,553.14
|
| Rate for Payer: Humana Commercial |
$10,337.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,972.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,974.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,648.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,701.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,120.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,728.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,580.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,391.23
|
| Rate for Payer: PHCS Commercial |
$11,674.75
|
| Rate for Payer: United Healthcare All Payer |
$10,701.86
|
|
|
ALTRX NEUT LNR 36 X 64
|
Facility
|
IP
|
$12,161.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,648.36 |
| Max. Negotiated Rate |
$11,674.75 |
| Rate for Payer: Aetna Commercial |
$9,364.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,485.74
|
| Rate for Payer: Cash Price |
$6,080.60
|
| Rate for Payer: Cigna Commercial |
$10,093.80
|
| Rate for Payer: First Health Commercial |
$11,553.14
|
| Rate for Payer: Humana Commercial |
$10,337.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,972.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,974.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,648.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,701.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,120.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,728.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,580.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,391.23
|
| Rate for Payer: PHCS Commercial |
$11,674.75
|
| Rate for Payer: United Healthcare All Payer |
$10,701.86
|
|
|
ALTRX NEUT LNR 36 X 64
|
Facility
|
OP
|
$12,161.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,648.36 |
| Max. Negotiated Rate |
$11,674.75 |
| Rate for Payer: Aetna Commercial |
$9,364.12
|
| Rate for Payer: Anthem Medicaid |
$4,182.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,485.74
|
| Rate for Payer: Cash Price |
$6,080.60
|
| Rate for Payer: Cigna Commercial |
$10,093.80
|
| Rate for Payer: First Health Commercial |
$11,553.14
|
| Rate for Payer: Humana Commercial |
$10,337.02
|
| Rate for Payer: Humana KY Medicaid |
$4,182.24
|
| Rate for Payer: Kentucky WC Medicaid |
$4,224.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,972.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,974.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,648.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,266.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,701.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,120.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,728.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,580.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,391.23
|
| Rate for Payer: PHCS Commercial |
$11,674.75
|
| Rate for Payer: United Healthcare All Payer |
$10,701.86
|
|
|
ALTRX NEUT LNR 36 X 66
|
Facility
|
OP
|
$12,161.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,648.36 |
| Max. Negotiated Rate |
$11,674.75 |
| Rate for Payer: Aetna Commercial |
$9,364.12
|
| Rate for Payer: Anthem Medicaid |
$4,182.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,485.74
|
| Rate for Payer: Cash Price |
$6,080.60
|
| Rate for Payer: Cigna Commercial |
$10,093.80
|
| Rate for Payer: First Health Commercial |
$11,553.14
|
| Rate for Payer: Humana Commercial |
$10,337.02
|
| Rate for Payer: Humana KY Medicaid |
$4,182.24
|
| Rate for Payer: Kentucky WC Medicaid |
$4,224.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,972.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,974.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,648.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,266.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,701.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,120.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,728.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,580.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,391.23
|
| Rate for Payer: PHCS Commercial |
$11,674.75
|
| Rate for Payer: United Healthcare All Payer |
$10,701.86
|
|
|
ALTRX NEUT LNR 36 X 66
|
Facility
|
IP
|
$12,161.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,648.36 |
| Max. Negotiated Rate |
$11,674.75 |
| Rate for Payer: Aetna Commercial |
$9,364.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,485.74
|
| Rate for Payer: Cash Price |
$6,080.60
|
| Rate for Payer: Cigna Commercial |
$10,093.80
|
| Rate for Payer: First Health Commercial |
$11,553.14
|
| Rate for Payer: Humana Commercial |
$10,337.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,972.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,974.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,648.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,701.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,120.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,728.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,580.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,391.23
|
| Rate for Payer: PHCS Commercial |
$11,674.75
|
| Rate for Payer: United Healthcare All Payer |
$10,701.86
|
|
|
ALTRX NEUTRAL LINER 32*48
|
Facility
|
IP
|
$11,444.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,433.45 |
| Max. Negotiated Rate |
$10,987.03 |
| Rate for Payer: Aetna Commercial |
$8,812.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,926.96
|
| Rate for Payer: Cash Price |
$5,722.41
|
| Rate for Payer: Cigna Commercial |
$9,499.20
|
| Rate for Payer: First Health Commercial |
$10,872.58
|
| Rate for Payer: Humana Commercial |
$9,728.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,384.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,446.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,433.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,071.44
|
| Rate for Payer: Ohio Health Group HMO |
$8,583.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,155.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,956.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,896.93
|
| Rate for Payer: PHCS Commercial |
$10,987.03
|
| Rate for Payer: United Healthcare All Payer |
$10,071.44
|
|
|
ALTRX NEUTRAL LINER 32*48
|
Facility
|
OP
|
$11,444.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,433.45 |
| Max. Negotiated Rate |
$10,987.03 |
| Rate for Payer: Aetna Commercial |
$8,812.51
|
| Rate for Payer: Anthem Medicaid |
$3,935.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,926.96
|
| Rate for Payer: Cash Price |
$5,722.41
|
| Rate for Payer: Cigna Commercial |
$9,499.20
|
| Rate for Payer: First Health Commercial |
$10,872.58
|
| Rate for Payer: Humana Commercial |
$9,728.10
|
| Rate for Payer: Humana KY Medicaid |
$3,935.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,975.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,384.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,446.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,433.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,014.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,071.44
|
| Rate for Payer: Ohio Health Group HMO |
$8,583.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,155.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,956.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,896.93
|
| Rate for Payer: PHCS Commercial |
$10,987.03
|
| Rate for Payer: United Healthcare All Payer |
$10,071.44
|
|
|
ALT-SGPT
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
HCPCS 84460
|
| Hospital Charge Code |
30000536
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$70.08 |
| Rate for Payer: Aetna Commercial |
$56.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.62
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna Commercial |
$60.59
|
| Rate for Payer: First Health Commercial |
$69.35
|
| Rate for Payer: Humana Commercial |
$62.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.24
|
| Rate for Payer: Ohio Health Group HMO |
$54.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.37
|
| Rate for Payer: PHCS Commercial |
$70.08
|
| Rate for Payer: United Healthcare All Payer |
$64.24
|
|
|
ALT-SGPT
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
HCPCS 84460
|
| Hospital Charge Code |
30000536
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$70.08 |
| Rate for Payer: Aetna Commercial |
$56.21
|
| Rate for Payer: Anthem Medicaid |
$5.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.30
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna Commercial |
$60.59
|
| Rate for Payer: First Health Commercial |
$69.35
|
| Rate for Payer: Humana Commercial |
$62.05
|
| Rate for Payer: Humana KY Medicaid |
$5.30
|
| Rate for Payer: Humana Medicare Advantage |
$5.30
|
| Rate for Payer: Kentucky WC Medicaid |
$5.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.24
|
| Rate for Payer: Ohio Health Group HMO |
$54.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.37
|
| Rate for Payer: PHCS Commercial |
$70.08
|
| Rate for Payer: United Healthcare All Payer |
$64.24
|
|
|
ALT-SGPT
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS 84460
|
| Hospital Charge Code |
30000536
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$43.80 |
| Rate for Payer: Aetna Commercial |
$10.87
|
| Rate for Payer: Ambetter Exchange |
$5.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$5.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$5.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.36
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna Commercial |
$4.80
|
| Rate for Payer: Healthspan PPO |
$5.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$5.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.30
|
| Rate for Payer: Multiplan PHCS |
$43.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6.89
|
| Rate for Payer: UHCCP Medicaid |
$25.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.30
|
|
