|
ALTRX NEUT LNR 36 X 64
|
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 64
|
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 66
|
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 66
|
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 NEUTRAL LINER 32*48
|
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 NEUTRAL LINER 32*48
|
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
|
|
|
ALT-SGPT
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 84460
|
| Hospital Charge Code |
30000536
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.30
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| 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 |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.39
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
ALT-SGPT
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 84460
|
| Hospital Charge Code |
30000536
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.97 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.39
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
ALT-SGPT
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
HCPCS 84460
|
| Hospital Charge Code |
30000536
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Aetna Commercial |
$10.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$69.00
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$4.80
|
| Rate for Payer: Healthspan PPO |
$5.55
|
| Rate for Payer: Multiplan PHCS |
$41.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$48.30
|
| Rate for Payer: UHCCP Medicaid |
$24.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3.18
|
|
|
ALUM 12/14 HEAD 36MM +0
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
ALUM 12/14 HEAD 36MM +0
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
ALUM 12/14 HEAD 36MM +4
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
ALUM 12/14 HEAD 36MM +4
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
ALUM 12/14 HEAD 36MM +8
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
ALUM 12/14 HEAD 36MM +8
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
ALUM CER 28 FEM HD 12/14 +0
|
Facility
|
OP
|
$8,739.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,136.13 |
| Max. Negotiated Rate |
$8,389.88 |
| Rate for Payer: Aetna Commercial |
$6,729.38
|
| Rate for Payer: Anthem Medicaid |
$3,005.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,816.78
|
| Rate for Payer: Cash Price |
$4,369.73
|
| Rate for Payer: Cigna Commercial |
$7,253.75
|
| Rate for Payer: First Health Commercial |
$8,302.49
|
| Rate for Payer: Humana Commercial |
$7,428.54
|
| Rate for Payer: Humana KY Medicaid |
$3,005.50
|
| Rate for Payer: Kentucky WC Medicaid |
$3,036.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,166.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,449.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,621.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,065.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,690.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,554.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,747.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,136.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,709.23
|
| Rate for Payer: PHCS Commercial |
$8,389.88
|
| Rate for Payer: United Healthcare All Payer |
$7,690.72
|
|
|
ALUM CER 28 FEM HD 12/14 +0
|
Facility
|
IP
|
$8,739.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,136.13 |
| Max. Negotiated Rate |
$8,389.88 |
| Rate for Payer: Aetna Commercial |
$6,729.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,816.78
|
| Rate for Payer: Cash Price |
$4,369.73
|
| Rate for Payer: Cigna Commercial |
$7,253.75
|
| Rate for Payer: First Health Commercial |
$8,302.49
|
| Rate for Payer: Humana Commercial |
$7,428.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,166.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,449.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,621.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,690.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,554.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,747.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,136.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,709.23
|
| Rate for Payer: PHCS Commercial |
$8,389.88
|
| Rate for Payer: United Healthcare All Payer |
$7,690.72
|
|
|
ALUM CER 28 FEM HD 12/14 +4
|
Facility
|
IP
|
$8,739.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,136.13 |
| Max. Negotiated Rate |
$8,389.88 |
| Rate for Payer: Aetna Commercial |
$6,729.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,816.78
|
| Rate for Payer: Cash Price |
$4,369.73
|
| Rate for Payer: Cigna Commercial |
$7,253.75
|
| Rate for Payer: First Health Commercial |
$8,302.49
|
| Rate for Payer: Humana Commercial |
$7,428.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,166.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,449.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,621.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,690.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,554.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,747.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,136.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,709.23
|
| Rate for Payer: PHCS Commercial |
$8,389.88
|
| Rate for Payer: United Healthcare All Payer |
$7,690.72
|
|
|
ALUM CER 28 FEM HD 12/14 +4
|
Facility
|
OP
|
$8,739.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,136.13 |
| Max. Negotiated Rate |
$8,389.88 |
| Rate for Payer: Aetna Commercial |
$6,729.38
|
| Rate for Payer: Anthem Medicaid |
$3,005.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,816.78
|
| Rate for Payer: Cash Price |
$4,369.73
|
| Rate for Payer: Cigna Commercial |
$7,253.75
|
| Rate for Payer: First Health Commercial |
$8,302.49
|
| Rate for Payer: Humana Commercial |
$7,428.54
|
| Rate for Payer: Humana KY Medicaid |
$3,005.50
|
| Rate for Payer: Kentucky WC Medicaid |
$3,036.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,166.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,449.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,621.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,065.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,690.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,554.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,747.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,136.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,709.23
|
| Rate for Payer: PHCS Commercial |
$8,389.88
|
| Rate for Payer: United Healthcare All Payer |
$7,690.72
|
|
|
ALUM CER 28 FEM HD 12/14 +8
|
Facility
|
OP
|
$8,739.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,136.13 |
| Max. Negotiated Rate |
$8,389.88 |
| Rate for Payer: Aetna Commercial |
$6,729.38
|
| Rate for Payer: Anthem Medicaid |
$3,005.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,816.78
|
| Rate for Payer: Cash Price |
$4,369.73
|
| Rate for Payer: Cigna Commercial |
$7,253.75
|
| Rate for Payer: First Health Commercial |
$8,302.49
|
| Rate for Payer: Humana Commercial |
$7,428.54
|
| Rate for Payer: Humana KY Medicaid |
$3,005.50
|
| Rate for Payer: Kentucky WC Medicaid |
$3,036.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,166.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,449.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,621.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,065.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,690.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,554.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,747.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,136.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,709.23
|
| Rate for Payer: PHCS Commercial |
$8,389.88
|
| Rate for Payer: United Healthcare All Payer |
$7,690.72
|
|
|
ALUM CER 28 FEM HD 12/14 +8
|
Facility
|
IP
|
$8,739.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,136.13 |
| Max. Negotiated Rate |
$8,389.88 |
| Rate for Payer: Aetna Commercial |
$6,729.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,816.78
|
| Rate for Payer: Cash Price |
$4,369.73
|
| Rate for Payer: Cigna Commercial |
$7,253.75
|
| Rate for Payer: First Health Commercial |
$8,302.49
|
| Rate for Payer: Humana Commercial |
$7,428.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,166.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,449.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,621.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,690.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,554.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,747.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,136.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,709.23
|
| Rate for Payer: PHCS Commercial |
$8,389.88
|
| Rate for Payer: United Healthcare All Payer |
$7,690.72
|
|
|
ALUM CER 28 HD 12/14 +0
|
Facility
|
IP
|
$8,126.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.51 |
| Max. Negotiated Rate |
$7,801.91 |
| Rate for Payer: Aetna Commercial |
$6,257.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,339.05
|
| Rate for Payer: Cash Price |
$4,063.50
|
| Rate for Payer: Cigna Commercial |
$6,745.40
|
| Rate for Payer: First Health Commercial |
$7,720.64
|
| Rate for Payer: Humana Commercial |
$6,907.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,664.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,997.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,438.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,151.75
|
| Rate for Payer: Ohio Health Group HMO |
$6,095.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,625.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,519.37
|
| Rate for Payer: PHCS Commercial |
$7,801.91
|
| Rate for Payer: United Healthcare All Payer |
$7,151.75
|
|
|
ALUM CER 28 HD 12/14 +0
|
Facility
|
OP
|
$8,126.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.51 |
| Max. Negotiated Rate |
$7,801.91 |
| Rate for Payer: Aetna Commercial |
$6,257.78
|
| Rate for Payer: Anthem Medicaid |
$2,794.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,339.05
|
| Rate for Payer: Cash Price |
$4,063.50
|
| Rate for Payer: Cigna Commercial |
$6,745.40
|
| Rate for Payer: First Health Commercial |
$7,720.64
|
| Rate for Payer: Humana Commercial |
$6,907.94
|
| Rate for Payer: Humana KY Medicaid |
$2,794.87
|
| Rate for Payer: Kentucky WC Medicaid |
$2,823.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,664.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,997.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,438.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,850.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,151.75
|
| Rate for Payer: Ohio Health Group HMO |
$6,095.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,625.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,519.37
|
| Rate for Payer: PHCS Commercial |
$7,801.91
|
| Rate for Payer: United Healthcare All Payer |
$7,151.75
|
|
|
ALUM CER 28 HD 12/14 +4
|
Facility
|
OP
|
$8,126.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.51 |
| Max. Negotiated Rate |
$7,801.91 |
| Rate for Payer: Aetna Commercial |
$6,257.78
|
| Rate for Payer: Anthem Medicaid |
$2,794.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,339.05
|
| Rate for Payer: Cash Price |
$4,063.50
|
| Rate for Payer: Cigna Commercial |
$6,745.40
|
| Rate for Payer: First Health Commercial |
$7,720.64
|
| Rate for Payer: Humana Commercial |
$6,907.94
|
| Rate for Payer: Humana KY Medicaid |
$2,794.87
|
| Rate for Payer: Kentucky WC Medicaid |
$2,823.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,664.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,997.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,438.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,850.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,151.75
|
| Rate for Payer: Ohio Health Group HMO |
$6,095.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,625.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,519.37
|
| Rate for Payer: PHCS Commercial |
$7,801.91
|
| Rate for Payer: United Healthcare All Payer |
$7,151.75
|
|
|
ALUM CER 28 HD 12/14 +4
|
Facility
|
IP
|
$8,126.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.51 |
| Max. Negotiated Rate |
$7,801.91 |
| Rate for Payer: Aetna Commercial |
$6,257.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,339.05
|
| Rate for Payer: Cash Price |
$4,063.50
|
| Rate for Payer: Cigna Commercial |
$6,745.40
|
| Rate for Payer: First Health Commercial |
$7,720.64
|
| Rate for Payer: Humana Commercial |
$6,907.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,664.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,997.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,438.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,151.75
|
| Rate for Payer: Ohio Health Group HMO |
$6,095.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,625.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,519.37
|
| Rate for Payer: PHCS Commercial |
$7,801.91
|
| Rate for Payer: United Healthcare All Payer |
$7,151.75
|
|
