|
ALUM CER 28 HD 12/14 +8
|
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 +8
|
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 32 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 32 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 32 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 32 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 32 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 32 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 32 HD 12/14 +0
|
Facility
|
OP
|
$6,560.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$852.83 |
| Max. Negotiated Rate |
$6,297.82 |
| Rate for Payer: Aetna Commercial |
$5,051.38
|
| Rate for Payer: Anthem Medicaid |
$2,256.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,116.98
|
| Rate for Payer: Cash Price |
$3,280.11
|
| Rate for Payer: Cigna Commercial |
$5,444.99
|
| Rate for Payer: First Health Commercial |
$6,232.22
|
| Rate for Payer: Humana Commercial |
$5,576.20
|
| Rate for Payer: Humana KY Medicaid |
$2,256.06
|
| Rate for Payer: Kentucky WC Medicaid |
$2,279.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,379.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,841.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,968.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,301.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,773.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,920.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,312.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$852.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,033.67
|
| Rate for Payer: PHCS Commercial |
$6,297.82
|
| Rate for Payer: United Healthcare All Payer |
$5,773.00
|
|
|
ALUM CER 32 HD 12/14 +0
|
Facility
|
IP
|
$6,560.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$852.83 |
| Max. Negotiated Rate |
$6,297.82 |
| Rate for Payer: Aetna Commercial |
$5,051.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,116.98
|
| Rate for Payer: Cash Price |
$3,280.11
|
| Rate for Payer: Cigna Commercial |
$5,444.99
|
| Rate for Payer: First Health Commercial |
$6,232.22
|
| Rate for Payer: Humana Commercial |
$5,576.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,379.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,841.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,968.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,773.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,920.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,312.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$852.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,033.67
|
| Rate for Payer: PHCS Commercial |
$6,297.82
|
| Rate for Payer: United Healthcare All Payer |
$5,773.00
|
|
|
ALUM CER 32 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
|
|
|
ALUM CER 32 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 32 HD 12/14 +8
|
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 32 HD 12/14 +8
|
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 38MM FEM HD 14/16 +4
|
Facility
|
IP
|
$12,911.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,678.50 |
| Max. Negotiated Rate |
$12,395.08 |
| Rate for Payer: Aetna Commercial |
$9,941.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,071.00
|
| Rate for Payer: Cash Price |
$6,455.77
|
| Rate for Payer: Cigna Commercial |
$10,716.58
|
| Rate for Payer: First Health Commercial |
$12,265.96
|
| Rate for Payer: Humana Commercial |
$10,974.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,587.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,528.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,873.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,362.16
|
| Rate for Payer: Ohio Health Group HMO |
$9,683.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,582.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,678.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,002.58
|
| Rate for Payer: PHCS Commercial |
$12,395.08
|
| Rate for Payer: United Healthcare All Payer |
$11,362.16
|
|
|
ALUM CER 38MM FEM HD 14/16 +4
|
Facility
|
OP
|
$12,911.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,678.50 |
| Max. Negotiated Rate |
$12,395.08 |
| Rate for Payer: Aetna Commercial |
$9,941.89
|
| Rate for Payer: Anthem Medicaid |
$4,440.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,071.00
|
| Rate for Payer: Cash Price |
$6,455.77
|
| Rate for Payer: Cigna Commercial |
$10,716.58
|
| Rate for Payer: First Health Commercial |
$12,265.96
|
| Rate for Payer: Humana Commercial |
$10,974.81
|
| Rate for Payer: Humana KY Medicaid |
$4,440.28
|
| Rate for Payer: Kentucky WC Medicaid |
$4,485.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,587.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,528.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,873.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,529.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,362.16
|
| Rate for Payer: Ohio Health Group HMO |
$9,683.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,582.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,678.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,002.58
|
| Rate for Payer: PHCS Commercial |
$12,395.08
|
| Rate for Payer: United Healthcare All Payer |
$11,362.16
|
|
|
ALUMINA HEAD 28MM V40 0
|
Facility
|
OP
|
$7,901.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,027.16 |
| Max. Negotiated Rate |
$7,585.19 |
| Rate for Payer: Aetna Commercial |
$6,083.95
|
| Rate for Payer: Anthem Medicaid |
$2,717.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,162.97
|
| Rate for Payer: Cash Price |
$3,950.62
|
| Rate for Payer: Cigna Commercial |
$6,558.03
|
| Rate for Payer: First Health Commercial |
$7,506.18
|
| Rate for Payer: Humana Commercial |
$6,716.05
|
| Rate for Payer: Humana KY Medicaid |
$2,717.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,744.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,479.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,831.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,370.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,771.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,953.09
|
| Rate for Payer: Ohio Health Group HMO |
$5,925.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,580.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,027.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,449.38
|
| Rate for Payer: PHCS Commercial |
$7,585.19
|
| Rate for Payer: United Healthcare All Payer |
$6,953.09
|
|
|
ALUMINA HEAD 28MM V40 0
|
Facility
|
IP
|
$7,901.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,027.16 |
| Max. Negotiated Rate |
$7,585.19 |
| Rate for Payer: Aetna Commercial |
$6,083.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,162.97
|
| Rate for Payer: Cash Price |
$3,950.62
|
| Rate for Payer: Cigna Commercial |
$6,558.03
|
| Rate for Payer: First Health Commercial |
$7,506.18
|
| Rate for Payer: Humana Commercial |
$6,716.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,479.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,831.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,370.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,953.09
|
| Rate for Payer: Ohio Health Group HMO |
$5,925.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,580.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,027.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,449.38
|
| Rate for Payer: PHCS Commercial |
$7,585.19
|
| Rate for Payer: United Healthcare All Payer |
$6,953.09
|
|
|
ALUMINA HEAD 28MM V40 +5
|
Facility
|
OP
|
$8,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,085.24 |
| Max. Negotiated Rate |
$8,014.08 |
| Rate for Payer: Aetna Commercial |
$6,427.96
|
| Rate for Payer: Anthem Medicaid |
$2,870.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,511.44
|
| Rate for Payer: Cash Price |
$4,174.00
|
| Rate for Payer: Cigna Commercial |
$6,928.84
|
| Rate for Payer: First Health Commercial |
$7,930.60
|
| Rate for Payer: Humana Commercial |
$7,095.80
|
| Rate for Payer: Humana KY Medicaid |
$2,870.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,900.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,845.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,160.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,504.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,928.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,346.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,261.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,669.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,085.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,587.88
|
| Rate for Payer: PHCS Commercial |
$8,014.08
|
| Rate for Payer: United Healthcare All Payer |
$7,346.24
|
|
|
ALUMINA HEAD 28MM V40 +5
|
Facility
|
IP
|
$8,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,085.24 |
| Max. Negotiated Rate |
$8,014.08 |
| Rate for Payer: Aetna Commercial |
$6,427.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,511.44
|
| Rate for Payer: Cash Price |
$4,174.00
|
| Rate for Payer: Cigna Commercial |
$6,928.84
|
| Rate for Payer: First Health Commercial |
$7,930.60
|
| Rate for Payer: Humana Commercial |
$7,095.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,845.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,160.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,504.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,346.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,261.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,669.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,085.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,587.88
|
| Rate for Payer: PHCS Commercial |
$8,014.08
|
| Rate for Payer: United Healthcare All Payer |
$7,346.24
|
|
|
ALUMINA HEAD 28MM V40 -5
|
Facility
|
IP
|
$8,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,085.24 |
| Max. Negotiated Rate |
$8,014.08 |
| Rate for Payer: Aetna Commercial |
$6,427.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,511.44
|
| Rate for Payer: Cash Price |
$4,174.00
|
| Rate for Payer: Cigna Commercial |
$6,928.84
|
| Rate for Payer: First Health Commercial |
$7,930.60
|
| Rate for Payer: Humana Commercial |
$7,095.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,845.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,160.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,504.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,346.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,261.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,669.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,085.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,587.88
|
| Rate for Payer: PHCS Commercial |
$8,014.08
|
| Rate for Payer: United Healthcare All Payer |
$7,346.24
|
|
|
ALUMINA HEAD 28MM V40 -5
|
Facility
|
OP
|
$8,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,085.24 |
| Max. Negotiated Rate |
$8,014.08 |
| Rate for Payer: Aetna Commercial |
$6,427.96
|
| Rate for Payer: Anthem Medicaid |
$2,870.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,511.44
|
| Rate for Payer: Cash Price |
$4,174.00
|
| Rate for Payer: Cigna Commercial |
$6,928.84
|
| Rate for Payer: First Health Commercial |
$7,930.60
|
| Rate for Payer: Humana Commercial |
$7,095.80
|
| Rate for Payer: Humana KY Medicaid |
$2,870.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,900.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,845.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,160.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,504.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,928.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,346.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,261.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,669.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,085.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,587.88
|
| Rate for Payer: PHCS Commercial |
$8,014.08
|
| Rate for Payer: United Healthcare All Payer |
$7,346.24
|
|
|
ALUMINA HEAD 32MM V40 0
|
Facility
|
OP
|
$7,545.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$980.85 |
| Max. Negotiated Rate |
$7,243.20 |
| Rate for Payer: Aetna Commercial |
$5,809.65
|
| Rate for Payer: Anthem Medicaid |
$2,594.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,885.10
|
| Rate for Payer: Cash Price |
$3,772.50
|
| Rate for Payer: Cigna Commercial |
$6,262.35
|
| Rate for Payer: First Health Commercial |
$7,167.75
|
| Rate for Payer: Humana Commercial |
$6,413.25
|
| Rate for Payer: Humana KY Medicaid |
$2,594.73
|
| Rate for Payer: Kentucky WC Medicaid |
$2,621.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,568.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,646.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,639.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$980.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,338.95
|
| Rate for Payer: PHCS Commercial |
$7,243.20
|
| Rate for Payer: United Healthcare All Payer |
$6,639.60
|
|
|
ALUMINA HEAD 32MM V40 0
|
Facility
|
IP
|
$7,545.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$980.85 |
| Max. Negotiated Rate |
$7,243.20 |
| Rate for Payer: Aetna Commercial |
$5,809.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,885.10
|
| Rate for Payer: Cash Price |
$3,772.50
|
| Rate for Payer: Cigna Commercial |
$6,262.35
|
| Rate for Payer: First Health Commercial |
$7,167.75
|
| Rate for Payer: Humana Commercial |
$6,413.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,568.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,639.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$980.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,338.95
|
| Rate for Payer: PHCS Commercial |
$7,243.20
|
| Rate for Payer: United Healthcare All Payer |
$6,639.60
|
|
|
ALUMINA HEAD 32MM V40 +5
|
Facility
|
IP
|
$7,457.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$969.46 |
| Max. Negotiated Rate |
$7,159.10 |
| Rate for Payer: Aetna Commercial |
$5,742.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,816.77
|
| Rate for Payer: Cash Price |
$3,728.70
|
| Rate for Payer: Cigna Commercial |
$6,189.64
|
| Rate for Payer: First Health Commercial |
$7,084.53
|
| Rate for Payer: Humana Commercial |
$6,338.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,115.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,503.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,237.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,562.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,593.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,491.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$969.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,311.79
|
| Rate for Payer: PHCS Commercial |
$7,159.10
|
| Rate for Payer: United Healthcare All Payer |
$6,562.51
|
|
