|
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 |
$1,500.00 |
| 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 |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| 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
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| 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 |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| 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 |
$1,500.00 |
| 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 |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| 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 |
$1,500.00 |
| 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 |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| 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 |
$1,500.00 |
| 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 |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| 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 |
$1,500.00 |
| 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 |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| 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
|
IP
|
$8,939.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,681.84 |
| Max. Negotiated Rate |
$8,581.88 |
| Rate for Payer: Aetna Commercial |
$6,883.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,972.78
|
| Rate for Payer: Cash Price |
$4,469.73
|
| Rate for Payer: Cigna Commercial |
$7,419.75
|
| Rate for Payer: First Health Commercial |
$8,492.49
|
| Rate for Payer: Humana Commercial |
$7,598.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,330.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,597.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,681.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,866.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,704.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,151.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,777.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,168.23
|
| Rate for Payer: PHCS Commercial |
$8,581.88
|
| Rate for Payer: United Healthcare All Payer |
$7,866.72
|
|
|
ALUM CER 28 FEM HD 12/14 +0
|
Facility
|
OP
|
$8,939.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,681.84 |
| Max. Negotiated Rate |
$8,581.88 |
| Rate for Payer: Aetna Commercial |
$6,883.38
|
| Rate for Payer: Anthem Medicaid |
$3,074.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,972.78
|
| Rate for Payer: Cash Price |
$4,469.73
|
| Rate for Payer: Cigna Commercial |
$7,419.75
|
| Rate for Payer: First Health Commercial |
$8,492.49
|
| Rate for Payer: Humana Commercial |
$7,598.54
|
| Rate for Payer: Humana KY Medicaid |
$3,074.28
|
| Rate for Payer: Kentucky WC Medicaid |
$3,105.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,330.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,597.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,681.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,135.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,866.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,704.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,151.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,777.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,168.23
|
| Rate for Payer: PHCS Commercial |
$8,581.88
|
| Rate for Payer: United Healthcare All Payer |
$7,866.72
|
|
|
ALUM CER 28 FEM HD 12/14 +4
|
Facility
|
IP
|
$8,939.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,681.84 |
| Max. Negotiated Rate |
$8,581.88 |
| Rate for Payer: Aetna Commercial |
$6,883.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,972.78
|
| Rate for Payer: Cash Price |
$4,469.73
|
| Rate for Payer: Cigna Commercial |
$7,419.75
|
| Rate for Payer: First Health Commercial |
$8,492.49
|
| Rate for Payer: Humana Commercial |
$7,598.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,330.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,597.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,681.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,866.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,704.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,151.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,777.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,168.23
|
| Rate for Payer: PHCS Commercial |
$8,581.88
|
| Rate for Payer: United Healthcare All Payer |
$7,866.72
|
|
|
ALUM CER 28 FEM HD 12/14 +4
|
Facility
|
OP
|
$8,939.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,681.84 |
| Max. Negotiated Rate |
$8,581.88 |
| Rate for Payer: Aetna Commercial |
$6,883.38
|
| Rate for Payer: Anthem Medicaid |
$3,074.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,972.78
|
| Rate for Payer: Cash Price |
$4,469.73
|
| Rate for Payer: Cigna Commercial |
$7,419.75
|
| Rate for Payer: First Health Commercial |
$8,492.49
|
| Rate for Payer: Humana Commercial |
$7,598.54
|
| Rate for Payer: Humana KY Medicaid |
$3,074.28
|
| Rate for Payer: Kentucky WC Medicaid |
$3,105.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,330.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,597.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,681.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,135.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,866.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,704.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,151.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,777.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,168.23
|
| Rate for Payer: PHCS Commercial |
$8,581.88
|
| Rate for Payer: United Healthcare All Payer |
$7,866.72
|
|
|
ALUM CER 28 FEM HD 12/14 +8
|
Facility
|
IP
|
$8,939.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,681.84 |
| Max. Negotiated Rate |
$8,581.88 |
| Rate for Payer: Aetna Commercial |
$6,883.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,972.78
|
| Rate for Payer: Cash Price |
$4,469.73
|
| Rate for Payer: Cigna Commercial |
$7,419.75
|
| Rate for Payer: First Health Commercial |
$8,492.49
|
| Rate for Payer: Humana Commercial |
$7,598.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,330.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,597.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,681.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,866.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,704.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,151.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,777.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,168.23
|
| Rate for Payer: PHCS Commercial |
$8,581.88
|
| Rate for Payer: United Healthcare All Payer |
$7,866.72
|
|
|
ALUM CER 28 FEM HD 12/14 +8
|
Facility
|
OP
|
$8,939.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,681.84 |
| Max. Negotiated Rate |
$8,581.88 |
| Rate for Payer: Aetna Commercial |
$6,883.38
|
| Rate for Payer: Anthem Medicaid |
$3,074.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,972.78
|
| Rate for Payer: Cash Price |
$4,469.73
|
| Rate for Payer: Cigna Commercial |
$7,419.75
|
| Rate for Payer: First Health Commercial |
$8,492.49
|
| Rate for Payer: Humana Commercial |
$7,598.54
|
| Rate for Payer: Humana KY Medicaid |
$3,074.28
|
| Rate for Payer: Kentucky WC Medicaid |
$3,105.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,330.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,597.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,681.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,135.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,866.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,704.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,151.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,777.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,168.23
|
| Rate for Payer: PHCS Commercial |
$8,581.88
|
| Rate for Payer: United Healthcare All Payer |
$7,866.72
|
|
|
ALUM CER 28 HD 12/14 +0
|
Facility
|
IP
|
$8,326.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,498.10 |
| Max. Negotiated Rate |
$7,993.91 |
| Rate for Payer: Aetna Commercial |
$6,411.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,495.05
|
| Rate for Payer: Cash Price |
$4,163.50
|
| Rate for Payer: Cigna Commercial |
$6,911.40
|
| Rate for Payer: First Health Commercial |
$7,910.64
|
| Rate for Payer: Humana Commercial |
$7,077.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,828.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,145.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,498.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,327.75
|
| Rate for Payer: Ohio Health Group HMO |
$6,245.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,661.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,244.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,745.62
|
| Rate for Payer: PHCS Commercial |
$7,993.91
|
| Rate for Payer: United Healthcare All Payer |
$7,327.75
|
|
|
ALUM CER 28 HD 12/14 +0
|
Facility
|
OP
|
$8,326.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,498.10 |
| Max. Negotiated Rate |
$7,993.91 |
| Rate for Payer: Aetna Commercial |
$6,411.78
|
| Rate for Payer: Anthem Medicaid |
$2,863.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,495.05
|
| Rate for Payer: Cash Price |
$4,163.50
|
| Rate for Payer: Cigna Commercial |
$6,911.40
|
| Rate for Payer: First Health Commercial |
$7,910.64
|
| Rate for Payer: Humana Commercial |
$7,077.94
|
| Rate for Payer: Humana KY Medicaid |
$2,863.65
|
| Rate for Payer: Kentucky WC Medicaid |
$2,892.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,828.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,145.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,498.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,921.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,327.75
|
| Rate for Payer: Ohio Health Group HMO |
$6,245.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,661.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,244.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,745.62
|
| Rate for Payer: PHCS Commercial |
$7,993.91
|
| Rate for Payer: United Healthcare All Payer |
$7,327.75
|
|
|
ALUM CER 28 HD 12/14 +4
|
Facility
|
IP
|
$8,326.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,498.10 |
| Max. Negotiated Rate |
$7,993.91 |
| Rate for Payer: Aetna Commercial |
$6,411.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,495.05
|
| Rate for Payer: Cash Price |
$4,163.50
|
| Rate for Payer: Cigna Commercial |
$6,911.40
|
| Rate for Payer: First Health Commercial |
$7,910.64
|
| Rate for Payer: Humana Commercial |
$7,077.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,828.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,145.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,498.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,327.75
|
| Rate for Payer: Ohio Health Group HMO |
$6,245.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,661.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,244.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,745.62
|
| Rate for Payer: PHCS Commercial |
$7,993.91
|
| Rate for Payer: United Healthcare All Payer |
$7,327.75
|
|
|
ALUM CER 28 HD 12/14 +4
|
Facility
|
OP
|
$8,326.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,498.10 |
| Max. Negotiated Rate |
$7,993.91 |
| Rate for Payer: Aetna Commercial |
$6,411.78
|
| Rate for Payer: Anthem Medicaid |
$2,863.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,495.05
|
| Rate for Payer: Cash Price |
$4,163.50
|
| Rate for Payer: Cigna Commercial |
$6,911.40
|
| Rate for Payer: First Health Commercial |
$7,910.64
|
| Rate for Payer: Humana Commercial |
$7,077.94
|
| Rate for Payer: Humana KY Medicaid |
$2,863.65
|
| Rate for Payer: Kentucky WC Medicaid |
$2,892.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,828.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,145.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,498.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,921.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,327.75
|
| Rate for Payer: Ohio Health Group HMO |
$6,245.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,661.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,244.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,745.62
|
| Rate for Payer: PHCS Commercial |
$7,993.91
|
| Rate for Payer: United Healthcare All Payer |
$7,327.75
|
|
|
ALUM CER 28 HD 12/14 +8
|
Facility
|
IP
|
$8,326.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,498.10 |
| Max. Negotiated Rate |
$7,993.91 |
| Rate for Payer: Aetna Commercial |
$6,411.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,495.05
|
| Rate for Payer: Cash Price |
$4,163.50
|
| Rate for Payer: Cigna Commercial |
$6,911.40
|
| Rate for Payer: First Health Commercial |
$7,910.64
|
| Rate for Payer: Humana Commercial |
$7,077.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,828.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,145.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,498.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,327.75
|
| Rate for Payer: Ohio Health Group HMO |
$6,245.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,661.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,244.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,745.62
|
| Rate for Payer: PHCS Commercial |
$7,993.91
|
| Rate for Payer: United Healthcare All Payer |
$7,327.75
|
|
|
ALUM CER 28 HD 12/14 +8
|
Facility
|
OP
|
$8,326.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,498.10 |
| Max. Negotiated Rate |
$7,993.91 |
| Rate for Payer: Aetna Commercial |
$6,411.78
|
| Rate for Payer: Anthem Medicaid |
$2,863.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,495.05
|
| Rate for Payer: Cash Price |
$4,163.50
|
| Rate for Payer: Cigna Commercial |
$6,911.40
|
| Rate for Payer: First Health Commercial |
$7,910.64
|
| Rate for Payer: Humana Commercial |
$7,077.94
|
| Rate for Payer: Humana KY Medicaid |
$2,863.65
|
| Rate for Payer: Kentucky WC Medicaid |
$2,892.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,828.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,145.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,498.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,921.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,327.75
|
| Rate for Payer: Ohio Health Group HMO |
$6,245.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,661.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,244.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,745.62
|
| Rate for Payer: PHCS Commercial |
$7,993.91
|
| Rate for Payer: United Healthcare All Payer |
$7,327.75
|
|
|
ALUM CER 32 FEM HD 12/14 +0
|
Facility
|
OP
|
$8,939.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,681.84 |
| Max. Negotiated Rate |
$8,581.88 |
| Rate for Payer: Aetna Commercial |
$6,883.38
|
| Rate for Payer: Anthem Medicaid |
$3,074.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,972.78
|
| Rate for Payer: Cash Price |
$4,469.73
|
| Rate for Payer: Cigna Commercial |
$7,419.75
|
| Rate for Payer: First Health Commercial |
$8,492.49
|
| Rate for Payer: Humana Commercial |
$7,598.54
|
| Rate for Payer: Humana KY Medicaid |
$3,074.28
|
| Rate for Payer: Kentucky WC Medicaid |
$3,105.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,330.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,597.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,681.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,135.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,866.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,704.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,151.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,777.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,168.23
|
| Rate for Payer: PHCS Commercial |
$8,581.88
|
| Rate for Payer: United Healthcare All Payer |
$7,866.72
|
|
|
ALUM CER 32 FEM HD 12/14 +0
|
Facility
|
IP
|
$8,939.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,681.84 |
| Max. Negotiated Rate |
$8,581.88 |
| Rate for Payer: Aetna Commercial |
$6,883.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,972.78
|
| Rate for Payer: Cash Price |
$4,469.73
|
| Rate for Payer: Cigna Commercial |
$7,419.75
|
| Rate for Payer: First Health Commercial |
$8,492.49
|
| Rate for Payer: Humana Commercial |
$7,598.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,330.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,597.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,681.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,866.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,704.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,151.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,777.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,168.23
|
| Rate for Payer: PHCS Commercial |
$8,581.88
|
| Rate for Payer: United Healthcare All Payer |
$7,866.72
|
|
|
ALUM CER 32 FEM HD 12/14 +4
|
Facility
|
IP
|
$8,939.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,681.84 |
| Max. Negotiated Rate |
$8,581.88 |
| Rate for Payer: Aetna Commercial |
$6,883.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,972.78
|
| Rate for Payer: Cash Price |
$4,469.73
|
| Rate for Payer: Cigna Commercial |
$7,419.75
|
| Rate for Payer: First Health Commercial |
$8,492.49
|
| Rate for Payer: Humana Commercial |
$7,598.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,330.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,597.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,681.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,866.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,704.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,151.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,777.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,168.23
|
| Rate for Payer: PHCS Commercial |
$8,581.88
|
| Rate for Payer: United Healthcare All Payer |
$7,866.72
|
|
|
ALUM CER 32 FEM HD 12/14 +4
|
Facility
|
OP
|
$8,939.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,681.84 |
| Max. Negotiated Rate |
$8,581.88 |
| Rate for Payer: Aetna Commercial |
$6,883.38
|
| Rate for Payer: Anthem Medicaid |
$3,074.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,972.78
|
| Rate for Payer: Cash Price |
$4,469.73
|
| Rate for Payer: Cigna Commercial |
$7,419.75
|
| Rate for Payer: First Health Commercial |
$8,492.49
|
| Rate for Payer: Humana Commercial |
$7,598.54
|
| Rate for Payer: Humana KY Medicaid |
$3,074.28
|
| Rate for Payer: Kentucky WC Medicaid |
$3,105.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,330.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,597.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,681.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,135.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,866.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,704.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,151.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,777.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,168.23
|
| Rate for Payer: PHCS Commercial |
$8,581.88
|
| Rate for Payer: United Healthcare All Payer |
$7,866.72
|
|
|
ALUM CER 32 FEM HD 12/14 +8
|
Facility
|
IP
|
$8,939.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,681.84 |
| Max. Negotiated Rate |
$8,581.88 |
| Rate for Payer: Aetna Commercial |
$6,883.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,972.78
|
| Rate for Payer: Cash Price |
$4,469.73
|
| Rate for Payer: Cigna Commercial |
$7,419.75
|
| Rate for Payer: First Health Commercial |
$8,492.49
|
| Rate for Payer: Humana Commercial |
$7,598.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,330.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,597.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,681.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,866.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,704.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,151.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,777.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,168.23
|
| Rate for Payer: PHCS Commercial |
$8,581.88
|
| Rate for Payer: United Healthcare All Payer |
$7,866.72
|
|
|
ALUM CER 32 FEM HD 12/14 +8
|
Facility
|
OP
|
$8,939.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,681.84 |
| Max. Negotiated Rate |
$8,581.88 |
| Rate for Payer: Aetna Commercial |
$6,883.38
|
| Rate for Payer: Anthem Medicaid |
$3,074.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,972.78
|
| Rate for Payer: Cash Price |
$4,469.73
|
| Rate for Payer: Cigna Commercial |
$7,419.75
|
| Rate for Payer: First Health Commercial |
$8,492.49
|
| Rate for Payer: Humana Commercial |
$7,598.54
|
| Rate for Payer: Humana KY Medicaid |
$3,074.28
|
| Rate for Payer: Kentucky WC Medicaid |
$3,105.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,330.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,597.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,681.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,135.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,866.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,704.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,151.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,777.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,168.23
|
| Rate for Payer: PHCS Commercial |
$8,581.88
|
| Rate for Payer: United Healthcare All Payer |
$7,866.72
|
|
|
ALUM CER 32 HD 12/14 +0
|
Facility
|
IP
|
$6,760.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,028.07 |
| Max. Negotiated Rate |
$6,489.82 |
| Rate for Payer: Aetna Commercial |
$5,205.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,272.98
|
| Rate for Payer: Cash Price |
$3,380.11
|
| Rate for Payer: Cigna Commercial |
$5,610.99
|
| Rate for Payer: First Health Commercial |
$6,422.22
|
| Rate for Payer: Humana Commercial |
$5,746.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,543.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,989.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,949.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,070.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,408.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,881.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,664.56
|
| Rate for Payer: PHCS Commercial |
$6,489.82
|
| Rate for Payer: United Healthcare All Payer |
$5,949.00
|
|
