|
ALUM CER 32 HD 12/14 +0
|
Facility
|
OP
|
$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 Medicaid |
$2,324.84
|
| 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: Humana KY Medicaid |
$2,324.84
|
| Rate for Payer: Kentucky WC Medicaid |
$2,348.50
|
| 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: Molina Healthcare Medicaid |
$2,371.49
|
| 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
|
|
|
ALUM CER 32 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 32 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 32 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 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 38MM FEM HD 14/16 +4
|
Facility
|
IP
|
$13,164.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,949.26 |
| Max. Negotiated Rate |
$12,637.64 |
| Rate for Payer: Aetna Commercial |
$10,136.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,268.08
|
| Rate for Payer: Cash Price |
$6,582.11
|
| Rate for Payer: Cigna Commercial |
$10,926.29
|
| Rate for Payer: First Health Commercial |
$12,506.00
|
| Rate for Payer: Humana Commercial |
$11,189.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,794.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,715.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,949.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,584.50
|
| Rate for Payer: Ohio Health Group HMO |
$9,873.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,531.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,452.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,083.30
|
| Rate for Payer: PHCS Commercial |
$12,637.64
|
| Rate for Payer: United Healthcare All Payer |
$11,584.50
|
|
|
ALUM CER 38MM FEM HD 14/16 +4
|
Facility
|
OP
|
$13,164.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,949.26 |
| Max. Negotiated Rate |
$12,637.64 |
| Rate for Payer: Aetna Commercial |
$10,136.44
|
| Rate for Payer: Anthem Medicaid |
$4,527.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,268.08
|
| Rate for Payer: Cash Price |
$6,582.11
|
| Rate for Payer: Cigna Commercial |
$10,926.29
|
| Rate for Payer: First Health Commercial |
$12,506.00
|
| Rate for Payer: Humana Commercial |
$11,189.58
|
| Rate for Payer: Humana KY Medicaid |
$4,527.17
|
| Rate for Payer: Kentucky WC Medicaid |
$4,573.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,794.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,715.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,949.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,618.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,584.50
|
| Rate for Payer: Ohio Health Group HMO |
$9,873.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,531.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,452.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,083.30
|
| Rate for Payer: PHCS Commercial |
$12,637.64
|
| Rate for Payer: United Healthcare All Payer |
$11,584.50
|
|
|
ALUMINA HEAD 28MM V40 0
|
Facility
|
IP
|
$8,101.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,430.37 |
| Max. Negotiated Rate |
$7,777.19 |
| Rate for Payer: Aetna Commercial |
$6,237.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,318.97
|
| Rate for Payer: Cash Price |
$4,050.62
|
| Rate for Payer: Cigna Commercial |
$6,724.03
|
| Rate for Payer: First Health Commercial |
$7,696.18
|
| Rate for Payer: Humana Commercial |
$6,886.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,643.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,978.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,430.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,129.09
|
| Rate for Payer: Ohio Health Group HMO |
$6,075.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,480.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,048.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,589.86
|
| Rate for Payer: PHCS Commercial |
$7,777.19
|
| Rate for Payer: United Healthcare All Payer |
$7,129.09
|
|
|
ALUMINA HEAD 28MM V40 0
|
Facility
|
OP
|
$8,101.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,430.37 |
| Max. Negotiated Rate |
$7,777.19 |
| Rate for Payer: Aetna Commercial |
$6,237.95
|
| Rate for Payer: Anthem Medicaid |
$2,786.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,318.97
|
| Rate for Payer: Cash Price |
$4,050.62
|
| Rate for Payer: Cigna Commercial |
$6,724.03
|
| Rate for Payer: First Health Commercial |
$7,696.18
|
| Rate for Payer: Humana Commercial |
$6,886.05
|
| Rate for Payer: Humana KY Medicaid |
$2,786.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,814.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,643.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,978.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,430.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,841.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,129.09
|
| Rate for Payer: Ohio Health Group HMO |
$6,075.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,480.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,048.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,589.86
|
| Rate for Payer: PHCS Commercial |
$7,777.19
|
| Rate for Payer: United Healthcare All Payer |
$7,129.09
|
|
|
ALUMINA HEAD 28MM V40 +5
|
Facility
|
OP
|
$8,548.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,564.40 |
| Max. Negotiated Rate |
$8,206.08 |
| Rate for Payer: Aetna Commercial |
$6,581.96
|
| Rate for Payer: Anthem Medicaid |
$2,939.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,667.44
|
| Rate for Payer: Cash Price |
$4,274.00
|
| Rate for Payer: Cigna Commercial |
$7,094.84
|
| Rate for Payer: First Health Commercial |
$8,120.60
|
| Rate for Payer: Humana Commercial |
$7,265.80
|
| Rate for Payer: Humana KY Medicaid |
$2,939.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,969.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,009.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,308.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,564.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,998.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,522.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,411.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,838.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,436.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,898.12
|
| Rate for Payer: PHCS Commercial |
$8,206.08
|
| Rate for Payer: United Healthcare All Payer |
$7,522.24
|
|
|
ALUMINA HEAD 28MM V40 +5
|
Facility
|
IP
|
$8,548.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,564.40 |
| Max. Negotiated Rate |
$8,206.08 |
| Rate for Payer: Aetna Commercial |
$6,581.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,667.44
|
| Rate for Payer: Cash Price |
$4,274.00
|
| Rate for Payer: Cigna Commercial |
$7,094.84
|
| Rate for Payer: First Health Commercial |
$8,120.60
|
| Rate for Payer: Humana Commercial |
$7,265.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,009.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,308.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,564.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,522.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,411.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,838.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,436.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,898.12
|
| Rate for Payer: PHCS Commercial |
$8,206.08
|
| Rate for Payer: United Healthcare All Payer |
$7,522.24
|
|
|
ALUMINA HEAD 28MM V40 -5
|
Facility
|
IP
|
$8,548.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,564.40 |
| Max. Negotiated Rate |
$8,206.08 |
| Rate for Payer: Aetna Commercial |
$6,581.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,667.44
|
| Rate for Payer: Cash Price |
$4,274.00
|
| Rate for Payer: Cigna Commercial |
$7,094.84
|
| Rate for Payer: First Health Commercial |
$8,120.60
|
| Rate for Payer: Humana Commercial |
$7,265.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,009.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,308.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,564.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,522.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,411.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,838.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,436.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,898.12
|
| Rate for Payer: PHCS Commercial |
$8,206.08
|
| Rate for Payer: United Healthcare All Payer |
$7,522.24
|
|
|
ALUMINA HEAD 28MM V40 -5
|
Facility
|
OP
|
$8,548.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,564.40 |
| Max. Negotiated Rate |
$8,206.08 |
| Rate for Payer: Aetna Commercial |
$6,581.96
|
| Rate for Payer: Anthem Medicaid |
$2,939.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,667.44
|
| Rate for Payer: Cash Price |
$4,274.00
|
| Rate for Payer: Cigna Commercial |
$7,094.84
|
| Rate for Payer: First Health Commercial |
$8,120.60
|
| Rate for Payer: Humana Commercial |
$7,265.80
|
| Rate for Payer: Humana KY Medicaid |
$2,939.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,969.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,009.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,308.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,564.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,998.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,522.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,411.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,838.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,436.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,898.12
|
| Rate for Payer: PHCS Commercial |
$8,206.08
|
| Rate for Payer: United Healthcare All Payer |
$7,522.24
|
|
|
ALUMINA HEAD 32MM V40 0
|
Facility
|
IP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
ALUMINA HEAD 32MM V40 0
|
Facility
|
OP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem Medicaid |
$2,663.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Humana KY Medicaid |
$2,663.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,690.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,716.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
ALUMINA HEAD 32MM V40 +5
|
Facility
|
IP
|
$7,657.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,297.22 |
| Max. Negotiated Rate |
$7,351.10 |
| Rate for Payer: Aetna Commercial |
$5,896.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,972.77
|
| Rate for Payer: Cash Price |
$3,828.70
|
| Rate for Payer: Cigna Commercial |
$6,355.64
|
| Rate for Payer: First Health Commercial |
$7,274.53
|
| Rate for Payer: Humana Commercial |
$6,508.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,279.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,651.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,297.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,738.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,743.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,125.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,661.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,283.61
|
| Rate for Payer: PHCS Commercial |
$7,351.10
|
| Rate for Payer: United Healthcare All Payer |
$6,738.51
|
|
|
ALUMINA HEAD 32MM V40 +5
|
Facility
|
OP
|
$7,657.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,297.22 |
| Max. Negotiated Rate |
$7,351.10 |
| Rate for Payer: Aetna Commercial |
$5,896.20
|
| Rate for Payer: Anthem Medicaid |
$2,633.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,972.77
|
| Rate for Payer: Cash Price |
$3,828.70
|
| Rate for Payer: Cigna Commercial |
$6,355.64
|
| Rate for Payer: First Health Commercial |
$7,274.53
|
| Rate for Payer: Humana Commercial |
$6,508.79
|
| Rate for Payer: Humana KY Medicaid |
$2,633.38
|
| Rate for Payer: Kentucky WC Medicaid |
$2,660.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,279.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,651.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,297.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,686.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,738.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,743.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,125.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,661.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,283.61
|
| Rate for Payer: PHCS Commercial |
$7,351.10
|
| Rate for Payer: United Healthcare All Payer |
$6,738.51
|
|
|
ALUMINA HEAD 32MM V40 -5
|
Facility
|
IP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
ALUMINA HEAD 32MM V40 -5
|
Facility
|
OP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem Medicaid |
$2,663.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Humana KY Medicaid |
$2,663.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,690.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,716.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
ALUMINA HEAD 36MM V40 0
|
Facility
|
IP
|
$8,402.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,520.60 |
| Max. Negotiated Rate |
$8,065.92 |
| Rate for Payer: Aetna Commercial |
$6,469.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,553.56
|
| Rate for Payer: Cash Price |
$4,201.00
|
| Rate for Payer: Cigna Commercial |
$6,973.66
|
| Rate for Payer: First Health Commercial |
$7,981.90
|
| Rate for Payer: Humana Commercial |
$7,141.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,889.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,200.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,520.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,393.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,301.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,721.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,309.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,797.38
|
| Rate for Payer: PHCS Commercial |
$8,065.92
|
| Rate for Payer: United Healthcare All Payer |
$7,393.76
|
|
|
ALUMINA HEAD 36MM V40 0
|
Facility
|
OP
|
$8,402.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,520.60 |
| Max. Negotiated Rate |
$8,065.92 |
| Rate for Payer: Aetna Commercial |
$6,469.54
|
| Rate for Payer: Anthem Medicaid |
$2,889.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,553.56
|
| Rate for Payer: Cash Price |
$4,201.00
|
| Rate for Payer: Cigna Commercial |
$6,973.66
|
| Rate for Payer: First Health Commercial |
$7,981.90
|
| Rate for Payer: Humana Commercial |
$7,141.70
|
| Rate for Payer: Humana KY Medicaid |
$2,889.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,918.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,889.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,200.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,520.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,947.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,393.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,301.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,721.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,309.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,797.38
|
| Rate for Payer: PHCS Commercial |
$8,065.92
|
| Rate for Payer: United Healthcare All Payer |
$7,393.76
|
|
|
ALUMINA HEAD 36MM V40 +5
|
Facility
|
IP
|
$8,402.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,520.60 |
| Max. Negotiated Rate |
$8,065.92 |
| Rate for Payer: Aetna Commercial |
$6,469.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,553.56
|
| Rate for Payer: Cash Price |
$4,201.00
|
| Rate for Payer: Cigna Commercial |
$6,973.66
|
| Rate for Payer: First Health Commercial |
$7,981.90
|
| Rate for Payer: Humana Commercial |
$7,141.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,889.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,200.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,520.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,393.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,301.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,721.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,309.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,797.38
|
| Rate for Payer: PHCS Commercial |
$8,065.92
|
| Rate for Payer: United Healthcare All Payer |
$7,393.76
|
|
|
ALUMINA HEAD 36MM V40 +5
|
Facility
|
OP
|
$8,402.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,520.60 |
| Max. Negotiated Rate |
$8,065.92 |
| Rate for Payer: Aetna Commercial |
$6,469.54
|
| Rate for Payer: Anthem Medicaid |
$2,889.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,553.56
|
| Rate for Payer: Cash Price |
$4,201.00
|
| Rate for Payer: Cigna Commercial |
$6,973.66
|
| Rate for Payer: First Health Commercial |
$7,981.90
|
| Rate for Payer: Humana Commercial |
$7,141.70
|
| Rate for Payer: Humana KY Medicaid |
$2,889.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,918.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,889.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,200.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,520.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,947.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,393.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,301.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,721.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,309.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,797.38
|
| Rate for Payer: PHCS Commercial |
$8,065.92
|
| Rate for Payer: United Healthcare All Payer |
$7,393.76
|
|
|
ALUMINA HEAD 36MM V40 -5
|
Facility
|
OP
|
$8,402.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,520.60 |
| Max. Negotiated Rate |
$8,065.92 |
| Rate for Payer: Aetna Commercial |
$6,469.54
|
| Rate for Payer: Anthem Medicaid |
$2,889.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,553.56
|
| Rate for Payer: Cash Price |
$4,201.00
|
| Rate for Payer: Cigna Commercial |
$6,973.66
|
| Rate for Payer: First Health Commercial |
$7,981.90
|
| Rate for Payer: Humana Commercial |
$7,141.70
|
| Rate for Payer: Humana KY Medicaid |
$2,889.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,918.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,889.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,200.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,520.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,947.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,393.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,301.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,721.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,309.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,797.38
|
| Rate for Payer: PHCS Commercial |
$8,065.92
|
| Rate for Payer: United Healthcare All Payer |
$7,393.76
|
|
|
ALUMINA HEAD 36MM V40 -5
|
Facility
|
IP
|
$8,402.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,520.60 |
| Max. Negotiated Rate |
$8,065.92 |
| Rate for Payer: Aetna Commercial |
$6,469.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,553.56
|
| Rate for Payer: Cash Price |
$4,201.00
|
| Rate for Payer: Cigna Commercial |
$6,973.66
|
| Rate for Payer: First Health Commercial |
$7,981.90
|
| Rate for Payer: Humana Commercial |
$7,141.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,889.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,200.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,520.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,393.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,301.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,721.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,309.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,797.38
|
| Rate for Payer: PHCS Commercial |
$8,065.92
|
| Rate for Payer: United Healthcare All Payer |
$7,393.76
|
|
