|
G2 CONST INSERT SZ 3-4 11MM
|
Facility
|
IP
|
$15,378.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,999.14 |
| Max. Negotiated Rate |
$14,762.88 |
| Rate for Payer: Aetna Commercial |
$11,841.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,994.84
|
| Rate for Payer: Cash Price |
$7,689.00
|
| Rate for Payer: Cigna Commercial |
$12,763.74
|
| Rate for Payer: First Health Commercial |
$14,609.10
|
| Rate for Payer: Humana Commercial |
$13,071.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,609.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,348.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,613.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,532.64
|
| Rate for Payer: Ohio Health Group HMO |
$11,533.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,075.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,999.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,767.18
|
| Rate for Payer: PHCS Commercial |
$14,762.88
|
| Rate for Payer: United Healthcare All Payer |
$13,532.64
|
|
|
G2 CONST INSERT SZ 3-4 11MM
|
Facility
|
OP
|
$15,378.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,999.14 |
| Max. Negotiated Rate |
$14,762.88 |
| Rate for Payer: Aetna Commercial |
$11,841.06
|
| Rate for Payer: Anthem Medicaid |
$5,288.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,994.84
|
| Rate for Payer: Cash Price |
$7,689.00
|
| Rate for Payer: Cigna Commercial |
$12,763.74
|
| Rate for Payer: First Health Commercial |
$14,609.10
|
| Rate for Payer: Humana Commercial |
$13,071.30
|
| Rate for Payer: Humana KY Medicaid |
$5,288.49
|
| Rate for Payer: Kentucky WC Medicaid |
$5,342.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,609.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,348.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,613.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,394.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,532.64
|
| Rate for Payer: Ohio Health Group HMO |
$11,533.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,075.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,999.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,767.18
|
| Rate for Payer: PHCS Commercial |
$14,762.88
|
| Rate for Payer: United Healthcare All Payer |
$13,532.64
|
|
|
G2 CONST INSERT SZ 3-4 13MM
|
Facility
|
IP
|
$15,378.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,999.14 |
| Max. Negotiated Rate |
$14,762.88 |
| Rate for Payer: Aetna Commercial |
$11,841.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,994.84
|
| Rate for Payer: Cash Price |
$7,689.00
|
| Rate for Payer: Cigna Commercial |
$12,763.74
|
| Rate for Payer: First Health Commercial |
$14,609.10
|
| Rate for Payer: Humana Commercial |
$13,071.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,609.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,348.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,613.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,532.64
|
| Rate for Payer: Ohio Health Group HMO |
$11,533.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,075.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,999.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,767.18
|
| Rate for Payer: PHCS Commercial |
$14,762.88
|
| Rate for Payer: United Healthcare All Payer |
$13,532.64
|
|
|
G2 CONST INSERT SZ 3-4 13MM
|
Facility
|
OP
|
$15,378.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,999.14 |
| Max. Negotiated Rate |
$14,762.88 |
| Rate for Payer: Aetna Commercial |
$11,841.06
|
| Rate for Payer: Anthem Medicaid |
$5,288.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,994.84
|
| Rate for Payer: Cash Price |
$7,689.00
|
| Rate for Payer: Cigna Commercial |
$12,763.74
|
| Rate for Payer: First Health Commercial |
$14,609.10
|
| Rate for Payer: Humana Commercial |
$13,071.30
|
| Rate for Payer: Humana KY Medicaid |
$5,288.49
|
| Rate for Payer: Kentucky WC Medicaid |
$5,342.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,609.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,348.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,613.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,394.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,532.64
|
| Rate for Payer: Ohio Health Group HMO |
$11,533.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,075.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,999.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,767.18
|
| Rate for Payer: PHCS Commercial |
$14,762.88
|
| Rate for Payer: United Healthcare All Payer |
$13,532.64
|
|
|
G2 CONST INSERT SZ 3-4 15MM
|
Facility
|
IP
|
$15,378.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,999.14 |
| Max. Negotiated Rate |
$14,762.88 |
| Rate for Payer: Aetna Commercial |
$11,841.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,994.84
|
| Rate for Payer: Cash Price |
$7,689.00
|
| Rate for Payer: Cigna Commercial |
$12,763.74
|
| Rate for Payer: First Health Commercial |
$14,609.10
|
| Rate for Payer: Humana Commercial |
$13,071.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,609.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,348.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,613.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,532.64
|
| Rate for Payer: Ohio Health Group HMO |
$11,533.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,075.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,999.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,767.18
|
| Rate for Payer: PHCS Commercial |
$14,762.88
|
| Rate for Payer: United Healthcare All Payer |
$13,532.64
|
|
|
G2 CONST INSERT SZ 3-4 15MM
|
Facility
|
OP
|
$15,378.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,999.14 |
| Max. Negotiated Rate |
$14,762.88 |
| Rate for Payer: Aetna Commercial |
$11,841.06
|
| Rate for Payer: Anthem Medicaid |
$5,288.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,994.84
|
| Rate for Payer: Cash Price |
$7,689.00
|
| Rate for Payer: Cigna Commercial |
$12,763.74
|
| Rate for Payer: First Health Commercial |
$14,609.10
|
| Rate for Payer: Humana Commercial |
$13,071.30
|
| Rate for Payer: Humana KY Medicaid |
$5,288.49
|
| Rate for Payer: Kentucky WC Medicaid |
$5,342.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,609.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,348.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,613.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,394.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,532.64
|
| Rate for Payer: Ohio Health Group HMO |
$11,533.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,075.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,999.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,767.18
|
| Rate for Payer: PHCS Commercial |
$14,762.88
|
| Rate for Payer: United Healthcare All Payer |
$13,532.64
|
|
|
G2 CONST INSERT SZ 3-4 18MM
|
Facility
|
OP
|
$15,378.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,999.14 |
| Max. Negotiated Rate |
$14,762.88 |
| Rate for Payer: Aetna Commercial |
$11,841.06
|
| Rate for Payer: Anthem Medicaid |
$5,288.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,994.84
|
| Rate for Payer: Cash Price |
$7,689.00
|
| Rate for Payer: Cigna Commercial |
$12,763.74
|
| Rate for Payer: First Health Commercial |
$14,609.10
|
| Rate for Payer: Humana Commercial |
$13,071.30
|
| Rate for Payer: Humana KY Medicaid |
$5,288.49
|
| Rate for Payer: Kentucky WC Medicaid |
$5,342.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,609.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,348.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,613.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,394.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,532.64
|
| Rate for Payer: Ohio Health Group HMO |
$11,533.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,075.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,999.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,767.18
|
| Rate for Payer: PHCS Commercial |
$14,762.88
|
| Rate for Payer: United Healthcare All Payer |
$13,532.64
|
|
|
G2 CONST INSERT SZ 3-4 18MM
|
Facility
|
IP
|
$15,378.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,999.14 |
| Max. Negotiated Rate |
$14,762.88 |
| Rate for Payer: Aetna Commercial |
$11,841.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,994.84
|
| Rate for Payer: Cash Price |
$7,689.00
|
| Rate for Payer: Cigna Commercial |
$12,763.74
|
| Rate for Payer: First Health Commercial |
$14,609.10
|
| Rate for Payer: Humana Commercial |
$13,071.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,609.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,348.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,613.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,532.64
|
| Rate for Payer: Ohio Health Group HMO |
$11,533.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,075.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,999.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,767.18
|
| Rate for Payer: PHCS Commercial |
$14,762.88
|
| Rate for Payer: United Healthcare All Payer |
$13,532.64
|
|
|
G2 CONST INSERT SZ 3-4 21MM
|
Facility
|
IP
|
$9,107.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,183.96 |
| Max. Negotiated Rate |
$8,743.08 |
| Rate for Payer: Aetna Commercial |
$7,012.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,103.76
|
| Rate for Payer: Cash Price |
$4,553.69
|
| Rate for Payer: Cigna Commercial |
$7,559.13
|
| Rate for Payer: First Health Commercial |
$8,652.01
|
| Rate for Payer: Humana Commercial |
$7,741.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,468.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,721.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,732.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,014.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,830.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,821.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,183.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,823.29
|
| Rate for Payer: PHCS Commercial |
$8,743.08
|
| Rate for Payer: United Healthcare All Payer |
$8,014.49
|
|
|
G2 CONST INSERT SZ 3-4 21MM
|
Facility
|
OP
|
$9,107.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,183.96 |
| Max. Negotiated Rate |
$8,743.08 |
| Rate for Payer: Aetna Commercial |
$7,012.68
|
| Rate for Payer: Anthem Medicaid |
$3,132.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,103.76
|
| Rate for Payer: Cash Price |
$4,553.69
|
| Rate for Payer: Cigna Commercial |
$7,559.13
|
| Rate for Payer: First Health Commercial |
$8,652.01
|
| Rate for Payer: Humana Commercial |
$7,741.27
|
| Rate for Payer: Humana KY Medicaid |
$3,132.03
|
| Rate for Payer: Kentucky WC Medicaid |
$3,163.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,468.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,721.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,732.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,194.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,014.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,830.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,821.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,183.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,823.29
|
| Rate for Payer: PHCS Commercial |
$8,743.08
|
| Rate for Payer: United Healthcare All Payer |
$8,014.49
|
|
|
G2 CONST INSERT SZ 3-4 25MM
|
Facility
|
OP
|
$9,107.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,183.96 |
| Max. Negotiated Rate |
$8,743.08 |
| Rate for Payer: Aetna Commercial |
$7,012.68
|
| Rate for Payer: Anthem Medicaid |
$3,132.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,103.76
|
| Rate for Payer: Cash Price |
$4,553.69
|
| Rate for Payer: Cigna Commercial |
$7,559.13
|
| Rate for Payer: First Health Commercial |
$8,652.01
|
| Rate for Payer: Humana Commercial |
$7,741.27
|
| Rate for Payer: Humana KY Medicaid |
$3,132.03
|
| Rate for Payer: Kentucky WC Medicaid |
$3,163.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,468.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,721.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,732.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,194.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,014.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,830.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,821.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,183.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,823.29
|
| Rate for Payer: PHCS Commercial |
$8,743.08
|
| Rate for Payer: United Healthcare All Payer |
$8,014.49
|
|
|
G2 CONST INSERT SZ 3-4 25MM
|
Facility
|
IP
|
$9,107.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,183.96 |
| Max. Negotiated Rate |
$8,743.08 |
| Rate for Payer: Aetna Commercial |
$7,012.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,103.76
|
| Rate for Payer: Cash Price |
$4,553.69
|
| Rate for Payer: Cigna Commercial |
$7,559.13
|
| Rate for Payer: First Health Commercial |
$8,652.01
|
| Rate for Payer: Humana Commercial |
$7,741.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,468.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,721.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,732.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,014.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,830.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,821.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,183.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,823.29
|
| Rate for Payer: PHCS Commercial |
$8,743.08
|
| Rate for Payer: United Healthcare All Payer |
$8,014.49
|
|
|
G2 CONST INSERT SZ 3-4 30MM
|
Facility
|
IP
|
$9,107.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,183.96 |
| Max. Negotiated Rate |
$8,743.08 |
| Rate for Payer: Aetna Commercial |
$7,012.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,103.76
|
| Rate for Payer: Cash Price |
$4,553.69
|
| Rate for Payer: Cigna Commercial |
$7,559.13
|
| Rate for Payer: First Health Commercial |
$8,652.01
|
| Rate for Payer: Humana Commercial |
$7,741.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,468.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,721.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,732.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,014.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,830.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,821.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,183.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,823.29
|
| Rate for Payer: PHCS Commercial |
$8,743.08
|
| Rate for Payer: United Healthcare All Payer |
$8,014.49
|
|
|
G2 CONST INSERT SZ 3-4 30MM
|
Facility
|
OP
|
$9,107.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,183.96 |
| Max. Negotiated Rate |
$8,743.08 |
| Rate for Payer: Aetna Commercial |
$7,012.68
|
| Rate for Payer: Anthem Medicaid |
$3,132.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,103.76
|
| Rate for Payer: Cash Price |
$4,553.69
|
| Rate for Payer: Cigna Commercial |
$7,559.13
|
| Rate for Payer: First Health Commercial |
$8,652.01
|
| Rate for Payer: Humana Commercial |
$7,741.27
|
| Rate for Payer: Humana KY Medicaid |
$3,132.03
|
| Rate for Payer: Kentucky WC Medicaid |
$3,163.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,468.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,721.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,732.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,194.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,014.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,830.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,821.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,183.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,823.29
|
| Rate for Payer: PHCS Commercial |
$8,743.08
|
| Rate for Payer: United Healthcare All Payer |
$8,014.49
|
|
|
G2 CONST INSERT SZ 5-6 11MM
|
Facility
|
IP
|
$15,378.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,999.14 |
| Max. Negotiated Rate |
$14,762.88 |
| Rate for Payer: Aetna Commercial |
$11,841.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,994.84
|
| Rate for Payer: Cash Price |
$7,689.00
|
| Rate for Payer: Cigna Commercial |
$12,763.74
|
| Rate for Payer: First Health Commercial |
$14,609.10
|
| Rate for Payer: Humana Commercial |
$13,071.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,609.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,348.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,613.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,532.64
|
| Rate for Payer: Ohio Health Group HMO |
$11,533.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,075.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,999.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,767.18
|
| Rate for Payer: PHCS Commercial |
$14,762.88
|
| Rate for Payer: United Healthcare All Payer |
$13,532.64
|
|
|
G2 CONST INSERT SZ 5-6 11MM
|
Facility
|
OP
|
$15,378.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,999.14 |
| Max. Negotiated Rate |
$14,762.88 |
| Rate for Payer: Aetna Commercial |
$11,841.06
|
| Rate for Payer: Anthem Medicaid |
$5,288.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,994.84
|
| Rate for Payer: Cash Price |
$7,689.00
|
| Rate for Payer: Cigna Commercial |
$12,763.74
|
| Rate for Payer: First Health Commercial |
$14,609.10
|
| Rate for Payer: Humana Commercial |
$13,071.30
|
| Rate for Payer: Humana KY Medicaid |
$5,288.49
|
| Rate for Payer: Kentucky WC Medicaid |
$5,342.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,609.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,348.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,613.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,394.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,532.64
|
| Rate for Payer: Ohio Health Group HMO |
$11,533.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,075.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,999.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,767.18
|
| Rate for Payer: PHCS Commercial |
$14,762.88
|
| Rate for Payer: United Healthcare All Payer |
$13,532.64
|
|
|
G2 CONST INSERT SZ 5-6 13MM
|
Facility
|
IP
|
$15,378.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,999.14 |
| Max. Negotiated Rate |
$14,762.88 |
| Rate for Payer: Aetna Commercial |
$11,841.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,994.84
|
| Rate for Payer: Cash Price |
$7,689.00
|
| Rate for Payer: Cigna Commercial |
$12,763.74
|
| Rate for Payer: First Health Commercial |
$14,609.10
|
| Rate for Payer: Humana Commercial |
$13,071.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,609.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,348.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,613.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,532.64
|
| Rate for Payer: Ohio Health Group HMO |
$11,533.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,075.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,999.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,767.18
|
| Rate for Payer: PHCS Commercial |
$14,762.88
|
| Rate for Payer: United Healthcare All Payer |
$13,532.64
|
|
|
G2 CONST INSERT SZ 5-6 13MM
|
Facility
|
OP
|
$15,378.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,999.14 |
| Max. Negotiated Rate |
$14,762.88 |
| Rate for Payer: Aetna Commercial |
$11,841.06
|
| Rate for Payer: Anthem Medicaid |
$5,288.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,994.84
|
| Rate for Payer: Cash Price |
$7,689.00
|
| Rate for Payer: Cigna Commercial |
$12,763.74
|
| Rate for Payer: First Health Commercial |
$14,609.10
|
| Rate for Payer: Humana Commercial |
$13,071.30
|
| Rate for Payer: Humana KY Medicaid |
$5,288.49
|
| Rate for Payer: Kentucky WC Medicaid |
$5,342.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,609.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,348.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,613.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,394.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,532.64
|
| Rate for Payer: Ohio Health Group HMO |
$11,533.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,075.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,999.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,767.18
|
| Rate for Payer: PHCS Commercial |
$14,762.88
|
| Rate for Payer: United Healthcare All Payer |
$13,532.64
|
|
|
G2 CONST INSERT SZ 5-6 15MM
|
Facility
|
IP
|
$15,378.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,999.14 |
| Max. Negotiated Rate |
$14,762.88 |
| Rate for Payer: Aetna Commercial |
$11,841.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,994.84
|
| Rate for Payer: Cash Price |
$7,689.00
|
| Rate for Payer: Cigna Commercial |
$12,763.74
|
| Rate for Payer: First Health Commercial |
$14,609.10
|
| Rate for Payer: Humana Commercial |
$13,071.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,609.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,348.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,613.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,532.64
|
| Rate for Payer: Ohio Health Group HMO |
$11,533.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,075.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,999.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,767.18
|
| Rate for Payer: PHCS Commercial |
$14,762.88
|
| Rate for Payer: United Healthcare All Payer |
$13,532.64
|
|
|
G2 CONST INSERT SZ 5-6 15MM
|
Facility
|
OP
|
$15,378.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,999.14 |
| Max. Negotiated Rate |
$14,762.88 |
| Rate for Payer: Aetna Commercial |
$11,841.06
|
| Rate for Payer: Anthem Medicaid |
$5,288.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,994.84
|
| Rate for Payer: Cash Price |
$7,689.00
|
| Rate for Payer: Cigna Commercial |
$12,763.74
|
| Rate for Payer: First Health Commercial |
$14,609.10
|
| Rate for Payer: Humana Commercial |
$13,071.30
|
| Rate for Payer: Humana KY Medicaid |
$5,288.49
|
| Rate for Payer: Kentucky WC Medicaid |
$5,342.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,609.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,348.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,613.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,394.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,532.64
|
| Rate for Payer: Ohio Health Group HMO |
$11,533.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,075.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,999.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,767.18
|
| Rate for Payer: PHCS Commercial |
$14,762.88
|
| Rate for Payer: United Healthcare All Payer |
$13,532.64
|
|
|
G2 CONST INSERT SZ 5-6 18MM
|
Facility
|
OP
|
$13,739.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,786.07 |
| Max. Negotiated Rate |
$13,189.44 |
| Rate for Payer: Aetna Commercial |
$10,579.03
|
| Rate for Payer: Anthem Medicaid |
$4,724.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,716.42
|
| Rate for Payer: Cash Price |
$6,869.50
|
| Rate for Payer: Cigna Commercial |
$11,403.37
|
| Rate for Payer: First Health Commercial |
$13,052.05
|
| Rate for Payer: Humana Commercial |
$11,678.15
|
| Rate for Payer: Humana KY Medicaid |
$4,724.84
|
| Rate for Payer: Kentucky WC Medicaid |
$4,772.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,265.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,139.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,121.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,819.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,090.32
|
| Rate for Payer: Ohio Health Group HMO |
$10,304.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,747.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,786.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,259.09
|
| Rate for Payer: PHCS Commercial |
$13,189.44
|
| Rate for Payer: United Healthcare All Payer |
$12,090.32
|
|
|
G2 CONST INSERT SZ 5-6 18MM
|
Facility
|
IP
|
$13,739.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,786.07 |
| Max. Negotiated Rate |
$13,189.44 |
| Rate for Payer: Aetna Commercial |
$10,579.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,716.42
|
| Rate for Payer: Cash Price |
$6,869.50
|
| Rate for Payer: Cigna Commercial |
$11,403.37
|
| Rate for Payer: First Health Commercial |
$13,052.05
|
| Rate for Payer: Humana Commercial |
$11,678.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,265.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,139.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,121.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,090.32
|
| Rate for Payer: Ohio Health Group HMO |
$10,304.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,747.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,786.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,259.09
|
| Rate for Payer: PHCS Commercial |
$13,189.44
|
| Rate for Payer: United Healthcare All Payer |
$12,090.32
|
|
|
G2 CONST INSERT SZ 5-6 21MM
|
Facility
|
IP
|
$9,107.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,183.96 |
| Max. Negotiated Rate |
$8,743.08 |
| Rate for Payer: Aetna Commercial |
$7,012.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,103.76
|
| Rate for Payer: Cash Price |
$4,553.69
|
| Rate for Payer: Cigna Commercial |
$7,559.13
|
| Rate for Payer: First Health Commercial |
$8,652.01
|
| Rate for Payer: Humana Commercial |
$7,741.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,468.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,721.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,732.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,014.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,830.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,821.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,183.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,823.29
|
| Rate for Payer: PHCS Commercial |
$8,743.08
|
| Rate for Payer: United Healthcare All Payer |
$8,014.49
|
|
|
G2 CONST INSERT SZ 5-6 21MM
|
Facility
|
OP
|
$9,107.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,183.96 |
| Max. Negotiated Rate |
$8,743.08 |
| Rate for Payer: Aetna Commercial |
$7,012.68
|
| Rate for Payer: Anthem Medicaid |
$3,132.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,103.76
|
| Rate for Payer: Cash Price |
$4,553.69
|
| Rate for Payer: Cigna Commercial |
$7,559.13
|
| Rate for Payer: First Health Commercial |
$8,652.01
|
| Rate for Payer: Humana Commercial |
$7,741.27
|
| Rate for Payer: Humana KY Medicaid |
$3,132.03
|
| Rate for Payer: Kentucky WC Medicaid |
$3,163.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,468.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,721.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,732.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,194.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,014.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,830.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,821.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,183.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,823.29
|
| Rate for Payer: PHCS Commercial |
$8,743.08
|
| Rate for Payer: United Healthcare All Payer |
$8,014.49
|
|
|
G2 CONST INSERT SZ 5-6 25MM
|
Facility
|
OP
|
$9,107.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,183.96 |
| Max. Negotiated Rate |
$8,743.08 |
| Rate for Payer: Aetna Commercial |
$7,012.68
|
| Rate for Payer: Anthem Medicaid |
$3,132.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,103.76
|
| Rate for Payer: Cash Price |
$4,553.69
|
| Rate for Payer: Cigna Commercial |
$7,559.13
|
| Rate for Payer: First Health Commercial |
$8,652.01
|
| Rate for Payer: Humana Commercial |
$7,741.27
|
| Rate for Payer: Humana KY Medicaid |
$3,132.03
|
| Rate for Payer: Kentucky WC Medicaid |
$3,163.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,468.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,721.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,732.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,194.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,014.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,830.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,821.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,183.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,823.29
|
| Rate for Payer: PHCS Commercial |
$8,743.08
|
| Rate for Payer: United Healthcare All Payer |
$8,014.49
|
|
