|
GEN CEM FINNED TIB BASE SM LFT
|
Facility
|
IP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
GEN CEM FINNED TIB BASE SM LFT
|
Facility
|
OP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem Medicaid |
$3,021.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Humana KY Medicaid |
$3,021.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,052.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,082.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
GEN CEM FINNED TIB BASE XLG LT
|
Facility
|
OP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem Medicaid |
$3,021.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Humana KY Medicaid |
$3,021.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,052.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,082.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
GEN CEM FINNED TIB BASE XLG LT
|
Facility
|
IP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
GEN CR ART LRG LT INSERT 8MM
|
Facility
|
OP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem Medicaid |
$3,021.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Humana KY Medicaid |
$3,021.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,052.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,082.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
GEN CR ART LRG LT INSERT 8MM
|
Facility
|
IP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
GEN CR ART LRG RT INSERT 12MM
|
Facility
|
IP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
GEN CR ART LRG RT INSERT 12MM
|
Facility
|
OP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem Medicaid |
$3,021.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Humana KY Medicaid |
$3,021.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,052.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,082.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
GENERAL HEALTH PANEL
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
HCPCS 80050
|
| Hospital Charge Code |
30000006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.12 |
| Max. Negotiated Rate |
$311.04 |
| Rate for Payer: Aetna Commercial |
$249.48
|
| Rate for Payer: Anthem Medicaid |
$44.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$260.17
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$268.92
|
| Rate for Payer: First Health Commercial |
$307.80
|
| Rate for Payer: Humana Commercial |
$275.40
|
| Rate for Payer: Humana KY Medicaid |
$44.93
|
| Rate for Payer: Kentucky WC Medicaid |
$45.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$265.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$239.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$285.12
|
| Rate for Payer: Ohio Health Group HMO |
$243.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.44
|
| Rate for Payer: PHCS Commercial |
$311.04
|
| Rate for Payer: United Healthcare All Payer |
$285.12
|
|
|
GENERAL HEALTH PANEL
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
HCPCS 80050
|
| Hospital Charge Code |
30000006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.12 |
| Max. Negotiated Rate |
$311.04 |
| Rate for Payer: Aetna Commercial |
$249.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$260.17
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$268.92
|
| Rate for Payer: First Health Commercial |
$307.80
|
| Rate for Payer: Humana Commercial |
$275.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$265.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$239.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$285.12
|
| Rate for Payer: Ohio Health Group HMO |
$243.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.44
|
| Rate for Payer: PHCS Commercial |
$311.04
|
| Rate for Payer: United Healthcare All Payer |
$285.12
|
|
|
GENERATOR
|
Facility
|
OP
|
$40,205.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,226.65 |
| Max. Negotiated Rate |
$38,596.80 |
| Rate for Payer: Aetna Commercial |
$30,957.85
|
| Rate for Payer: Anthem Medicaid |
$13,826.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,359.90
|
| Rate for Payer: Cash Price |
$20,102.50
|
| Rate for Payer: Cigna Commercial |
$33,370.15
|
| Rate for Payer: First Health Commercial |
$38,194.75
|
| Rate for Payer: Humana Commercial |
$34,174.25
|
| Rate for Payer: Humana KY Medicaid |
$13,826.50
|
| Rate for Payer: Kentucky WC Medicaid |
$13,967.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,968.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,671.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,061.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,103.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,380.40
|
| Rate for Payer: Ohio Health Group HMO |
$30,153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,041.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,226.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,463.55
|
| Rate for Payer: PHCS Commercial |
$38,596.80
|
| Rate for Payer: United Healthcare All Payer |
$35,380.40
|
|
|
GENERATOR
|
Facility
|
IP
|
$40,205.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,226.65 |
| Max. Negotiated Rate |
$38,596.80 |
| Rate for Payer: Aetna Commercial |
$30,957.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,359.90
|
| Rate for Payer: Cash Price |
$20,102.50
|
| Rate for Payer: Cigna Commercial |
$33,370.15
|
| Rate for Payer: First Health Commercial |
$38,194.75
|
| Rate for Payer: Humana Commercial |
$34,174.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32,968.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29,671.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,061.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,380.40
|
| Rate for Payer: Ohio Health Group HMO |
$30,153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,041.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,226.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,463.55
|
| Rate for Payer: PHCS Commercial |
$38,596.80
|
| Rate for Payer: United Healthcare All Payer |
$35,380.40
|
|
|
GENERATOR ADAPTA SCRR ADSR01
|
Facility
|
OP
|
$12,425.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,615.25 |
| Max. Negotiated Rate |
$11,928.00 |
| Rate for Payer: Aetna Commercial |
$9,567.25
|
| Rate for Payer: Anthem Medicaid |
$4,272.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,691.50
|
| Rate for Payer: Cash Price |
$6,212.50
|
| Rate for Payer: Cigna Commercial |
$10,312.75
|
| Rate for Payer: First Health Commercial |
$11,803.75
|
| Rate for Payer: Humana Commercial |
$10,561.25
|
| Rate for Payer: Humana KY Medicaid |
$4,272.96
|
| Rate for Payer: Kentucky WC Medicaid |
$4,316.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,188.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,169.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,727.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,358.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,934.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,615.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,851.75
|
| Rate for Payer: PHCS Commercial |
$11,928.00
|
| Rate for Payer: United Healthcare All Payer |
$10,934.00
|
|
|
GENERATOR ADAPTA SCRR ADSR01
|
Facility
|
IP
|
$12,425.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,615.25 |
| Max. Negotiated Rate |
$11,928.00 |
| Rate for Payer: Aetna Commercial |
$9,567.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,691.50
|
| Rate for Payer: Cash Price |
$6,212.50
|
| Rate for Payer: Cigna Commercial |
$10,312.75
|
| Rate for Payer: First Health Commercial |
$11,803.75
|
| Rate for Payer: Humana Commercial |
$10,561.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,188.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,169.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,727.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,934.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,615.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,851.75
|
| Rate for Payer: PHCS Commercial |
$11,928.00
|
| Rate for Payer: United Healthcare All Payer |
$10,934.00
|
|
|
GENERATOR ADAPTA SCRR ADSR03
|
Facility
|
IP
|
$12,425.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,615.25 |
| Max. Negotiated Rate |
$11,928.00 |
| Rate for Payer: Aetna Commercial |
$9,567.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,691.50
|
| Rate for Payer: Cash Price |
$6,212.50
|
| Rate for Payer: Cigna Commercial |
$10,312.75
|
| Rate for Payer: First Health Commercial |
$11,803.75
|
| Rate for Payer: Humana Commercial |
$10,561.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,188.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,169.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,727.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,934.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,615.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,851.75
|
| Rate for Payer: PHCS Commercial |
$11,928.00
|
| Rate for Payer: United Healthcare All Payer |
$10,934.00
|
|
|
GENERATOR ADAPTA SCRR ADSR03
|
Facility
|
OP
|
$12,425.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,615.25 |
| Max. Negotiated Rate |
$11,928.00 |
| Rate for Payer: Aetna Commercial |
$9,567.25
|
| Rate for Payer: Anthem Medicaid |
$4,272.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,691.50
|
| Rate for Payer: Cash Price |
$6,212.50
|
| Rate for Payer: Cigna Commercial |
$10,312.75
|
| Rate for Payer: First Health Commercial |
$11,803.75
|
| Rate for Payer: Humana Commercial |
$10,561.25
|
| Rate for Payer: Humana KY Medicaid |
$4,272.96
|
| Rate for Payer: Kentucky WC Medicaid |
$4,316.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,188.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,169.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,727.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,358.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,934.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,615.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,851.75
|
| Rate for Payer: PHCS Commercial |
$11,928.00
|
| Rate for Payer: United Healthcare All Payer |
$10,934.00
|
|
|
GENERATOR ADAPTA SCRR ADSR06
|
Facility
|
IP
|
$12,425.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,615.25 |
| Max. Negotiated Rate |
$11,928.00 |
| Rate for Payer: Aetna Commercial |
$9,567.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,691.50
|
| Rate for Payer: Cash Price |
$6,212.50
|
| Rate for Payer: Cigna Commercial |
$10,312.75
|
| Rate for Payer: First Health Commercial |
$11,803.75
|
| Rate for Payer: Humana Commercial |
$10,561.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,188.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,169.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,727.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,934.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,615.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,851.75
|
| Rate for Payer: PHCS Commercial |
$11,928.00
|
| Rate for Payer: United Healthcare All Payer |
$10,934.00
|
|
|
GENERATOR ADAPTA SCRR ADSR06
|
Facility
|
OP
|
$12,425.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,615.25 |
| Max. Negotiated Rate |
$11,928.00 |
| Rate for Payer: Aetna Commercial |
$9,567.25
|
| Rate for Payer: Anthem Medicaid |
$4,272.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,691.50
|
| Rate for Payer: Cash Price |
$6,212.50
|
| Rate for Payer: Cigna Commercial |
$10,312.75
|
| Rate for Payer: First Health Commercial |
$11,803.75
|
| Rate for Payer: Humana Commercial |
$10,561.25
|
| Rate for Payer: Humana KY Medicaid |
$4,272.96
|
| Rate for Payer: Kentucky WC Medicaid |
$4,316.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,188.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,169.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,727.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,358.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,934.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,615.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,851.75
|
| Rate for Payer: PHCS Commercial |
$11,928.00
|
| Rate for Payer: United Healthcare All Payer |
$10,934.00
|
|
|
GENERATOR ALTRUA 40 DCRR S404
|
Facility
|
IP
|
$25,667.05
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,336.72 |
| Max. Negotiated Rate |
$24,640.37 |
| Rate for Payer: Aetna Commercial |
$19,763.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,020.30
|
| Rate for Payer: Cash Price |
$12,833.52
|
| Rate for Payer: Cigna Commercial |
$21,303.65
|
| Rate for Payer: First Health Commercial |
$24,383.70
|
| Rate for Payer: Humana Commercial |
$21,816.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,046.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,942.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,700.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,587.00
|
| Rate for Payer: Ohio Health Group HMO |
$19,250.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,133.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,336.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,956.79
|
| Rate for Payer: PHCS Commercial |
$24,640.37
|
| Rate for Payer: United Healthcare All Payer |
$22,587.00
|
|
|
GENERATOR ALTRUA 40 DCRR S404
|
Facility
|
OP
|
$25,667.05
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,336.72 |
| Max. Negotiated Rate |
$24,640.37 |
| Rate for Payer: Aetna Commercial |
$19,763.63
|
| Rate for Payer: Anthem Medicaid |
$8,826.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,020.30
|
| Rate for Payer: Cash Price |
$12,833.52
|
| Rate for Payer: Cigna Commercial |
$21,303.65
|
| Rate for Payer: First Health Commercial |
$24,383.70
|
| Rate for Payer: Humana Commercial |
$21,816.99
|
| Rate for Payer: Humana KY Medicaid |
$8,826.90
|
| Rate for Payer: Kentucky WC Medicaid |
$8,916.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,046.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,942.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,700.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,004.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,587.00
|
| Rate for Payer: Ohio Health Group HMO |
$19,250.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,133.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,336.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,956.79
|
| Rate for Payer: PHCS Commercial |
$24,640.37
|
| Rate for Payer: United Healthcare All Payer |
$22,587.00
|
|
|
GENERATOR ALTRUA 40 SCRR S401
|
Facility
|
IP
|
$16,800.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,184.00 |
| Max. Negotiated Rate |
$16,128.00 |
| Rate for Payer: Aetna Commercial |
$12,936.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,104.00
|
| Rate for Payer: Cash Price |
$8,400.00
|
| Rate for Payer: Cigna Commercial |
$13,944.00
|
| Rate for Payer: First Health Commercial |
$15,960.00
|
| Rate for Payer: Humana Commercial |
$14,280.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,776.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,398.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,040.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,184.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,208.00
|
| Rate for Payer: PHCS Commercial |
$16,128.00
|
| Rate for Payer: United Healthcare All Payer |
$14,784.00
|
|
|
GENERATOR ALTRUA 40 SCRR S401
|
Facility
|
OP
|
$16,800.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,184.00 |
| Max. Negotiated Rate |
$16,128.00 |
| Rate for Payer: Aetna Commercial |
$12,936.00
|
| Rate for Payer: Anthem Medicaid |
$5,777.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,104.00
|
| Rate for Payer: Cash Price |
$8,400.00
|
| Rate for Payer: Cigna Commercial |
$13,944.00
|
| Rate for Payer: First Health Commercial |
$15,960.00
|
| Rate for Payer: Humana Commercial |
$14,280.00
|
| Rate for Payer: Humana KY Medicaid |
$5,777.52
|
| Rate for Payer: Kentucky WC Medicaid |
$5,836.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,776.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,398.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,040.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,893.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$12,600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,184.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,208.00
|
| Rate for Payer: PHCS Commercial |
$16,128.00
|
| Rate for Payer: United Healthcare All Payer |
$14,784.00
|
|
|
GENERATOR ALTRUA 60 SCRR S601
|
Facility
|
OP
|
$13,702.50
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,781.32 |
| Max. Negotiated Rate |
$13,154.40 |
| Rate for Payer: Aetna Commercial |
$10,550.92
|
| Rate for Payer: Anthem Medicaid |
$4,712.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,687.95
|
| Rate for Payer: Cash Price |
$6,851.25
|
| Rate for Payer: Cigna Commercial |
$11,373.08
|
| Rate for Payer: First Health Commercial |
$13,017.38
|
| Rate for Payer: Humana Commercial |
$11,647.12
|
| Rate for Payer: Humana KY Medicaid |
$4,712.29
|
| Rate for Payer: Kentucky WC Medicaid |
$4,760.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,236.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,112.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,110.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,806.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,058.20
|
| Rate for Payer: Ohio Health Group HMO |
$10,276.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,740.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,781.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,247.78
|
| Rate for Payer: PHCS Commercial |
$13,154.40
|
| Rate for Payer: United Healthcare All Payer |
$12,058.20
|
|
|
GENERATOR ALTRUA 60 SCRR S601
|
Facility
|
IP
|
$13,702.50
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,781.32 |
| Max. Negotiated Rate |
$13,154.40 |
| Rate for Payer: Aetna Commercial |
$10,550.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,687.95
|
| Rate for Payer: Cash Price |
$6,851.25
|
| Rate for Payer: Cigna Commercial |
$11,373.08
|
| Rate for Payer: First Health Commercial |
$13,017.38
|
| Rate for Payer: Humana Commercial |
$11,647.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,236.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,112.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,110.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,058.20
|
| Rate for Payer: Ohio Health Group HMO |
$10,276.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,740.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,781.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,247.78
|
| Rate for Payer: PHCS Commercial |
$13,154.40
|
| Rate for Payer: United Healthcare All Payer |
$12,058.20
|
|
|
GENERATOR ALTRUA DCRR S208
|
Facility
|
IP
|
$19,400.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,522.00 |
| Max. Negotiated Rate |
$18,624.00 |
| Rate for Payer: Aetna Commercial |
$14,938.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,132.00
|
| Rate for Payer: Cash Price |
$9,700.00
|
| Rate for Payer: Cigna Commercial |
$16,102.00
|
| Rate for Payer: First Health Commercial |
$18,430.00
|
| Rate for Payer: Humana Commercial |
$16,490.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,908.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,317.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,820.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,072.00
|
| Rate for Payer: Ohio Health Group HMO |
$14,550.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,014.00
|
| Rate for Payer: PHCS Commercial |
$18,624.00
|
| Rate for Payer: United Healthcare All Payer |
$17,072.00
|
|
