|
HEAD COCR DIA MOD 26MM +3MM NK
|
Facility
|
IP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
HEAD COCR DIA MOD 26MM +3MM NK
|
Facility
|
OP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem Medicaid |
$1,478.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Humana KY Medicaid |
$1,478.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,493.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,508.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
HEAD COCR DIA MOD 26MM -3MM NK
|
Facility
|
OP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem Medicaid |
$1,478.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Humana KY Medicaid |
$1,478.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,493.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,508.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
HEAD COCR DIA MOD 26MM -3MM NK
|
Facility
|
IP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
HEAD COCR DIA MOD 26MM -6MM NK
|
Facility
|
OP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem Medicaid |
$1,478.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Humana KY Medicaid |
$1,478.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,493.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,508.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
HEAD COCR DIA MOD 26MM -6MM NK
|
Facility
|
IP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
HEAD COCR DIA MOD 26MM +9MM NK
|
Facility
|
OP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem Medicaid |
$1,478.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Humana KY Medicaid |
$1,478.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,493.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,508.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
HEAD COCR DIA MOD 26MM +9MM NK
|
Facility
|
IP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
HEAD COCR DIA MOD 26MM STD NK
|
Facility
|
IP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
HEAD COCR DIA MOD 26MM STD NK
|
Facility
|
OP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem Medicaid |
$1,478.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Humana KY Medicaid |
$1,478.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,493.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,508.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
HEAD COCR FEM 40MM TYPE 1 -3MM
|
Facility
|
OP
|
$4,930.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.90 |
| Max. Negotiated Rate |
$4,732.80 |
| Rate for Payer: Aetna Commercial |
$3,796.10
|
| Rate for Payer: Anthem Medicaid |
$1,695.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,845.40
|
| Rate for Payer: Cash Price |
$2,465.00
|
| Rate for Payer: Cigna Commercial |
$4,091.90
|
| Rate for Payer: First Health Commercial |
$4,683.50
|
| Rate for Payer: Humana Commercial |
$4,190.50
|
| Rate for Payer: Humana KY Medicaid |
$1,695.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,712.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,042.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,638.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,479.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,729.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,338.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$640.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.30
|
| Rate for Payer: PHCS Commercial |
$4,732.80
|
| Rate for Payer: United Healthcare All Payer |
$4,338.40
|
|
|
HEAD COCR FEM 40MM TYPE 1 -3MM
|
Facility
|
IP
|
$4,930.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.90 |
| Max. Negotiated Rate |
$4,732.80 |
| Rate for Payer: Aetna Commercial |
$3,796.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,845.40
|
| Rate for Payer: Cash Price |
$2,465.00
|
| Rate for Payer: Cigna Commercial |
$4,091.90
|
| Rate for Payer: First Health Commercial |
$4,683.50
|
| Rate for Payer: Humana Commercial |
$4,190.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,042.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,638.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,479.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,338.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$640.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.30
|
| Rate for Payer: PHCS Commercial |
$4,732.80
|
| Rate for Payer: United Healthcare All Payer |
$4,338.40
|
|
|
HEAD COCR FEM 40MM TYPE 1 +6MM
|
Facility
|
IP
|
$4,930.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.90 |
| Max. Negotiated Rate |
$4,732.80 |
| Rate for Payer: Aetna Commercial |
$3,796.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,845.40
|
| Rate for Payer: Cash Price |
$2,465.00
|
| Rate for Payer: Cigna Commercial |
$4,091.90
|
| Rate for Payer: First Health Commercial |
$4,683.50
|
| Rate for Payer: Humana Commercial |
$4,190.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,042.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,638.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,479.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,338.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$640.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.30
|
| Rate for Payer: PHCS Commercial |
$4,732.80
|
| Rate for Payer: United Healthcare All Payer |
$4,338.40
|
|
|
HEAD COCR FEM 40MM TYPE 1 +6MM
|
Facility
|
OP
|
$4,930.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.90 |
| Max. Negotiated Rate |
$4,732.80 |
| Rate for Payer: Aetna Commercial |
$3,796.10
|
| Rate for Payer: Anthem Medicaid |
$1,695.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,845.40
|
| Rate for Payer: Cash Price |
$2,465.00
|
| Rate for Payer: Cigna Commercial |
$4,091.90
|
| Rate for Payer: First Health Commercial |
$4,683.50
|
| Rate for Payer: Humana Commercial |
$4,190.50
|
| Rate for Payer: Humana KY Medicaid |
$1,695.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,712.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,042.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,638.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,479.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,729.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,338.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$640.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.30
|
| Rate for Payer: PHCS Commercial |
$4,732.80
|
| Rate for Payer: United Healthcare All Payer |
$4,338.40
|
|
|
HEAD COCR FEM 40MM TYPE 1 -6MM
|
Facility
|
IP
|
$4,930.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.90 |
| Max. Negotiated Rate |
$4,732.80 |
| Rate for Payer: Aetna Commercial |
$3,796.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,845.40
|
| Rate for Payer: Cash Price |
$2,465.00
|
| Rate for Payer: Cigna Commercial |
$4,091.90
|
| Rate for Payer: First Health Commercial |
$4,683.50
|
| Rate for Payer: Humana Commercial |
$4,190.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,042.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,638.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,479.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,338.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$640.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.30
|
| Rate for Payer: PHCS Commercial |
$4,732.80
|
| Rate for Payer: United Healthcare All Payer |
$4,338.40
|
|
|
HEAD COCR FEM 40MM TYPE 1 -6MM
|
Facility
|
OP
|
$4,930.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.90 |
| Max. Negotiated Rate |
$4,732.80 |
| Rate for Payer: Aetna Commercial |
$3,796.10
|
| Rate for Payer: Anthem Medicaid |
$1,695.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,845.40
|
| Rate for Payer: Cash Price |
$2,465.00
|
| Rate for Payer: Cigna Commercial |
$4,091.90
|
| Rate for Payer: First Health Commercial |
$4,683.50
|
| Rate for Payer: Humana Commercial |
$4,190.50
|
| Rate for Payer: Humana KY Medicaid |
$1,695.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,712.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,042.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,638.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,479.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,729.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,338.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$640.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.30
|
| Rate for Payer: PHCS Commercial |
$4,732.80
|
| Rate for Payer: United Healthcare All Payer |
$4,338.40
|
|
|
HEAD COCR FEM 44MM TYPE 1 +3MM
|
Facility
|
OP
|
$4,930.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.90 |
| Max. Negotiated Rate |
$4,732.80 |
| Rate for Payer: Aetna Commercial |
$3,796.10
|
| Rate for Payer: Anthem Medicaid |
$1,695.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,845.40
|
| Rate for Payer: Cash Price |
$2,465.00
|
| Rate for Payer: Cigna Commercial |
$4,091.90
|
| Rate for Payer: First Health Commercial |
$4,683.50
|
| Rate for Payer: Humana Commercial |
$4,190.50
|
| Rate for Payer: Humana KY Medicaid |
$1,695.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,712.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,042.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,638.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,479.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,729.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,338.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$640.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.30
|
| Rate for Payer: PHCS Commercial |
$4,732.80
|
| Rate for Payer: United Healthcare All Payer |
$4,338.40
|
|
|
HEAD COCR FEM 44MM TYPE 1 +3MM
|
Facility
|
IP
|
$4,930.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.90 |
| Max. Negotiated Rate |
$4,732.80 |
| Rate for Payer: Aetna Commercial |
$3,796.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,845.40
|
| Rate for Payer: Cash Price |
$2,465.00
|
| Rate for Payer: Cigna Commercial |
$4,091.90
|
| Rate for Payer: First Health Commercial |
$4,683.50
|
| Rate for Payer: Humana Commercial |
$4,190.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,042.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,638.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,479.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,338.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$640.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.30
|
| Rate for Payer: PHCS Commercial |
$4,732.80
|
| Rate for Payer: United Healthcare All Payer |
$4,338.40
|
|
|
HEAD COCR FEM 44MM TYPE 1 -3MM
|
Facility
|
IP
|
$4,930.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.90 |
| Max. Negotiated Rate |
$4,732.80 |
| Rate for Payer: Aetna Commercial |
$3,796.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,845.40
|
| Rate for Payer: Cash Price |
$2,465.00
|
| Rate for Payer: Cigna Commercial |
$4,091.90
|
| Rate for Payer: First Health Commercial |
$4,683.50
|
| Rate for Payer: Humana Commercial |
$4,190.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,042.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,638.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,479.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,338.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$640.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.30
|
| Rate for Payer: PHCS Commercial |
$4,732.80
|
| Rate for Payer: United Healthcare All Payer |
$4,338.40
|
|
|
HEAD COCR FEM 44MM TYPE 1 -3MM
|
Facility
|
OP
|
$4,930.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.90 |
| Max. Negotiated Rate |
$4,732.80 |
| Rate for Payer: Aetna Commercial |
$3,796.10
|
| Rate for Payer: Anthem Medicaid |
$1,695.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,845.40
|
| Rate for Payer: Cash Price |
$2,465.00
|
| Rate for Payer: Cigna Commercial |
$4,091.90
|
| Rate for Payer: First Health Commercial |
$4,683.50
|
| Rate for Payer: Humana Commercial |
$4,190.50
|
| Rate for Payer: Humana KY Medicaid |
$1,695.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,712.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,042.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,638.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,479.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,729.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,338.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$640.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.30
|
| Rate for Payer: PHCS Commercial |
$4,732.80
|
| Rate for Payer: United Healthcare All Payer |
$4,338.40
|
|
|
HEAD COCR FEM 44MM TYPE 1 +6MM
|
Facility
|
IP
|
$4,930.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.90 |
| Max. Negotiated Rate |
$4,732.80 |
| Rate for Payer: Aetna Commercial |
$3,796.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,845.40
|
| Rate for Payer: Cash Price |
$2,465.00
|
| Rate for Payer: Cigna Commercial |
$4,091.90
|
| Rate for Payer: First Health Commercial |
$4,683.50
|
| Rate for Payer: Humana Commercial |
$4,190.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,042.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,638.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,479.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,338.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$640.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.30
|
| Rate for Payer: PHCS Commercial |
$4,732.80
|
| Rate for Payer: United Healthcare All Payer |
$4,338.40
|
|
|
HEAD COCR FEM 44MM TYPE 1 +6MM
|
Facility
|
OP
|
$4,930.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.90 |
| Max. Negotiated Rate |
$4,732.80 |
| Rate for Payer: Aetna Commercial |
$3,796.10
|
| Rate for Payer: Anthem Medicaid |
$1,695.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,845.40
|
| Rate for Payer: Cash Price |
$2,465.00
|
| Rate for Payer: Cigna Commercial |
$4,091.90
|
| Rate for Payer: First Health Commercial |
$4,683.50
|
| Rate for Payer: Humana Commercial |
$4,190.50
|
| Rate for Payer: Humana KY Medicaid |
$1,695.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,712.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,042.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,638.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,479.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,729.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,338.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$640.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.30
|
| Rate for Payer: PHCS Commercial |
$4,732.80
|
| Rate for Payer: United Healthcare All Payer |
$4,338.40
|
|
|
HEAD COCR FEM 44MM TYPE 1 -6MM
|
Facility
|
OP
|
$4,930.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.90 |
| Max. Negotiated Rate |
$4,732.80 |
| Rate for Payer: Aetna Commercial |
$3,796.10
|
| Rate for Payer: Anthem Medicaid |
$1,695.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,845.40
|
| Rate for Payer: Cash Price |
$2,465.00
|
| Rate for Payer: Cigna Commercial |
$4,091.90
|
| Rate for Payer: First Health Commercial |
$4,683.50
|
| Rate for Payer: Humana Commercial |
$4,190.50
|
| Rate for Payer: Humana KY Medicaid |
$1,695.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,712.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,042.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,638.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,479.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,729.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,338.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$640.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.30
|
| Rate for Payer: PHCS Commercial |
$4,732.80
|
| Rate for Payer: United Healthcare All Payer |
$4,338.40
|
|
|
HEAD COCR FEM 44MM TYPE 1 -6MM
|
Facility
|
IP
|
$4,930.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.90 |
| Max. Negotiated Rate |
$4,732.80 |
| Rate for Payer: Aetna Commercial |
$3,796.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,845.40
|
| Rate for Payer: Cash Price |
$2,465.00
|
| Rate for Payer: Cigna Commercial |
$4,091.90
|
| Rate for Payer: First Health Commercial |
$4,683.50
|
| Rate for Payer: Humana Commercial |
$4,190.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,042.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,638.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,479.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,338.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$640.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.30
|
| Rate for Payer: PHCS Commercial |
$4,732.80
|
| Rate for Payer: United Healthcare All Payer |
$4,338.40
|
|
|
HEAD COCR FEM 44MM TYPE 1 +9MM
|
Facility
|
IP
|
$4,930.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.90 |
| Max. Negotiated Rate |
$4,732.80 |
| Rate for Payer: Aetna Commercial |
$3,796.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,845.40
|
| Rate for Payer: Cash Price |
$2,465.00
|
| Rate for Payer: Cigna Commercial |
$4,091.90
|
| Rate for Payer: First Health Commercial |
$4,683.50
|
| Rate for Payer: Humana Commercial |
$4,190.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,042.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,638.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,479.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,338.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$640.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.30
|
| Rate for Payer: PHCS Commercial |
$4,732.80
|
| Rate for Payer: United Healthcare All Payer |
$4,338.40
|
|
