|
HEAD LEGACY COCR 12/14 26MM +0
|
Facility
|
IP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HEAD LEGACY COCR 12/14 26MM +0
|
Facility
|
OP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem Medicaid |
$1,499.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Humana KY Medicaid |
$1,499.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,515.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,529.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HEAD LEGACY COCR 12/14 26MM +8
|
Facility
|
IP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HEAD LEGACY COCR 12/14 26MM +8
|
Facility
|
OP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem Medicaid |
$1,499.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Humana KY Medicaid |
$1,499.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,515.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,529.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HEAD LEGACY COCR 12/14 28MM +0
|
Facility
|
IP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HEAD LEGACY COCR 12/14 28MM +0
|
Facility
|
OP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem Medicaid |
$1,499.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Humana KY Medicaid |
$1,499.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,515.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,529.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HEAD LEGACY COCR 12/14 28MM +4
|
Facility
|
IP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HEAD LEGACY COCR 12/14 28MM +4
|
Facility
|
OP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem Medicaid |
$1,499.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Humana KY Medicaid |
$1,499.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,515.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,529.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HEAD LEGACY COCR 12/14 28MM -4
|
Facility
|
OP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem Medicaid |
$1,499.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Humana KY Medicaid |
$1,499.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,515.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,529.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HEAD LEGACY COCR 12/14 28MM -4
|
Facility
|
IP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HEAD LEGACY COCR 12/14 28MM +8
|
Facility
|
OP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem Medicaid |
$1,499.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Humana KY Medicaid |
$1,499.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,515.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,529.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HEAD LEGACY COCR 12/14 28MM +8
|
Facility
|
IP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HEAD LEGACY COCR 12/14 32MM +0
|
Facility
|
OP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem Medicaid |
$1,499.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Humana KY Medicaid |
$1,499.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,515.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,529.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HEAD LEGACY COCR 12/14 32MM +0
|
Facility
|
IP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HEAD LEGACY COCR 12/14 32MM +4
|
Facility
|
IP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HEAD LEGACY COCR 12/14 32MM +4
|
Facility
|
OP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem Medicaid |
$1,499.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Humana KY Medicaid |
$1,499.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,515.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,529.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HEAD LEGACY COCR 12/14 32MM -4
|
Facility
|
IP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HEAD LEGACY COCR 12/14 32MM -4
|
Facility
|
OP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem Medicaid |
$1,499.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Humana KY Medicaid |
$1,499.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,515.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,529.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HEAD LEGACY COCR 12/14 32MM +8
|
Facility
|
OP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem Medicaid |
$1,499.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Humana KY Medicaid |
$1,499.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,515.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,529.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HEAD LEGACY COCR 12/14 32MM +8
|
Facility
|
IP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HEAD LEGACY COCR 12/14 38MM +0
|
Facility
|
IP
|
$4,860.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.80 |
| Max. Negotiated Rate |
$4,665.60 |
| Rate for Payer: Aetna Commercial |
$3,742.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,790.80
|
| Rate for Payer: Cash Price |
$2,430.00
|
| Rate for Payer: Cigna Commercial |
$4,033.80
|
| Rate for Payer: First Health Commercial |
$4,617.00
|
| Rate for Payer: Humana Commercial |
$4,131.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,985.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,586.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,458.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,276.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,645.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$972.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,506.60
|
| Rate for Payer: PHCS Commercial |
$4,665.60
|
| Rate for Payer: United Healthcare All Payer |
$4,276.80
|
|
|
HEAD LEGACY COCR 12/14 38MM +0
|
Facility
|
OP
|
$4,860.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.80 |
| Max. Negotiated Rate |
$4,665.60 |
| Rate for Payer: Aetna Commercial |
$3,742.20
|
| Rate for Payer: Anthem Medicaid |
$1,671.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,790.80
|
| Rate for Payer: Cash Price |
$2,430.00
|
| Rate for Payer: Cigna Commercial |
$4,033.80
|
| Rate for Payer: First Health Commercial |
$4,617.00
|
| Rate for Payer: Humana Commercial |
$4,131.00
|
| Rate for Payer: Humana KY Medicaid |
$1,671.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,688.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,985.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,586.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,458.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,704.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,276.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,645.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$972.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,506.60
|
| Rate for Payer: PHCS Commercial |
$4,665.60
|
| Rate for Payer: United Healthcare All Payer |
$4,276.80
|
|
|
HEAD LEGACY COCR 12/14 38MM +4
|
Facility
|
IP
|
$4,860.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.80 |
| Max. Negotiated Rate |
$4,665.60 |
| Rate for Payer: Aetna Commercial |
$3,742.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,790.80
|
| Rate for Payer: Cash Price |
$2,430.00
|
| Rate for Payer: Cigna Commercial |
$4,033.80
|
| Rate for Payer: First Health Commercial |
$4,617.00
|
| Rate for Payer: Humana Commercial |
$4,131.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,985.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,586.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,458.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,276.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,645.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$972.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,506.60
|
| Rate for Payer: PHCS Commercial |
$4,665.60
|
| Rate for Payer: United Healthcare All Payer |
$4,276.80
|
|
|
HEAD LEGACY COCR 12/14 38MM +4
|
Facility
|
OP
|
$4,860.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.80 |
| Max. Negotiated Rate |
$4,665.60 |
| Rate for Payer: Aetna Commercial |
$3,742.20
|
| Rate for Payer: Anthem Medicaid |
$1,671.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,790.80
|
| Rate for Payer: Cash Price |
$2,430.00
|
| Rate for Payer: Cigna Commercial |
$4,033.80
|
| Rate for Payer: First Health Commercial |
$4,617.00
|
| Rate for Payer: Humana Commercial |
$4,131.00
|
| Rate for Payer: Humana KY Medicaid |
$1,671.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,688.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,985.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,586.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,458.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,704.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,276.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,645.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$972.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,506.60
|
| Rate for Payer: PHCS Commercial |
$4,665.60
|
| Rate for Payer: United Healthcare All Payer |
$4,276.80
|
|
|
HEAD LEGACY COCR 12/14 38MM -4
|
Facility
|
OP
|
$4,860.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.80 |
| Max. Negotiated Rate |
$4,665.60 |
| Rate for Payer: Aetna Commercial |
$3,742.20
|
| Rate for Payer: Anthem Medicaid |
$1,671.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,790.80
|
| Rate for Payer: Cash Price |
$2,430.00
|
| Rate for Payer: Cigna Commercial |
$4,033.80
|
| Rate for Payer: First Health Commercial |
$4,617.00
|
| Rate for Payer: Humana Commercial |
$4,131.00
|
| Rate for Payer: Humana KY Medicaid |
$1,671.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,688.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,985.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,586.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,458.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,704.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,276.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,645.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$972.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,506.60
|
| Rate for Payer: PHCS Commercial |
$4,665.60
|
| Rate for Payer: United Healthcare All Payer |
$4,276.80
|
|
