|
B/F MODULAR STEM STD IMP SET
|
Facility
|
OP
|
$203,369.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26,438.00 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$156,594.28
|
| Rate for Payer: Anthem Medicaid |
$69,938.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$158,627.98
|
| Rate for Payer: Cash Price |
$101,684.60
|
| Rate for Payer: Cigna Commercial |
$168,796.44
|
| Rate for Payer: First Health Commercial |
$193,200.74
|
| Rate for Payer: Humana Commercial |
$172,863.82
|
| Rate for Payer: Humana KY Medicaid |
$69,938.67
|
| Rate for Payer: Kentucky WC Medicaid |
$70,650.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$166,762.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$150,086.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61,010.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$71,341.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$178,964.90
|
| Rate for Payer: Ohio Health Group HMO |
$152,526.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40,673.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,438.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63,044.45
|
| Rate for Payer: PHCS Commercial |
$195,234.43
|
| Rate for Payer: United Healthcare All Payer |
$178,964.90
|
|
|
B/F MODULAR STEM STD IMP SET
|
Facility
|
IP
|
$203,369.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26,438.00 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$156,594.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$158,627.98
|
| Rate for Payer: Cash Price |
$101,684.60
|
| Rate for Payer: Cigna Commercial |
$168,796.44
|
| Rate for Payer: First Health Commercial |
$193,200.74
|
| Rate for Payer: Humana Commercial |
$172,863.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$166,762.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$150,086.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61,010.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$178,964.90
|
| Rate for Payer: Ohio Health Group HMO |
$152,526.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40,673.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,438.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63,044.45
|
| Rate for Payer: PHCS Commercial |
$195,234.43
|
| Rate for Payer: United Healthcare All Payer |
$178,964.90
|
|
|
B/F MONOBLCK STEM MCRO IMP SET
|
Facility
|
OP
|
$68,797.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,943.69 |
| Max. Negotiated Rate |
$66,045.70 |
| Rate for Payer: Aetna Commercial |
$52,974.15
|
| Rate for Payer: Anthem Medicaid |
$23,659.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,662.13
|
| Rate for Payer: Cash Price |
$34,398.80
|
| Rate for Payer: Cigna Commercial |
$57,102.01
|
| Rate for Payer: First Health Commercial |
$65,357.72
|
| Rate for Payer: Humana Commercial |
$58,477.96
|
| Rate for Payer: Humana KY Medicaid |
$23,659.49
|
| Rate for Payer: Kentucky WC Medicaid |
$23,900.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,414.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,772.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,639.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,134.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,541.89
|
| Rate for Payer: Ohio Health Group HMO |
$51,598.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,759.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,943.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,327.26
|
| Rate for Payer: PHCS Commercial |
$66,045.70
|
| Rate for Payer: United Healthcare All Payer |
$60,541.89
|
|
|
B/F MONOBLCK STEM MCRO IMP SET
|
Facility
|
IP
|
$68,797.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,943.69 |
| Max. Negotiated Rate |
$66,045.70 |
| Rate for Payer: Aetna Commercial |
$52,974.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,662.13
|
| Rate for Payer: Cash Price |
$34,398.80
|
| Rate for Payer: Cigna Commercial |
$57,102.01
|
| Rate for Payer: First Health Commercial |
$65,357.72
|
| Rate for Payer: Humana Commercial |
$58,477.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,414.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,772.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,639.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,541.89
|
| Rate for Payer: Ohio Health Group HMO |
$51,598.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,759.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,943.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,327.26
|
| Rate for Payer: PHCS Commercial |
$66,045.70
|
| Rate for Payer: United Healthcare All Payer |
$60,541.89
|
|
|
B/F MONOBLCK STEM STD IMP SET
|
Facility
|
OP
|
$106,856.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13,891.38 |
| Max. Negotiated Rate |
$102,582.53 |
| Rate for Payer: Aetna Commercial |
$82,279.74
|
| Rate for Payer: Anthem Medicaid |
$36,748.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83,348.30
|
| Rate for Payer: Cash Price |
$53,428.40
|
| Rate for Payer: Cigna Commercial |
$88,691.14
|
| Rate for Payer: First Health Commercial |
$101,513.96
|
| Rate for Payer: Humana Commercial |
$90,828.28
|
| Rate for Payer: Humana KY Medicaid |
$36,748.05
|
| Rate for Payer: Kentucky WC Medicaid |
$37,122.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$87,622.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$78,860.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32,057.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$37,485.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$94,033.98
|
| Rate for Payer: Ohio Health Group HMO |
$80,142.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,371.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,891.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33,125.61
|
| Rate for Payer: PHCS Commercial |
$102,582.53
|
| Rate for Payer: United Healthcare All Payer |
$94,033.98
|
|
|
B/F MONOBLCK STEM STD IMP SET
|
Facility
|
IP
|
$106,856.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13,891.38 |
| Max. Negotiated Rate |
$102,582.53 |
| Rate for Payer: Aetna Commercial |
$82,279.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83,348.30
|
| Rate for Payer: Cash Price |
$53,428.40
|
| Rate for Payer: Cigna Commercial |
$88,691.14
|
| Rate for Payer: First Health Commercial |
$101,513.96
|
| Rate for Payer: Humana Commercial |
$90,828.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$87,622.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$78,860.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32,057.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$94,033.98
|
| Rate for Payer: Ohio Health Group HMO |
$80,142.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,371.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,891.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33,125.61
|
| Rate for Payer: PHCS Commercial |
$102,582.53
|
| Rate for Payer: United Healthcare All Payer |
$94,033.98
|
|
|
BF OFFSET HD. IMPLANT SET
|
Facility
|
OP
|
$9,092.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,182.04 |
| Max. Negotiated Rate |
$8,728.90 |
| Rate for Payer: Aetna Commercial |
$7,001.30
|
| Rate for Payer: Anthem Medicaid |
$3,126.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,092.23
|
| Rate for Payer: Cash Price |
$4,546.30
|
| Rate for Payer: Cigna Commercial |
$7,546.86
|
| Rate for Payer: First Health Commercial |
$8,637.97
|
| Rate for Payer: Humana Commercial |
$7,728.71
|
| Rate for Payer: Humana KY Medicaid |
$3,126.95
|
| Rate for Payer: Kentucky WC Medicaid |
$3,158.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,455.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,710.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,727.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,189.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,001.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,819.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,818.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,182.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,818.71
|
| Rate for Payer: PHCS Commercial |
$8,728.90
|
| Rate for Payer: United Healthcare All Payer |
$8,001.49
|
|
|
BF OFFSET HD. IMPLANT SET
|
Facility
|
IP
|
$9,092.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,182.04 |
| Max. Negotiated Rate |
$8,728.90 |
| Rate for Payer: Aetna Commercial |
$7,001.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,092.23
|
| Rate for Payer: Cash Price |
$4,546.30
|
| Rate for Payer: Cigna Commercial |
$7,546.86
|
| Rate for Payer: First Health Commercial |
$8,637.97
|
| Rate for Payer: Humana Commercial |
$7,728.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,455.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,710.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,727.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,001.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,819.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,818.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,182.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,818.71
|
| Rate for Payer: PHCS Commercial |
$8,728.90
|
| Rate for Payer: United Healthcare All Payer |
$8,001.49
|
|
|
BF OFFSET HUM HEAD 15*40
|
Facility
|
IP
|
$10,976.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.97 |
| Max. Negotiated Rate |
$10,537.61 |
| Rate for Payer: Aetna Commercial |
$8,452.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,561.81
|
| Rate for Payer: Cash Price |
$5,488.34
|
| Rate for Payer: Cigna Commercial |
$9,110.64
|
| Rate for Payer: First Health Commercial |
$10,427.85
|
| Rate for Payer: Humana Commercial |
$9,330.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,000.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,100.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,293.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,659.48
|
| Rate for Payer: Ohio Health Group HMO |
$8,232.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.77
|
| Rate for Payer: PHCS Commercial |
$10,537.61
|
| Rate for Payer: United Healthcare All Payer |
$9,659.48
|
|
|
BF OFFSET HUM HEAD 15*40
|
Facility
|
OP
|
$10,976.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.97 |
| Max. Negotiated Rate |
$10,537.61 |
| Rate for Payer: Aetna Commercial |
$8,452.04
|
| Rate for Payer: Anthem Medicaid |
$3,774.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,561.81
|
| Rate for Payer: Cash Price |
$5,488.34
|
| Rate for Payer: Cigna Commercial |
$9,110.64
|
| Rate for Payer: First Health Commercial |
$10,427.85
|
| Rate for Payer: Humana Commercial |
$9,330.18
|
| Rate for Payer: Humana KY Medicaid |
$3,774.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,813.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,000.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,100.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,293.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,850.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,659.48
|
| Rate for Payer: Ohio Health Group HMO |
$8,232.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.77
|
| Rate for Payer: PHCS Commercial |
$10,537.61
|
| Rate for Payer: United Healthcare All Payer |
$9,659.48
|
|
|
BF OFFSET HUM HEAD 15*46
|
Facility
|
IP
|
$10,976.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.97 |
| Max. Negotiated Rate |
$10,537.61 |
| Rate for Payer: Aetna Commercial |
$8,452.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,561.81
|
| Rate for Payer: Cash Price |
$5,488.34
|
| Rate for Payer: Cigna Commercial |
$9,110.64
|
| Rate for Payer: First Health Commercial |
$10,427.85
|
| Rate for Payer: Humana Commercial |
$9,330.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,000.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,100.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,293.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,659.48
|
| Rate for Payer: Ohio Health Group HMO |
$8,232.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.77
|
| Rate for Payer: PHCS Commercial |
$10,537.61
|
| Rate for Payer: United Healthcare All Payer |
$9,659.48
|
|
|
BF OFFSET HUM HEAD 15*46
|
Facility
|
OP
|
$10,976.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.97 |
| Max. Negotiated Rate |
$10,537.61 |
| Rate for Payer: Aetna Commercial |
$8,452.04
|
| Rate for Payer: Anthem Medicaid |
$3,774.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,561.81
|
| Rate for Payer: Cash Price |
$5,488.34
|
| Rate for Payer: Cigna Commercial |
$9,110.64
|
| Rate for Payer: First Health Commercial |
$10,427.85
|
| Rate for Payer: Humana Commercial |
$9,330.18
|
| Rate for Payer: Humana KY Medicaid |
$3,774.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,813.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,000.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,100.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,293.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,850.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,659.48
|
| Rate for Payer: Ohio Health Group HMO |
$8,232.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.77
|
| Rate for Payer: PHCS Commercial |
$10,537.61
|
| Rate for Payer: United Healthcare All Payer |
$9,659.48
|
|
|
BF OFFSET HUM HEAD 17*46
|
Facility
|
IP
|
$10,976.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.97 |
| Max. Negotiated Rate |
$10,537.61 |
| Rate for Payer: Aetna Commercial |
$8,452.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,561.81
|
| Rate for Payer: Cash Price |
$5,488.34
|
| Rate for Payer: Cigna Commercial |
$9,110.64
|
| Rate for Payer: First Health Commercial |
$10,427.85
|
| Rate for Payer: Humana Commercial |
$9,330.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,000.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,100.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,293.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,659.48
|
| Rate for Payer: Ohio Health Group HMO |
$8,232.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.77
|
| Rate for Payer: PHCS Commercial |
$10,537.61
|
| Rate for Payer: United Healthcare All Payer |
$9,659.48
|
|
|
BF OFFSET HUM HEAD 17*46
|
Facility
|
OP
|
$10,976.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.97 |
| Max. Negotiated Rate |
$10,537.61 |
| Rate for Payer: Aetna Commercial |
$8,452.04
|
| Rate for Payer: Anthem Medicaid |
$3,774.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,561.81
|
| Rate for Payer: Cash Price |
$5,488.34
|
| Rate for Payer: Cigna Commercial |
$9,110.64
|
| Rate for Payer: First Health Commercial |
$10,427.85
|
| Rate for Payer: Humana Commercial |
$9,330.18
|
| Rate for Payer: Humana KY Medicaid |
$3,774.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,813.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,000.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,100.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,293.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,850.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,659.48
|
| Rate for Payer: Ohio Health Group HMO |
$8,232.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.77
|
| Rate for Payer: PHCS Commercial |
$10,537.61
|
| Rate for Payer: United Healthcare All Payer |
$9,659.48
|
|
|
BF OFFSET HUM HEAD 18*40
|
Facility
|
OP
|
$10,976.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.97 |
| Max. Negotiated Rate |
$10,537.61 |
| Rate for Payer: Aetna Commercial |
$8,452.04
|
| Rate for Payer: Anthem Medicaid |
$3,774.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,561.81
|
| Rate for Payer: Cash Price |
$5,488.34
|
| Rate for Payer: Cigna Commercial |
$9,110.64
|
| Rate for Payer: First Health Commercial |
$10,427.85
|
| Rate for Payer: Humana Commercial |
$9,330.18
|
| Rate for Payer: Humana KY Medicaid |
$3,774.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,813.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,000.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,100.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,293.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,850.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,659.48
|
| Rate for Payer: Ohio Health Group HMO |
$8,232.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.77
|
| Rate for Payer: PHCS Commercial |
$10,537.61
|
| Rate for Payer: United Healthcare All Payer |
$9,659.48
|
|
|
BF OFFSET HUM HEAD 18*40
|
Facility
|
IP
|
$10,976.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.97 |
| Max. Negotiated Rate |
$10,537.61 |
| Rate for Payer: Aetna Commercial |
$8,452.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,561.81
|
| Rate for Payer: Cash Price |
$5,488.34
|
| Rate for Payer: Cigna Commercial |
$9,110.64
|
| Rate for Payer: First Health Commercial |
$10,427.85
|
| Rate for Payer: Humana Commercial |
$9,330.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,000.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,100.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,293.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,659.48
|
| Rate for Payer: Ohio Health Group HMO |
$8,232.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.77
|
| Rate for Payer: PHCS Commercial |
$10,537.61
|
| Rate for Payer: United Healthcare All Payer |
$9,659.48
|
|
|
BF OFFSET HUM HEAD 18*52
|
Facility
|
IP
|
$10,976.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.97 |
| Max. Negotiated Rate |
$10,537.61 |
| Rate for Payer: Aetna Commercial |
$8,452.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,561.81
|
| Rate for Payer: Cash Price |
$5,488.34
|
| Rate for Payer: Cigna Commercial |
$9,110.64
|
| Rate for Payer: First Health Commercial |
$10,427.85
|
| Rate for Payer: Humana Commercial |
$9,330.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,000.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,100.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,293.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,659.48
|
| Rate for Payer: Ohio Health Group HMO |
$8,232.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.77
|
| Rate for Payer: PHCS Commercial |
$10,537.61
|
| Rate for Payer: United Healthcare All Payer |
$9,659.48
|
|
|
BF OFFSET HUM HEAD 18*52
|
Facility
|
OP
|
$10,976.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.97 |
| Max. Negotiated Rate |
$10,537.61 |
| Rate for Payer: Aetna Commercial |
$8,452.04
|
| Rate for Payer: Anthem Medicaid |
$3,774.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,561.81
|
| Rate for Payer: Cash Price |
$5,488.34
|
| Rate for Payer: Cigna Commercial |
$9,110.64
|
| Rate for Payer: First Health Commercial |
$10,427.85
|
| Rate for Payer: Humana Commercial |
$9,330.18
|
| Rate for Payer: Humana KY Medicaid |
$3,774.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,813.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,000.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,100.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,293.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,850.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,659.48
|
| Rate for Payer: Ohio Health Group HMO |
$8,232.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.77
|
| Rate for Payer: PHCS Commercial |
$10,537.61
|
| Rate for Payer: United Healthcare All Payer |
$9,659.48
|
|
|
BF OFFSET HUM HEAD 18*56
|
Facility
|
OP
|
$10,976.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.97 |
| Max. Negotiated Rate |
$10,537.61 |
| Rate for Payer: Aetna Commercial |
$8,452.04
|
| Rate for Payer: Anthem Medicaid |
$3,774.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,561.81
|
| Rate for Payer: Cash Price |
$5,488.34
|
| Rate for Payer: Cigna Commercial |
$9,110.64
|
| Rate for Payer: First Health Commercial |
$10,427.85
|
| Rate for Payer: Humana Commercial |
$9,330.18
|
| Rate for Payer: Humana KY Medicaid |
$3,774.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,813.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,000.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,100.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,293.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,850.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,659.48
|
| Rate for Payer: Ohio Health Group HMO |
$8,232.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.77
|
| Rate for Payer: PHCS Commercial |
$10,537.61
|
| Rate for Payer: United Healthcare All Payer |
$9,659.48
|
|
|
BF OFFSET HUM HEAD 18*56
|
Facility
|
IP
|
$10,976.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.97 |
| Max. Negotiated Rate |
$10,537.61 |
| Rate for Payer: Aetna Commercial |
$8,452.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,561.81
|
| Rate for Payer: Cash Price |
$5,488.34
|
| Rate for Payer: Cigna Commercial |
$9,110.64
|
| Rate for Payer: First Health Commercial |
$10,427.85
|
| Rate for Payer: Humana Commercial |
$9,330.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,000.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,100.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,293.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,659.48
|
| Rate for Payer: Ohio Health Group HMO |
$8,232.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.77
|
| Rate for Payer: PHCS Commercial |
$10,537.61
|
| Rate for Payer: United Healthcare All Payer |
$9,659.48
|
|
|
BF OFFSET HUM HEAD 19*46
|
Facility
|
OP
|
$10,976.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.97 |
| Max. Negotiated Rate |
$10,537.61 |
| Rate for Payer: Aetna Commercial |
$8,452.04
|
| Rate for Payer: Anthem Medicaid |
$3,774.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,561.81
|
| Rate for Payer: Cash Price |
$5,488.34
|
| Rate for Payer: Cigna Commercial |
$9,110.64
|
| Rate for Payer: First Health Commercial |
$10,427.85
|
| Rate for Payer: Humana Commercial |
$9,330.18
|
| Rate for Payer: Humana KY Medicaid |
$3,774.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,813.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,000.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,100.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,293.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,850.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,659.48
|
| Rate for Payer: Ohio Health Group HMO |
$8,232.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.77
|
| Rate for Payer: PHCS Commercial |
$10,537.61
|
| Rate for Payer: United Healthcare All Payer |
$9,659.48
|
|
|
BF OFFSET HUM HEAD 19*46
|
Facility
|
IP
|
$10,976.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.97 |
| Max. Negotiated Rate |
$10,537.61 |
| Rate for Payer: Aetna Commercial |
$8,452.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,561.81
|
| Rate for Payer: Cash Price |
$5,488.34
|
| Rate for Payer: Cigna Commercial |
$9,110.64
|
| Rate for Payer: First Health Commercial |
$10,427.85
|
| Rate for Payer: Humana Commercial |
$9,330.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,000.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,100.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,293.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,659.48
|
| Rate for Payer: Ohio Health Group HMO |
$8,232.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.77
|
| Rate for Payer: PHCS Commercial |
$10,537.61
|
| Rate for Payer: United Healthcare All Payer |
$9,659.48
|
|
|
BF OFFSET HUM HEAD 19*52
|
Facility
|
OP
|
$9,041.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,175.40 |
| Max. Negotiated Rate |
$8,679.84 |
| Rate for Payer: Aetna Commercial |
$6,961.96
|
| Rate for Payer: Anthem Medicaid |
$3,109.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.37
|
| Rate for Payer: Cash Price |
$4,520.75
|
| Rate for Payer: Cigna Commercial |
$7,504.44
|
| Rate for Payer: First Health Commercial |
$8,589.42
|
| Rate for Payer: Humana Commercial |
$7,685.28
|
| Rate for Payer: Humana KY Medicaid |
$3,109.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3,141.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,171.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,808.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,175.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,802.86
|
| Rate for Payer: PHCS Commercial |
$8,679.84
|
| Rate for Payer: United Healthcare All Payer |
$7,956.52
|
|
|
BF OFFSET HUM HEAD 19*52
|
Facility
|
IP
|
$9,041.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,175.40 |
| Max. Negotiated Rate |
$8,679.84 |
| Rate for Payer: Aetna Commercial |
$6,961.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.37
|
| Rate for Payer: Cash Price |
$4,520.75
|
| Rate for Payer: Cigna Commercial |
$7,504.44
|
| Rate for Payer: First Health Commercial |
$8,589.42
|
| Rate for Payer: Humana Commercial |
$7,685.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,808.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,175.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,802.86
|
| Rate for Payer: PHCS Commercial |
$8,679.84
|
| Rate for Payer: United Healthcare All Payer |
$7,956.52
|
|
|
BF OFFSET HUM HEAD 19*56
|
Facility
|
IP
|
$10,976.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.97 |
| Max. Negotiated Rate |
$10,537.61 |
| Rate for Payer: Aetna Commercial |
$8,452.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,561.81
|
| Rate for Payer: Cash Price |
$5,488.34
|
| Rate for Payer: Cigna Commercial |
$9,110.64
|
| Rate for Payer: First Health Commercial |
$10,427.85
|
| Rate for Payer: Humana Commercial |
$9,330.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,000.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,100.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,293.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,659.48
|
| Rate for Payer: Ohio Health Group HMO |
$8,232.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,195.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,402.77
|
| Rate for Payer: PHCS Commercial |
$10,537.61
|
| Rate for Payer: United Healthcare All Payer |
$9,659.48
|
|
