|
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
|
|
|
BF OFFSET HUM HEAD 21*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 21*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 21*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 21*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 21*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 21*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 23*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 23*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 23*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 23*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 24*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 24*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 24*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 24*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 24*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 24*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 24*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 24*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 27*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 27*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 27*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 27*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 27*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 27*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
|
|
