|
SROM EXT FEM STM BOW 11*150
|
Facility
|
OP
|
$7,490.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.22 |
| Max. Negotiated Rate |
$7,191.11 |
| Rate for Payer: Aetna Commercial |
$5,767.87
|
| Rate for Payer: Anthem Medicaid |
$2,576.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,842.78
|
| Rate for Payer: Cash Price |
$3,745.37
|
| Rate for Payer: Cigna Commercial |
$6,217.31
|
| Rate for Payer: First Health Commercial |
$7,116.20
|
| Rate for Payer: Humana Commercial |
$6,367.13
|
| Rate for Payer: Humana KY Medicaid |
$2,576.07
|
| Rate for Payer: Kentucky WC Medicaid |
$2,602.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,142.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,528.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,247.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,627.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,591.85
|
| Rate for Payer: Ohio Health Group HMO |
$5,618.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,992.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,516.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,168.61
|
| Rate for Payer: PHCS Commercial |
$7,191.11
|
| Rate for Payer: United Healthcare All Payer |
$6,591.85
|
|
|
SROM EXT FEM STM BOW 11*150
|
Facility
|
IP
|
$7,490.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.22 |
| Max. Negotiated Rate |
$7,191.11 |
| Rate for Payer: Aetna Commercial |
$5,767.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,842.78
|
| Rate for Payer: Cash Price |
$3,745.37
|
| Rate for Payer: Cigna Commercial |
$6,217.31
|
| Rate for Payer: First Health Commercial |
$7,116.20
|
| Rate for Payer: Humana Commercial |
$6,367.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,142.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,528.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,247.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,591.85
|
| Rate for Payer: Ohio Health Group HMO |
$5,618.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,992.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,516.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,168.61
|
| Rate for Payer: PHCS Commercial |
$7,191.11
|
| Rate for Payer: United Healthcare All Payer |
$6,591.85
|
|
|
SROM EXT FEM STM BOW 13*150
|
Facility
|
OP
|
$7,490.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.22 |
| Max. Negotiated Rate |
$7,191.11 |
| Rate for Payer: Aetna Commercial |
$5,767.87
|
| Rate for Payer: Anthem Medicaid |
$2,576.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,842.78
|
| Rate for Payer: Cash Price |
$3,745.37
|
| Rate for Payer: Cigna Commercial |
$6,217.31
|
| Rate for Payer: First Health Commercial |
$7,116.20
|
| Rate for Payer: Humana Commercial |
$6,367.13
|
| Rate for Payer: Humana KY Medicaid |
$2,576.07
|
| Rate for Payer: Kentucky WC Medicaid |
$2,602.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,142.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,528.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,247.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,627.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,591.85
|
| Rate for Payer: Ohio Health Group HMO |
$5,618.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,992.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,516.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,168.61
|
| Rate for Payer: PHCS Commercial |
$7,191.11
|
| Rate for Payer: United Healthcare All Payer |
$6,591.85
|
|
|
SROM EXT FEM STM BOW 13*150
|
Facility
|
IP
|
$7,490.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.22 |
| Max. Negotiated Rate |
$7,191.11 |
| Rate for Payer: Aetna Commercial |
$5,767.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,842.78
|
| Rate for Payer: Cash Price |
$3,745.37
|
| Rate for Payer: Cigna Commercial |
$6,217.31
|
| Rate for Payer: First Health Commercial |
$7,116.20
|
| Rate for Payer: Humana Commercial |
$6,367.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,142.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,528.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,247.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,591.85
|
| Rate for Payer: Ohio Health Group HMO |
$5,618.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,992.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,516.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,168.61
|
| Rate for Payer: PHCS Commercial |
$7,191.11
|
| Rate for Payer: United Healthcare All Payer |
$6,591.85
|
|
|
SROM EXT FEM STM BOW 15*150
|
Facility
|
OP
|
$7,490.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.22 |
| Max. Negotiated Rate |
$7,191.11 |
| Rate for Payer: Aetna Commercial |
$5,767.87
|
| Rate for Payer: Anthem Medicaid |
$2,576.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,842.78
|
| Rate for Payer: Cash Price |
$3,745.37
|
| Rate for Payer: Cigna Commercial |
$6,217.31
|
| Rate for Payer: First Health Commercial |
$7,116.20
|
| Rate for Payer: Humana Commercial |
$6,367.13
|
| Rate for Payer: Humana KY Medicaid |
$2,576.07
|
| Rate for Payer: Kentucky WC Medicaid |
$2,602.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,142.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,528.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,247.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,627.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,591.85
|
| Rate for Payer: Ohio Health Group HMO |
$5,618.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,992.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,516.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,168.61
|
| Rate for Payer: PHCS Commercial |
$7,191.11
|
| Rate for Payer: United Healthcare All Payer |
$6,591.85
|
|
|
SROM EXT FEM STM BOW 15*150
|
Facility
|
IP
|
$7,490.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,247.22 |
| Max. Negotiated Rate |
$7,191.11 |
| Rate for Payer: Aetna Commercial |
$5,767.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,842.78
|
| Rate for Payer: Cash Price |
$3,745.37
|
| Rate for Payer: Cigna Commercial |
$6,217.31
|
| Rate for Payer: First Health Commercial |
$7,116.20
|
| Rate for Payer: Humana Commercial |
$6,367.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,142.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,528.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,247.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,591.85
|
| Rate for Payer: Ohio Health Group HMO |
$5,618.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,992.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,516.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,168.61
|
| Rate for Payer: PHCS Commercial |
$7,191.11
|
| Rate for Payer: United Healthcare All Payer |
$6,591.85
|
|
|
SROM EXT FEM STM STR 11*100
|
Facility
|
IP
|
$6,937.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,081.12 |
| Max. Negotiated Rate |
$6,659.59 |
| Rate for Payer: Aetna Commercial |
$5,341.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,410.91
|
| Rate for Payer: Cash Price |
$3,468.54
|
| Rate for Payer: Cigna Commercial |
$5,757.77
|
| Rate for Payer: First Health Commercial |
$6,590.22
|
| Rate for Payer: Humana Commercial |
$5,896.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,688.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,119.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,081.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,104.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,202.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,549.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,035.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,786.58
|
| Rate for Payer: PHCS Commercial |
$6,659.59
|
| Rate for Payer: United Healthcare All Payer |
$6,104.62
|
|
|
SROM EXT FEM STM STR 11*100
|
Facility
|
OP
|
$6,937.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,081.12 |
| Max. Negotiated Rate |
$6,659.59 |
| Rate for Payer: Aetna Commercial |
$5,341.54
|
| Rate for Payer: Anthem Medicaid |
$2,385.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,410.91
|
| Rate for Payer: Cash Price |
$3,468.54
|
| Rate for Payer: Cigna Commercial |
$5,757.77
|
| Rate for Payer: First Health Commercial |
$6,590.22
|
| Rate for Payer: Humana Commercial |
$5,896.51
|
| Rate for Payer: Humana KY Medicaid |
$2,385.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,409.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,688.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,119.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,081.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,433.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,104.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,202.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,549.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,035.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,786.58
|
| Rate for Payer: PHCS Commercial |
$6,659.59
|
| Rate for Payer: United Healthcare All Payer |
$6,104.62
|
|
|
SROM EXT FEM STM STR 13*100
|
Facility
|
OP
|
$6,937.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,081.12 |
| Max. Negotiated Rate |
$6,659.59 |
| Rate for Payer: Aetna Commercial |
$5,341.54
|
| Rate for Payer: Anthem Medicaid |
$2,385.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,410.91
|
| Rate for Payer: Cash Price |
$3,468.54
|
| Rate for Payer: Cigna Commercial |
$5,757.77
|
| Rate for Payer: First Health Commercial |
$6,590.22
|
| Rate for Payer: Humana Commercial |
$5,896.51
|
| Rate for Payer: Humana KY Medicaid |
$2,385.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,409.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,688.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,119.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,081.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,433.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,104.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,202.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,549.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,035.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,786.58
|
| Rate for Payer: PHCS Commercial |
$6,659.59
|
| Rate for Payer: United Healthcare All Payer |
$6,104.62
|
|
|
SROM EXT FEM STM STR 13*100
|
Facility
|
IP
|
$6,937.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,081.12 |
| Max. Negotiated Rate |
$6,659.59 |
| Rate for Payer: Aetna Commercial |
$5,341.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,410.91
|
| Rate for Payer: Cash Price |
$3,468.54
|
| Rate for Payer: Cigna Commercial |
$5,757.77
|
| Rate for Payer: First Health Commercial |
$6,590.22
|
| Rate for Payer: Humana Commercial |
$5,896.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,688.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,119.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,081.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,104.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,202.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,549.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,035.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,786.58
|
| Rate for Payer: PHCS Commercial |
$6,659.59
|
| Rate for Payer: United Healthcare All Payer |
$6,104.62
|
|
|
SROM EXT FEM STM STR 15*100
|
Facility
|
OP
|
$6,937.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,081.12 |
| Max. Negotiated Rate |
$6,659.59 |
| Rate for Payer: Aetna Commercial |
$5,341.54
|
| Rate for Payer: Anthem Medicaid |
$2,385.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,410.91
|
| Rate for Payer: Cash Price |
$3,468.54
|
| Rate for Payer: Cigna Commercial |
$5,757.77
|
| Rate for Payer: First Health Commercial |
$6,590.22
|
| Rate for Payer: Humana Commercial |
$5,896.51
|
| Rate for Payer: Humana KY Medicaid |
$2,385.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,409.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,688.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,119.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,081.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,433.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,104.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,202.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,549.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,035.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,786.58
|
| Rate for Payer: PHCS Commercial |
$6,659.59
|
| Rate for Payer: United Healthcare All Payer |
$6,104.62
|
|
|
SROM EXT FEM STM STR 15*100
|
Facility
|
IP
|
$6,937.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,081.12 |
| Max. Negotiated Rate |
$6,659.59 |
| Rate for Payer: Aetna Commercial |
$5,341.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,410.91
|
| Rate for Payer: Cash Price |
$3,468.54
|
| Rate for Payer: Cigna Commercial |
$5,757.77
|
| Rate for Payer: First Health Commercial |
$6,590.22
|
| Rate for Payer: Humana Commercial |
$5,896.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,688.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,119.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,081.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,104.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,202.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,549.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,035.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,786.58
|
| Rate for Payer: PHCS Commercial |
$6,659.59
|
| Rate for Payer: United Healthcare All Payer |
$6,104.62
|
|
|
SROM EXT TIB STEM 09*100MM
|
Facility
|
OP
|
$6,937.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,081.12 |
| Max. Negotiated Rate |
$6,659.59 |
| Rate for Payer: Aetna Commercial |
$5,341.54
|
| Rate for Payer: Anthem Medicaid |
$2,385.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,410.91
|
| Rate for Payer: Cash Price |
$3,468.54
|
| Rate for Payer: Cigna Commercial |
$5,757.77
|
| Rate for Payer: First Health Commercial |
$6,590.22
|
| Rate for Payer: Humana Commercial |
$5,896.51
|
| Rate for Payer: Humana KY Medicaid |
$2,385.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,409.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,688.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,119.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,081.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,433.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,104.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,202.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,549.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,035.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,786.58
|
| Rate for Payer: PHCS Commercial |
$6,659.59
|
| Rate for Payer: United Healthcare All Payer |
$6,104.62
|
|
|
SROM EXT TIB STEM 09*100MM
|
Facility
|
IP
|
$6,937.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,081.12 |
| Max. Negotiated Rate |
$6,659.59 |
| Rate for Payer: Aetna Commercial |
$5,341.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,410.91
|
| Rate for Payer: Cash Price |
$3,468.54
|
| Rate for Payer: Cigna Commercial |
$5,757.77
|
| Rate for Payer: First Health Commercial |
$6,590.22
|
| Rate for Payer: Humana Commercial |
$5,896.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,688.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,119.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,081.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,104.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,202.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,549.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,035.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,786.58
|
| Rate for Payer: PHCS Commercial |
$6,659.59
|
| Rate for Payer: United Healthcare All Payer |
$6,104.62
|
|
|
SROM EXT TIB STEM 09*150MM
|
Facility
|
OP
|
$7,183.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,154.95 |
| Max. Negotiated Rate |
$6,895.83 |
| Rate for Payer: Aetna Commercial |
$5,531.03
|
| Rate for Payer: Anthem Medicaid |
$2,470.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,602.86
|
| Rate for Payer: Cash Price |
$3,591.58
|
| Rate for Payer: Cigna Commercial |
$5,962.02
|
| Rate for Payer: First Health Commercial |
$6,824.00
|
| Rate for Payer: Humana Commercial |
$6,105.69
|
| Rate for Payer: Humana KY Medicaid |
$2,470.29
|
| Rate for Payer: Kentucky WC Medicaid |
$2,495.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,890.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,301.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,519.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,321.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,387.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,746.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,249.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,956.38
|
| Rate for Payer: PHCS Commercial |
$6,895.83
|
| Rate for Payer: United Healthcare All Payer |
$6,321.18
|
|
|
SROM EXT TIB STEM 09*150MM
|
Facility
|
IP
|
$7,183.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,154.95 |
| Max. Negotiated Rate |
$6,895.83 |
| Rate for Payer: Aetna Commercial |
$5,531.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,602.86
|
| Rate for Payer: Cash Price |
$3,591.58
|
| Rate for Payer: Cigna Commercial |
$5,962.02
|
| Rate for Payer: First Health Commercial |
$6,824.00
|
| Rate for Payer: Humana Commercial |
$6,105.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,890.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,301.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,321.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,387.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,746.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,249.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,956.38
|
| Rate for Payer: PHCS Commercial |
$6,895.83
|
| Rate for Payer: United Healthcare All Payer |
$6,321.18
|
|
|
SROM EXT TIB STEM 11*100MM
|
Facility
|
IP
|
$6,937.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,081.12 |
| Max. Negotiated Rate |
$6,659.59 |
| Rate for Payer: Aetna Commercial |
$5,341.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,410.91
|
| Rate for Payer: Cash Price |
$3,468.54
|
| Rate for Payer: Cigna Commercial |
$5,757.77
|
| Rate for Payer: First Health Commercial |
$6,590.22
|
| Rate for Payer: Humana Commercial |
$5,896.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,688.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,119.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,081.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,104.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,202.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,549.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,035.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,786.58
|
| Rate for Payer: PHCS Commercial |
$6,659.59
|
| Rate for Payer: United Healthcare All Payer |
$6,104.62
|
|
|
SROM EXT TIB STEM 11*100MM
|
Facility
|
OP
|
$6,937.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,081.12 |
| Max. Negotiated Rate |
$6,659.59 |
| Rate for Payer: Aetna Commercial |
$5,341.54
|
| Rate for Payer: Anthem Medicaid |
$2,385.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,410.91
|
| Rate for Payer: Cash Price |
$3,468.54
|
| Rate for Payer: Cigna Commercial |
$5,757.77
|
| Rate for Payer: First Health Commercial |
$6,590.22
|
| Rate for Payer: Humana Commercial |
$5,896.51
|
| Rate for Payer: Humana KY Medicaid |
$2,385.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,409.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,688.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,119.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,081.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,433.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,104.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,202.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,549.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,035.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,786.58
|
| Rate for Payer: PHCS Commercial |
$6,659.59
|
| Rate for Payer: United Healthcare All Payer |
$6,104.62
|
|
|
SROM EXT TIB STEM 11*150MM
|
Facility
|
IP
|
$6,936.71
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,081.01 |
| Max. Negotiated Rate |
$6,659.24 |
| Rate for Payer: Aetna Commercial |
$5,341.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,410.63
|
| Rate for Payer: Cash Price |
$3,468.35
|
| Rate for Payer: Cigna Commercial |
$5,757.47
|
| Rate for Payer: First Health Commercial |
$6,589.87
|
| Rate for Payer: Humana Commercial |
$5,896.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,688.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,119.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,081.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,104.30
|
| Rate for Payer: Ohio Health Group HMO |
$5,202.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,549.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,034.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,786.33
|
| Rate for Payer: PHCS Commercial |
$6,659.24
|
| Rate for Payer: United Healthcare All Payer |
$6,104.30
|
|
|
SROM EXT TIB STEM 11*150MM
|
Facility
|
OP
|
$6,936.71
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,081.01 |
| Max. Negotiated Rate |
$6,659.24 |
| Rate for Payer: Aetna Commercial |
$5,341.27
|
| Rate for Payer: Anthem Medicaid |
$2,385.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,410.63
|
| Rate for Payer: Cash Price |
$3,468.35
|
| Rate for Payer: Cigna Commercial |
$5,757.47
|
| Rate for Payer: First Health Commercial |
$6,589.87
|
| Rate for Payer: Humana Commercial |
$5,896.20
|
| Rate for Payer: Humana KY Medicaid |
$2,385.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,409.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,688.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,119.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,081.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,433.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,104.30
|
| Rate for Payer: Ohio Health Group HMO |
$5,202.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,549.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,034.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,786.33
|
| Rate for Payer: PHCS Commercial |
$6,659.24
|
| Rate for Payer: United Healthcare All Payer |
$6,104.30
|
|
|
SROM EXT TIB STEM 13*100MM
|
Facility
|
OP
|
$6,937.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,081.12 |
| Max. Negotiated Rate |
$6,659.59 |
| Rate for Payer: Aetna Commercial |
$5,341.54
|
| Rate for Payer: Anthem Medicaid |
$2,385.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,410.91
|
| Rate for Payer: Cash Price |
$3,468.54
|
| Rate for Payer: Cigna Commercial |
$5,757.77
|
| Rate for Payer: First Health Commercial |
$6,590.22
|
| Rate for Payer: Humana Commercial |
$5,896.51
|
| Rate for Payer: Humana KY Medicaid |
$2,385.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,409.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,688.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,119.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,081.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,433.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,104.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,202.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,549.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,035.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,786.58
|
| Rate for Payer: PHCS Commercial |
$6,659.59
|
| Rate for Payer: United Healthcare All Payer |
$6,104.62
|
|
|
SROM EXT TIB STEM 13*100MM
|
Facility
|
IP
|
$6,937.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,081.12 |
| Max. Negotiated Rate |
$6,659.59 |
| Rate for Payer: Aetna Commercial |
$5,341.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,410.91
|
| Rate for Payer: Cash Price |
$3,468.54
|
| Rate for Payer: Cigna Commercial |
$5,757.77
|
| Rate for Payer: First Health Commercial |
$6,590.22
|
| Rate for Payer: Humana Commercial |
$5,896.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,688.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,119.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,081.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,104.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,202.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,549.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,035.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,786.58
|
| Rate for Payer: PHCS Commercial |
$6,659.59
|
| Rate for Payer: United Healthcare All Payer |
$6,104.62
|
|
|
SROM EXT TIB STEM 13*150MM
|
Facility
|
OP
|
$6,937.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,081.12 |
| Max. Negotiated Rate |
$6,659.59 |
| Rate for Payer: Aetna Commercial |
$5,341.54
|
| Rate for Payer: Anthem Medicaid |
$2,385.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,410.91
|
| Rate for Payer: Cash Price |
$3,468.54
|
| Rate for Payer: Cigna Commercial |
$5,757.77
|
| Rate for Payer: First Health Commercial |
$6,590.22
|
| Rate for Payer: Humana Commercial |
$5,896.51
|
| Rate for Payer: Humana KY Medicaid |
$2,385.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,409.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,688.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,119.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,081.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,433.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,104.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,202.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,549.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,035.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,786.58
|
| Rate for Payer: PHCS Commercial |
$6,659.59
|
| Rate for Payer: United Healthcare All Payer |
$6,104.62
|
|
|
SROM EXT TIB STEM 13*150MM
|
Facility
|
IP
|
$6,937.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,081.12 |
| Max. Negotiated Rate |
$6,659.59 |
| Rate for Payer: Aetna Commercial |
$5,341.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,410.91
|
| Rate for Payer: Cash Price |
$3,468.54
|
| Rate for Payer: Cigna Commercial |
$5,757.77
|
| Rate for Payer: First Health Commercial |
$6,590.22
|
| Rate for Payer: Humana Commercial |
$5,896.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,688.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,119.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,081.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,104.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,202.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,549.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,035.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,786.58
|
| Rate for Payer: PHCS Commercial |
$6,659.59
|
| Rate for Payer: United Healthcare All Payer |
$6,104.62
|
|
|
SROM EXT TIB STEM 15*100MM
|
Facility
|
IP
|
$6,937.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,081.12 |
| Max. Negotiated Rate |
$6,659.59 |
| Rate for Payer: Aetna Commercial |
$5,341.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,410.91
|
| Rate for Payer: Cash Price |
$3,468.54
|
| Rate for Payer: Cigna Commercial |
$5,757.77
|
| Rate for Payer: First Health Commercial |
$6,590.22
|
| Rate for Payer: Humana Commercial |
$5,896.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,688.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,119.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,081.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,104.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,202.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,549.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,035.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,786.58
|
| Rate for Payer: PHCS Commercial |
$6,659.59
|
| Rate for Payer: United Healthcare All Payer |
$6,104.62
|
|
