|
B/F MODULAR HEAD STD IMP SET
|
Facility
|
IP
|
$123,151.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36,945.30 |
| Max. Negotiated Rate |
$118,224.96 |
| Rate for Payer: Aetna Commercial |
$94,826.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$96,057.78
|
| Rate for Payer: Cash Price |
$61,575.50
|
| Rate for Payer: Cigna Commercial |
$102,215.33
|
| Rate for Payer: First Health Commercial |
$116,993.45
|
| Rate for Payer: Humana Commercial |
$104,678.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100,983.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90,885.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36,945.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$108,372.88
|
| Rate for Payer: Ohio Health Group HMO |
$92,363.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98,520.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107,141.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84,974.19
|
| Rate for Payer: PHCS Commercial |
$118,224.96
|
| Rate for Payer: United Healthcare All Payer |
$108,372.88
|
|
|
B/F MODULAR HEAD STD IMP SET
|
Facility
|
OP
|
$123,151.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36,945.30 |
| Max. Negotiated Rate |
$118,224.96 |
| Rate for Payer: Aetna Commercial |
$94,826.27
|
| Rate for Payer: Anthem Medicaid |
$42,351.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$96,057.78
|
| Rate for Payer: Cash Price |
$61,575.50
|
| Rate for Payer: Cigna Commercial |
$102,215.33
|
| Rate for Payer: First Health Commercial |
$116,993.45
|
| Rate for Payer: Humana Commercial |
$104,678.35
|
| Rate for Payer: Humana KY Medicaid |
$42,351.63
|
| Rate for Payer: Kentucky WC Medicaid |
$42,782.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100,983.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90,885.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36,945.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$43,201.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$108,372.88
|
| Rate for Payer: Ohio Health Group HMO |
$92,363.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98,520.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107,141.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84,974.19
|
| Rate for Payer: PHCS Commercial |
$118,224.96
|
| Rate for Payer: United Healthcare All Payer |
$108,372.88
|
|
|
B/F MODULAR STEM MICRO IMP SET
|
Facility
|
IP
|
$75,312.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,593.84 |
| Max. Negotiated Rate |
$72,300.29 |
| Rate for Payer: Aetna Commercial |
$57,990.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,743.98
|
| Rate for Payer: Cash Price |
$37,656.40
|
| Rate for Payer: Cigna Commercial |
$62,509.62
|
| Rate for Payer: First Health Commercial |
$71,547.16
|
| Rate for Payer: Humana Commercial |
$64,015.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,756.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,580.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,593.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,275.26
|
| Rate for Payer: Ohio Health Group HMO |
$56,484.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,250.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,522.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,965.83
|
| Rate for Payer: PHCS Commercial |
$72,300.29
|
| Rate for Payer: United Healthcare All Payer |
$66,275.26
|
|
|
B/F MODULAR STEM MICRO IMP SET
|
Facility
|
OP
|
$75,312.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,593.84 |
| Max. Negotiated Rate |
$72,300.29 |
| Rate for Payer: Aetna Commercial |
$57,990.86
|
| Rate for Payer: Anthem Medicaid |
$25,900.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,743.98
|
| Rate for Payer: Cash Price |
$37,656.40
|
| Rate for Payer: Cigna Commercial |
$62,509.62
|
| Rate for Payer: First Health Commercial |
$71,547.16
|
| Rate for Payer: Humana Commercial |
$64,015.88
|
| Rate for Payer: Humana KY Medicaid |
$25,900.07
|
| Rate for Payer: Kentucky WC Medicaid |
$26,163.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,756.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,580.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,593.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,419.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,275.26
|
| Rate for Payer: Ohio Health Group HMO |
$56,484.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,250.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,522.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,965.83
|
| Rate for Payer: PHCS Commercial |
$72,300.29
|
| Rate for Payer: United Healthcare All Payer |
$66,275.26
|
|
|
B/F MODULAR STEM REV IMP SET
|
Facility
|
IP
|
$99,347.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29,804.34 |
| Max. Negotiated Rate |
$95,373.89 |
| Rate for Payer: Aetna Commercial |
$76,497.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77,491.28
|
| Rate for Payer: Cash Price |
$49,673.90
|
| Rate for Payer: Cigna Commercial |
$82,458.67
|
| Rate for Payer: First Health Commercial |
$94,380.41
|
| Rate for Payer: Humana Commercial |
$84,445.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$81,465.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73,318.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,804.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$87,426.06
|
| Rate for Payer: Ohio Health Group HMO |
$74,510.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$79,478.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$86,432.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$68,549.98
|
| Rate for Payer: PHCS Commercial |
$95,373.89
|
| Rate for Payer: United Healthcare All Payer |
$87,426.06
|
|
|
B/F MODULAR STEM REV IMP SET
|
Facility
|
OP
|
$99,347.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29,804.34 |
| Max. Negotiated Rate |
$95,373.89 |
| Rate for Payer: Aetna Commercial |
$76,497.81
|
| Rate for Payer: Anthem Medicaid |
$34,165.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77,491.28
|
| Rate for Payer: Cash Price |
$49,673.90
|
| Rate for Payer: Cigna Commercial |
$82,458.67
|
| Rate for Payer: First Health Commercial |
$94,380.41
|
| Rate for Payer: Humana Commercial |
$84,445.63
|
| Rate for Payer: Humana KY Medicaid |
$34,165.71
|
| Rate for Payer: Kentucky WC Medicaid |
$34,513.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$81,465.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73,318.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,804.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$34,851.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$87,426.06
|
| Rate for Payer: Ohio Health Group HMO |
$74,510.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$79,478.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$86,432.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$68,549.98
|
| Rate for Payer: PHCS Commercial |
$95,373.89
|
| Rate for Payer: United Healthcare All Payer |
$87,426.06
|
|
|
B/F MODULAR STEM STD IMP SET
|
Facility
|
IP
|
$213,028.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63,908.58 |
| Max. Negotiated Rate |
$204,507.46 |
| Rate for Payer: Aetna Commercial |
$164,032.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$166,162.31
|
| Rate for Payer: Cash Price |
$106,514.30
|
| Rate for Payer: Cigna Commercial |
$176,813.74
|
| Rate for Payer: First Health Commercial |
$202,377.17
|
| Rate for Payer: Humana Commercial |
$181,074.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$174,683.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$157,215.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63,908.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$187,465.17
|
| Rate for Payer: Ohio Health Group HMO |
$159,771.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$170,422.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$185,334.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$146,989.73
|
| Rate for Payer: PHCS Commercial |
$204,507.46
|
| Rate for Payer: United Healthcare All Payer |
$187,465.17
|
|
|
B/F MODULAR STEM STD IMP SET
|
Facility
|
OP
|
$213,028.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63,908.58 |
| Max. Negotiated Rate |
$204,507.46 |
| Rate for Payer: Aetna Commercial |
$164,032.02
|
| Rate for Payer: Anthem Medicaid |
$73,260.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$166,162.31
|
| Rate for Payer: Cash Price |
$106,514.30
|
| Rate for Payer: Cigna Commercial |
$176,813.74
|
| Rate for Payer: First Health Commercial |
$202,377.17
|
| Rate for Payer: Humana Commercial |
$181,074.31
|
| Rate for Payer: Humana KY Medicaid |
$73,260.54
|
| Rate for Payer: Kentucky WC Medicaid |
$74,006.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$174,683.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$157,215.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63,908.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$74,730.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$187,465.17
|
| Rate for Payer: Ohio Health Group HMO |
$159,771.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$170,422.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$185,334.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$146,989.73
|
| Rate for Payer: PHCS Commercial |
$204,507.46
|
| Rate for Payer: United Healthcare All Payer |
$187,465.17
|
|
|
B/F MONOBLCK STEM MCRO IMP SET
|
Facility
|
OP
|
$70,980.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,294.24 |
| Max. Negotiated Rate |
$68,141.57 |
| Rate for Payer: Aetna Commercial |
$54,655.22
|
| Rate for Payer: Anthem Medicaid |
$24,410.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,365.02
|
| Rate for Payer: Cash Price |
$35,490.40
|
| Rate for Payer: Cigna Commercial |
$58,914.06
|
| Rate for Payer: First Health Commercial |
$67,431.76
|
| Rate for Payer: Humana Commercial |
$60,333.68
|
| Rate for Payer: Humana KY Medicaid |
$24,410.30
|
| Rate for Payer: Kentucky WC Medicaid |
$24,658.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,204.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,383.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,294.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,900.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,463.10
|
| Rate for Payer: Ohio Health Group HMO |
$53,235.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,784.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,753.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,976.75
|
| Rate for Payer: PHCS Commercial |
$68,141.57
|
| Rate for Payer: United Healthcare All Payer |
$62,463.10
|
|
|
B/F MONOBLCK STEM MCRO IMP SET
|
Facility
|
IP
|
$70,980.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,294.24 |
| Max. Negotiated Rate |
$68,141.57 |
| Rate for Payer: Aetna Commercial |
$54,655.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,365.02
|
| Rate for Payer: Cash Price |
$35,490.40
|
| Rate for Payer: Cigna Commercial |
$58,914.06
|
| Rate for Payer: First Health Commercial |
$67,431.76
|
| Rate for Payer: Humana Commercial |
$60,333.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,204.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,383.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,294.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,463.10
|
| Rate for Payer: Ohio Health Group HMO |
$53,235.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,784.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,753.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,976.75
|
| Rate for Payer: PHCS Commercial |
$68,141.57
|
| Rate for Payer: United Healthcare All Payer |
$62,463.10
|
|
|
B/F MONOBLCK STEM STD IMP SET
|
Facility
|
IP
|
$111,154.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33,346.32 |
| Max. Negotiated Rate |
$106,708.22 |
| Rate for Payer: Aetna Commercial |
$85,588.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$86,700.43
|
| Rate for Payer: Cash Price |
$55,577.20
|
| Rate for Payer: Cigna Commercial |
$92,258.15
|
| Rate for Payer: First Health Commercial |
$105,596.68
|
| Rate for Payer: Humana Commercial |
$94,481.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91,146.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82,031.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33,346.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$97,815.87
|
| Rate for Payer: Ohio Health Group HMO |
$83,365.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88,923.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96,704.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$76,696.54
|
| Rate for Payer: PHCS Commercial |
$106,708.22
|
| Rate for Payer: United Healthcare All Payer |
$97,815.87
|
|
|
B/F MONOBLCK STEM STD IMP SET
|
Facility
|
OP
|
$111,154.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33,346.32 |
| Max. Negotiated Rate |
$106,708.22 |
| Rate for Payer: Aetna Commercial |
$85,588.89
|
| Rate for Payer: Anthem Medicaid |
$38,226.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$86,700.43
|
| Rate for Payer: Cash Price |
$55,577.20
|
| Rate for Payer: Cigna Commercial |
$92,258.15
|
| Rate for Payer: First Health Commercial |
$105,596.68
|
| Rate for Payer: Humana Commercial |
$94,481.24
|
| Rate for Payer: Humana KY Medicaid |
$38,226.00
|
| Rate for Payer: Kentucky WC Medicaid |
$38,615.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91,146.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82,031.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33,346.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$38,992.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$97,815.87
|
| Rate for Payer: Ohio Health Group HMO |
$83,365.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88,923.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96,704.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$76,696.54
|
| Rate for Payer: PHCS Commercial |
$106,708.22
|
| Rate for Payer: United Healthcare All Payer |
$97,815.87
|
|
|
BF OFFSET HD. IMPLANT SET
|
Facility
|
IP
|
$9,292.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,787.78 |
| Max. Negotiated Rate |
$8,920.90 |
| Rate for Payer: Aetna Commercial |
$7,155.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,248.23
|
| Rate for Payer: Cash Price |
$4,646.30
|
| Rate for Payer: Cigna Commercial |
$7,712.86
|
| Rate for Payer: First Health Commercial |
$8,827.97
|
| Rate for Payer: Humana Commercial |
$7,898.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,619.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,857.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,787.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,177.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,969.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,434.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,084.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,411.89
|
| Rate for Payer: PHCS Commercial |
$8,920.90
|
| Rate for Payer: United Healthcare All Payer |
$8,177.49
|
|
|
BF OFFSET HD. IMPLANT SET
|
Facility
|
OP
|
$9,292.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,787.78 |
| Max. Negotiated Rate |
$8,920.90 |
| Rate for Payer: Aetna Commercial |
$7,155.30
|
| Rate for Payer: Anthem Medicaid |
$3,195.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,248.23
|
| Rate for Payer: Cash Price |
$4,646.30
|
| Rate for Payer: Cigna Commercial |
$7,712.86
|
| Rate for Payer: First Health Commercial |
$8,827.97
|
| Rate for Payer: Humana Commercial |
$7,898.71
|
| Rate for Payer: Humana KY Medicaid |
$3,195.73
|
| Rate for Payer: Kentucky WC Medicaid |
$3,228.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,619.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,857.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,787.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,259.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,177.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,969.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,434.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,084.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,411.89
|
| Rate for Payer: PHCS Commercial |
$8,920.90
|
| Rate for Payer: United Healthcare All Payer |
$8,177.49
|
|
|
BF OFFSET HUM HEAD 15*40
|
Facility
|
OP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem Medicaid |
$3,858.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Humana KY Medicaid |
$3,858.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,897.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,935.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 15*40
|
Facility
|
IP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 15*46
|
Facility
|
OP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem Medicaid |
$3,858.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Humana KY Medicaid |
$3,858.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,897.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,935.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 15*46
|
Facility
|
IP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 17*46
|
Facility
|
OP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem Medicaid |
$3,858.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Humana KY Medicaid |
$3,858.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,897.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,935.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 17*46
|
Facility
|
IP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 18*40
|
Facility
|
IP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 18*40
|
Facility
|
OP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem Medicaid |
$3,858.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Humana KY Medicaid |
$3,858.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,897.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,935.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 18*52
|
Facility
|
IP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 18*52
|
Facility
|
OP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem Medicaid |
$3,858.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Humana KY Medicaid |
$3,858.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,897.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,935.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 18*56
|
Facility
|
OP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem Medicaid |
$3,858.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Humana KY Medicaid |
$3,858.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,897.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,935.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
