|
COMPRES ELPSH SPDL W PINS 800F
|
Facility
|
OP
|
$26,445.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,437.97 |
| Max. Negotiated Rate |
$25,388.12 |
| Rate for Payer: Aetna Commercial |
$20,363.39
|
| Rate for Payer: Anthem Medicaid |
$9,094.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,627.85
|
| Rate for Payer: Cash Price |
$13,222.98
|
| Rate for Payer: Cigna Commercial |
$21,950.15
|
| Rate for Payer: First Health Commercial |
$25,123.66
|
| Rate for Payer: Humana Commercial |
$22,479.07
|
| Rate for Payer: Humana KY Medicaid |
$9,094.77
|
| Rate for Payer: Kentucky WC Medicaid |
$9,187.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,685.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,517.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,933.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,277.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,272.44
|
| Rate for Payer: Ohio Health Group HMO |
$19,834.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,289.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,437.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,198.25
|
| Rate for Payer: PHCS Commercial |
$25,388.12
|
| Rate for Payer: United Healthcare All Payer |
$23,272.44
|
|
|
COMPRES ELPSH SPDL W PINS 800F
|
Facility
|
IP
|
$26,445.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,437.97 |
| Max. Negotiated Rate |
$25,388.12 |
| Rate for Payer: Aetna Commercial |
$20,363.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,627.85
|
| Rate for Payer: Cash Price |
$13,222.98
|
| Rate for Payer: Cigna Commercial |
$21,950.15
|
| Rate for Payer: First Health Commercial |
$25,123.66
|
| Rate for Payer: Humana Commercial |
$22,479.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,685.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,517.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,933.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,272.44
|
| Rate for Payer: Ohio Health Group HMO |
$19,834.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,289.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,437.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,198.25
|
| Rate for Payer: PHCS Commercial |
$25,388.12
|
| Rate for Payer: United Healthcare All Payer |
$23,272.44
|
|
|
COMPRES LG SH SPDL W PINS 400F
|
Facility
|
OP
|
$26,445.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,437.97 |
| Max. Negotiated Rate |
$25,388.12 |
| Rate for Payer: Aetna Commercial |
$20,363.39
|
| Rate for Payer: Anthem Medicaid |
$9,094.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,627.85
|
| Rate for Payer: Cash Price |
$13,222.98
|
| Rate for Payer: Cigna Commercial |
$21,950.15
|
| Rate for Payer: First Health Commercial |
$25,123.66
|
| Rate for Payer: Humana Commercial |
$22,479.07
|
| Rate for Payer: Humana KY Medicaid |
$9,094.77
|
| Rate for Payer: Kentucky WC Medicaid |
$9,187.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,685.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,517.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,933.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,277.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,272.44
|
| Rate for Payer: Ohio Health Group HMO |
$19,834.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,289.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,437.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,198.25
|
| Rate for Payer: PHCS Commercial |
$25,388.12
|
| Rate for Payer: United Healthcare All Payer |
$23,272.44
|
|
|
COMPRES LG SH SPDL W PINS 400F
|
Facility
|
IP
|
$26,445.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,437.97 |
| Max. Negotiated Rate |
$25,388.12 |
| Rate for Payer: Aetna Commercial |
$20,363.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,627.85
|
| Rate for Payer: Cash Price |
$13,222.98
|
| Rate for Payer: Cigna Commercial |
$21,950.15
|
| Rate for Payer: First Health Commercial |
$25,123.66
|
| Rate for Payer: Humana Commercial |
$22,479.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,685.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,517.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,933.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,272.44
|
| Rate for Payer: Ohio Health Group HMO |
$19,834.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,289.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,437.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,198.25
|
| Rate for Payer: PHCS Commercial |
$25,388.12
|
| Rate for Payer: United Healthcare All Payer |
$23,272.44
|
|
|
COMPRES LG SH SPDL W PINS 600F
|
Facility
|
OP
|
$26,445.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,437.97 |
| Max. Negotiated Rate |
$25,388.12 |
| Rate for Payer: Aetna Commercial |
$20,363.39
|
| Rate for Payer: Anthem Medicaid |
$9,094.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,627.85
|
| Rate for Payer: Cash Price |
$13,222.98
|
| Rate for Payer: Cigna Commercial |
$21,950.15
|
| Rate for Payer: First Health Commercial |
$25,123.66
|
| Rate for Payer: Humana Commercial |
$22,479.07
|
| Rate for Payer: Humana KY Medicaid |
$9,094.77
|
| Rate for Payer: Kentucky WC Medicaid |
$9,187.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,685.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,517.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,933.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,277.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,272.44
|
| Rate for Payer: Ohio Health Group HMO |
$19,834.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,289.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,437.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,198.25
|
| Rate for Payer: PHCS Commercial |
$25,388.12
|
| Rate for Payer: United Healthcare All Payer |
$23,272.44
|
|
|
COMPRES LG SH SPDL W PINS 600F
|
Facility
|
IP
|
$26,445.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,437.97 |
| Max. Negotiated Rate |
$25,388.12 |
| Rate for Payer: Aetna Commercial |
$20,363.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,627.85
|
| Rate for Payer: Cash Price |
$13,222.98
|
| Rate for Payer: Cigna Commercial |
$21,950.15
|
| Rate for Payer: First Health Commercial |
$25,123.66
|
| Rate for Payer: Humana Commercial |
$22,479.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,685.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,517.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,933.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,272.44
|
| Rate for Payer: Ohio Health Group HMO |
$19,834.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,289.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,437.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,198.25
|
| Rate for Payer: PHCS Commercial |
$25,388.12
|
| Rate for Payer: United Healthcare All Payer |
$23,272.44
|
|
|
COMPRES LG SH SPDL W PINS 800F
|
Facility
|
IP
|
$26,445.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,437.97 |
| Max. Negotiated Rate |
$25,388.12 |
| Rate for Payer: Aetna Commercial |
$20,363.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,627.85
|
| Rate for Payer: Cash Price |
$13,222.98
|
| Rate for Payer: Cigna Commercial |
$21,950.15
|
| Rate for Payer: First Health Commercial |
$25,123.66
|
| Rate for Payer: Humana Commercial |
$22,479.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,685.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,517.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,933.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,272.44
|
| Rate for Payer: Ohio Health Group HMO |
$19,834.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,289.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,437.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,198.25
|
| Rate for Payer: PHCS Commercial |
$25,388.12
|
| Rate for Payer: United Healthcare All Payer |
$23,272.44
|
|
|
COMPRES LG SH SPDL W PINS 800F
|
Facility
|
OP
|
$26,445.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,437.97 |
| Max. Negotiated Rate |
$25,388.12 |
| Rate for Payer: Aetna Commercial |
$20,363.39
|
| Rate for Payer: Anthem Medicaid |
$9,094.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,627.85
|
| Rate for Payer: Cash Price |
$13,222.98
|
| Rate for Payer: Cigna Commercial |
$21,950.15
|
| Rate for Payer: First Health Commercial |
$25,123.66
|
| Rate for Payer: Humana Commercial |
$22,479.07
|
| Rate for Payer: Humana KY Medicaid |
$9,094.77
|
| Rate for Payer: Kentucky WC Medicaid |
$9,187.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,685.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,517.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,933.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,277.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,272.44
|
| Rate for Payer: Ohio Health Group HMO |
$19,834.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,289.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,437.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,198.25
|
| Rate for Payer: PHCS Commercial |
$25,388.12
|
| Rate for Payer: United Healthcare All Payer |
$23,272.44
|
|
|
COMPRESSION STAPLE 13I*11L
|
Facility
|
OP
|
$3,827.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$497.58 |
| Max. Negotiated Rate |
$3,674.40 |
| Rate for Payer: Aetna Commercial |
$2,947.18
|
| Rate for Payer: Anthem Medicaid |
$1,316.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,985.45
|
| Rate for Payer: Cash Price |
$1,913.75
|
| Rate for Payer: Cigna Commercial |
$3,176.82
|
| Rate for Payer: First Health Commercial |
$3,636.12
|
| Rate for Payer: Humana Commercial |
$3,253.38
|
| Rate for Payer: Humana KY Medicaid |
$1,316.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,329.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,138.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,824.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,148.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,342.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,368.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,870.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$765.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$497.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,186.52
|
| Rate for Payer: PHCS Commercial |
$3,674.40
|
| Rate for Payer: United Healthcare All Payer |
$3,368.20
|
|
|
COMPRESSION STAPLE 13I*11L
|
Facility
|
IP
|
$3,827.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$497.58 |
| Max. Negotiated Rate |
$3,674.40 |
| Rate for Payer: Aetna Commercial |
$2,947.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,985.45
|
| Rate for Payer: Cash Price |
$1,913.75
|
| Rate for Payer: Cigna Commercial |
$3,176.82
|
| Rate for Payer: First Health Commercial |
$3,636.12
|
| Rate for Payer: Humana Commercial |
$3,253.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,138.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,824.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,148.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,368.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,870.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$765.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$497.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,186.52
|
| Rate for Payer: PHCS Commercial |
$3,674.40
|
| Rate for Payer: United Healthcare All Payer |
$3,368.20
|
|
|
COMPRES SM SH SPDL W PINS 400F
|
Facility
|
OP
|
$26,445.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,437.97 |
| Max. Negotiated Rate |
$25,388.12 |
| Rate for Payer: Aetna Commercial |
$20,363.39
|
| Rate for Payer: Anthem Medicaid |
$9,094.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,627.85
|
| Rate for Payer: Cash Price |
$13,222.98
|
| Rate for Payer: Cigna Commercial |
$21,950.15
|
| Rate for Payer: First Health Commercial |
$25,123.66
|
| Rate for Payer: Humana Commercial |
$22,479.07
|
| Rate for Payer: Humana KY Medicaid |
$9,094.77
|
| Rate for Payer: Kentucky WC Medicaid |
$9,187.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,685.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,517.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,933.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,277.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,272.44
|
| Rate for Payer: Ohio Health Group HMO |
$19,834.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,289.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,437.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,198.25
|
| Rate for Payer: PHCS Commercial |
$25,388.12
|
| Rate for Payer: United Healthcare All Payer |
$23,272.44
|
|
|
COMPRES SM SH SPDL W PINS 400F
|
Facility
|
IP
|
$26,445.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,437.97 |
| Max. Negotiated Rate |
$25,388.12 |
| Rate for Payer: Aetna Commercial |
$20,363.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,627.85
|
| Rate for Payer: Cash Price |
$13,222.98
|
| Rate for Payer: Cigna Commercial |
$21,950.15
|
| Rate for Payer: First Health Commercial |
$25,123.66
|
| Rate for Payer: Humana Commercial |
$22,479.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,685.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,517.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,933.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,272.44
|
| Rate for Payer: Ohio Health Group HMO |
$19,834.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,289.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,437.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,198.25
|
| Rate for Payer: PHCS Commercial |
$25,388.12
|
| Rate for Payer: United Healthcare All Payer |
$23,272.44
|
|
|
COMPRES SM SH SPDL W PINS 600F
|
Facility
|
OP
|
$26,445.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,437.97 |
| Max. Negotiated Rate |
$25,388.12 |
| Rate for Payer: Aetna Commercial |
$20,363.39
|
| Rate for Payer: Anthem Medicaid |
$9,094.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,627.85
|
| Rate for Payer: Cash Price |
$13,222.98
|
| Rate for Payer: Cigna Commercial |
$21,950.15
|
| Rate for Payer: First Health Commercial |
$25,123.66
|
| Rate for Payer: Humana Commercial |
$22,479.07
|
| Rate for Payer: Humana KY Medicaid |
$9,094.77
|
| Rate for Payer: Kentucky WC Medicaid |
$9,187.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,685.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,517.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,933.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,277.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,272.44
|
| Rate for Payer: Ohio Health Group HMO |
$19,834.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,289.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,437.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,198.25
|
| Rate for Payer: PHCS Commercial |
$25,388.12
|
| Rate for Payer: United Healthcare All Payer |
$23,272.44
|
|
|
COMPRES SM SH SPDL W PINS 600F
|
Facility
|
IP
|
$26,445.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,437.97 |
| Max. Negotiated Rate |
$25,388.12 |
| Rate for Payer: Aetna Commercial |
$20,363.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,627.85
|
| Rate for Payer: Cash Price |
$13,222.98
|
| Rate for Payer: Cigna Commercial |
$21,950.15
|
| Rate for Payer: First Health Commercial |
$25,123.66
|
| Rate for Payer: Humana Commercial |
$22,479.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,685.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,517.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,933.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,272.44
|
| Rate for Payer: Ohio Health Group HMO |
$19,834.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,289.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,437.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,198.25
|
| Rate for Payer: PHCS Commercial |
$25,388.12
|
| Rate for Payer: United Healthcare All Payer |
$23,272.44
|
|
|
COMPRES SM SH SPDL W PINS 800F
|
Facility
|
OP
|
$26,445.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,437.97 |
| Max. Negotiated Rate |
$25,388.12 |
| Rate for Payer: Aetna Commercial |
$20,363.39
|
| Rate for Payer: Anthem Medicaid |
$9,094.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,627.85
|
| Rate for Payer: Cash Price |
$13,222.98
|
| Rate for Payer: Cigna Commercial |
$21,950.15
|
| Rate for Payer: First Health Commercial |
$25,123.66
|
| Rate for Payer: Humana Commercial |
$22,479.07
|
| Rate for Payer: Humana KY Medicaid |
$9,094.77
|
| Rate for Payer: Kentucky WC Medicaid |
$9,187.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,685.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,517.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,933.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,277.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,272.44
|
| Rate for Payer: Ohio Health Group HMO |
$19,834.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,289.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,437.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,198.25
|
| Rate for Payer: PHCS Commercial |
$25,388.12
|
| Rate for Payer: United Healthcare All Payer |
$23,272.44
|
|
|
COMPRES SM SH SPDL W PINS 800F
|
Facility
|
IP
|
$26,445.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,437.97 |
| Max. Negotiated Rate |
$25,388.12 |
| Rate for Payer: Aetna Commercial |
$20,363.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,627.85
|
| Rate for Payer: Cash Price |
$13,222.98
|
| Rate for Payer: Cigna Commercial |
$21,950.15
|
| Rate for Payer: First Health Commercial |
$25,123.66
|
| Rate for Payer: Humana Commercial |
$22,479.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,685.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,517.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,933.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,272.44
|
| Rate for Payer: Ohio Health Group HMO |
$19,834.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,289.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,437.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,198.25
|
| Rate for Payer: PHCS Commercial |
$25,388.12
|
| Rate for Payer: United Healthcare All Payer |
$23,272.44
|
|
|
COMPRES XS SH SPDL W PINS 400F
|
Facility
|
OP
|
$26,445.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,437.97 |
| Max. Negotiated Rate |
$25,388.12 |
| Rate for Payer: Aetna Commercial |
$20,363.39
|
| Rate for Payer: Anthem Medicaid |
$9,094.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,627.85
|
| Rate for Payer: Cash Price |
$13,222.98
|
| Rate for Payer: Cigna Commercial |
$21,950.15
|
| Rate for Payer: First Health Commercial |
$25,123.66
|
| Rate for Payer: Humana Commercial |
$22,479.07
|
| Rate for Payer: Humana KY Medicaid |
$9,094.77
|
| Rate for Payer: Kentucky WC Medicaid |
$9,187.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,685.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,517.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,933.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,277.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,272.44
|
| Rate for Payer: Ohio Health Group HMO |
$19,834.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,289.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,437.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,198.25
|
| Rate for Payer: PHCS Commercial |
$25,388.12
|
| Rate for Payer: United Healthcare All Payer |
$23,272.44
|
|
|
COMPRES XS SH SPDL W PINS 400F
|
Facility
|
IP
|
$26,445.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,437.97 |
| Max. Negotiated Rate |
$25,388.12 |
| Rate for Payer: Aetna Commercial |
$20,363.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,627.85
|
| Rate for Payer: Cash Price |
$13,222.98
|
| Rate for Payer: Cigna Commercial |
$21,950.15
|
| Rate for Payer: First Health Commercial |
$25,123.66
|
| Rate for Payer: Humana Commercial |
$22,479.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,685.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,517.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,933.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,272.44
|
| Rate for Payer: Ohio Health Group HMO |
$19,834.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,289.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,437.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,198.25
|
| Rate for Payer: PHCS Commercial |
$25,388.12
|
| Rate for Payer: United Healthcare All Payer |
$23,272.44
|
|
|
COMPRES XS SH SPDL W PINS 600F
|
Facility
|
IP
|
$26,445.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,437.97 |
| Max. Negotiated Rate |
$25,388.12 |
| Rate for Payer: Aetna Commercial |
$20,363.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,627.85
|
| Rate for Payer: Cash Price |
$13,222.98
|
| Rate for Payer: Cigna Commercial |
$21,950.15
|
| Rate for Payer: First Health Commercial |
$25,123.66
|
| Rate for Payer: Humana Commercial |
$22,479.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,685.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,517.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,933.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,272.44
|
| Rate for Payer: Ohio Health Group HMO |
$19,834.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,289.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,437.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,198.25
|
| Rate for Payer: PHCS Commercial |
$25,388.12
|
| Rate for Payer: United Healthcare All Payer |
$23,272.44
|
|
|
COMPRES XS SH SPDL W PINS 600F
|
Facility
|
OP
|
$26,445.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,437.97 |
| Max. Negotiated Rate |
$25,388.12 |
| Rate for Payer: Aetna Commercial |
$20,363.39
|
| Rate for Payer: Anthem Medicaid |
$9,094.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,627.85
|
| Rate for Payer: Cash Price |
$13,222.98
|
| Rate for Payer: Cigna Commercial |
$21,950.15
|
| Rate for Payer: First Health Commercial |
$25,123.66
|
| Rate for Payer: Humana Commercial |
$22,479.07
|
| Rate for Payer: Humana KY Medicaid |
$9,094.77
|
| Rate for Payer: Kentucky WC Medicaid |
$9,187.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,685.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,517.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,933.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,277.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,272.44
|
| Rate for Payer: Ohio Health Group HMO |
$19,834.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,289.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,437.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,198.25
|
| Rate for Payer: PHCS Commercial |
$25,388.12
|
| Rate for Payer: United Healthcare All Payer |
$23,272.44
|
|
|
COMPRES XS SH SPDL W PINS 800F
|
Facility
|
IP
|
$26,445.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,437.97 |
| Max. Negotiated Rate |
$25,388.12 |
| Rate for Payer: Aetna Commercial |
$20,363.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,627.85
|
| Rate for Payer: Cash Price |
$13,222.98
|
| Rate for Payer: Cigna Commercial |
$21,950.15
|
| Rate for Payer: First Health Commercial |
$25,123.66
|
| Rate for Payer: Humana Commercial |
$22,479.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,685.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,517.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,933.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,272.44
|
| Rate for Payer: Ohio Health Group HMO |
$19,834.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,289.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,437.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,198.25
|
| Rate for Payer: PHCS Commercial |
$25,388.12
|
| Rate for Payer: United Healthcare All Payer |
$23,272.44
|
|
|
COMPRES XS SH SPDL W PINS 800F
|
Facility
|
OP
|
$26,445.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,437.97 |
| Max. Negotiated Rate |
$25,388.12 |
| Rate for Payer: Aetna Commercial |
$20,363.39
|
| Rate for Payer: Anthem Medicaid |
$9,094.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,627.85
|
| Rate for Payer: Cash Price |
$13,222.98
|
| Rate for Payer: Cigna Commercial |
$21,950.15
|
| Rate for Payer: First Health Commercial |
$25,123.66
|
| Rate for Payer: Humana Commercial |
$22,479.07
|
| Rate for Payer: Humana KY Medicaid |
$9,094.77
|
| Rate for Payer: Kentucky WC Medicaid |
$9,187.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,685.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,517.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,933.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,277.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,272.44
|
| Rate for Payer: Ohio Health Group HMO |
$19,834.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,289.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,437.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,198.25
|
| Rate for Payer: PHCS Commercial |
$25,388.12
|
| Rate for Payer: United Healthcare All Payer |
$23,272.44
|
|
|
COMPR FX HMRL POS SLV 10*12MM
|
Facility
|
IP
|
$2,186.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.24 |
| Max. Negotiated Rate |
$2,099.04 |
| Rate for Payer: Aetna Commercial |
$1,683.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,705.47
|
| Rate for Payer: Cash Price |
$1,093.25
|
| Rate for Payer: Cigna Commercial |
$1,814.80
|
| Rate for Payer: First Health Commercial |
$2,077.18
|
| Rate for Payer: Humana Commercial |
$1,858.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,792.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,613.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$655.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,924.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,639.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$437.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$677.82
|
| Rate for Payer: PHCS Commercial |
$2,099.04
|
| Rate for Payer: United Healthcare All Payer |
$1,924.12
|
|
|
COMPR FX HMRL POS SLV 10*12MM
|
Facility
|
OP
|
$2,186.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.24 |
| Max. Negotiated Rate |
$2,099.04 |
| Rate for Payer: Aetna Commercial |
$1,683.60
|
| Rate for Payer: Anthem Medicaid |
$751.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,705.47
|
| Rate for Payer: Cash Price |
$1,093.25
|
| Rate for Payer: Cigna Commercial |
$1,814.80
|
| Rate for Payer: First Health Commercial |
$2,077.18
|
| Rate for Payer: Humana Commercial |
$1,858.52
|
| Rate for Payer: Humana KY Medicaid |
$751.94
|
| Rate for Payer: Kentucky WC Medicaid |
$759.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,792.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,613.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$655.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$767.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,924.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,639.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$437.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$677.82
|
| Rate for Payer: PHCS Commercial |
$2,099.04
|
| Rate for Payer: United Healthcare All Payer |
$1,924.12
|
|
|
COMPR FX HMRL POS SLV 10*13MM
|
Facility
|
OP
|
$2,186.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.24 |
| Max. Negotiated Rate |
$2,099.04 |
| Rate for Payer: Aetna Commercial |
$1,683.60
|
| Rate for Payer: Anthem Medicaid |
$751.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,705.47
|
| Rate for Payer: Cash Price |
$1,093.25
|
| Rate for Payer: Cigna Commercial |
$1,814.80
|
| Rate for Payer: First Health Commercial |
$2,077.18
|
| Rate for Payer: Humana Commercial |
$1,858.52
|
| Rate for Payer: Humana KY Medicaid |
$751.94
|
| Rate for Payer: Kentucky WC Medicaid |
$759.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,792.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,613.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$655.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$767.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,924.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,639.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$437.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$677.82
|
| Rate for Payer: PHCS Commercial |
$2,099.04
|
| Rate for Payer: United Healthcare All Payer |
$1,924.12
|
|
