|
COMPR FX HMRL POS SLV 10*13MM
|
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 12*14MM
|
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 12*14MM
|
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 12*15MM
|
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 12*15MM
|
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 14*16MM
|
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 14*16MM
|
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 14*17MM
|
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 14*17MM
|
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 4*6MM
|
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 4*6MM
|
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 4*7MM
|
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 4*7MM
|
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 6*8MM
|
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 6*8MM
|
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 6*9MM
|
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 6*9MM
|
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 8*10MM
|
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 8*10MM
|
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 8*11MM
|
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 8*11MM
|
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 HMRL FX STEM MACRO 10MM
|
Facility
|
OP
|
$16,227.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,109.59 |
| Max. Negotiated Rate |
$15,578.50 |
| Rate for Payer: Aetna Commercial |
$12,495.25
|
| Rate for Payer: Anthem Medicaid |
$5,580.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,657.53
|
| Rate for Payer: Cash Price |
$8,113.80
|
| Rate for Payer: Cigna Commercial |
$13,468.91
|
| Rate for Payer: First Health Commercial |
$15,416.22
|
| Rate for Payer: Humana Commercial |
$13,793.46
|
| Rate for Payer: Humana KY Medicaid |
$5,580.67
|
| Rate for Payer: Kentucky WC Medicaid |
$5,637.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,306.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,975.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,868.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,692.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,280.29
|
| Rate for Payer: Ohio Health Group HMO |
$12,170.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,245.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,109.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,030.56
|
| Rate for Payer: PHCS Commercial |
$15,578.50
|
| Rate for Payer: United Healthcare All Payer |
$14,280.29
|
|
|
COMPR HMRL FX STEM MACRO 10MM
|
Facility
|
IP
|
$16,227.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,109.59 |
| Max. Negotiated Rate |
$15,578.50 |
| Rate for Payer: Aetna Commercial |
$12,495.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,657.53
|
| Rate for Payer: Cash Price |
$8,113.80
|
| Rate for Payer: Cigna Commercial |
$13,468.91
|
| Rate for Payer: First Health Commercial |
$15,416.22
|
| Rate for Payer: Humana Commercial |
$13,793.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,306.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,975.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,868.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,280.29
|
| Rate for Payer: Ohio Health Group HMO |
$12,170.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,245.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,109.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,030.56
|
| Rate for Payer: PHCS Commercial |
$15,578.50
|
| Rate for Payer: United Healthcare All Payer |
$14,280.29
|
|
|
COMPR HMRL FX STEM MACRO 12MM
|
Facility
|
IP
|
$16,227.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,109.59 |
| Max. Negotiated Rate |
$15,578.50 |
| Rate for Payer: Aetna Commercial |
$12,495.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,657.53
|
| Rate for Payer: Cash Price |
$8,113.80
|
| Rate for Payer: Cigna Commercial |
$13,468.91
|
| Rate for Payer: First Health Commercial |
$15,416.22
|
| Rate for Payer: Humana Commercial |
$13,793.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,306.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,975.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,868.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,280.29
|
| Rate for Payer: Ohio Health Group HMO |
$12,170.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,245.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,109.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,030.56
|
| Rate for Payer: PHCS Commercial |
$15,578.50
|
| Rate for Payer: United Healthcare All Payer |
$14,280.29
|
|
|
COMPR HMRL FX STEM MACRO 12MM
|
Facility
|
OP
|
$16,227.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,109.59 |
| Max. Negotiated Rate |
$15,578.50 |
| Rate for Payer: Aetna Commercial |
$12,495.25
|
| Rate for Payer: Anthem Medicaid |
$5,580.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,657.53
|
| Rate for Payer: Cash Price |
$8,113.80
|
| Rate for Payer: Cigna Commercial |
$13,468.91
|
| Rate for Payer: First Health Commercial |
$15,416.22
|
| Rate for Payer: Humana Commercial |
$13,793.46
|
| Rate for Payer: Humana KY Medicaid |
$5,580.67
|
| Rate for Payer: Kentucky WC Medicaid |
$5,637.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,306.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,975.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,868.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,692.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,280.29
|
| Rate for Payer: Ohio Health Group HMO |
$12,170.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,245.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,109.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,030.56
|
| Rate for Payer: PHCS Commercial |
$15,578.50
|
| Rate for Payer: United Healthcare All Payer |
$14,280.29
|
|
