|
COMPR HMRL FX STEM MACRO 14MM
|
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 14MM
|
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 4MM
|
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 4MM
|
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 6MM
|
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 6MM
|
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 8MM
|
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 8MM
|
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 RVS SHLDER GLENSPR 36M+3
|
Facility
|
IP
|
$9,085.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.09 |
| Max. Negotiated Rate |
$8,721.89 |
| Rate for Payer: Aetna Commercial |
$6,995.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,086.53
|
| Rate for Payer: Cash Price |
$4,542.65
|
| Rate for Payer: Cigna Commercial |
$7,540.80
|
| Rate for Payer: First Health Commercial |
$8,631.04
|
| Rate for Payer: Humana Commercial |
$7,722.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,449.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,704.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,725.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,995.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,813.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,817.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,181.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,816.44
|
| Rate for Payer: PHCS Commercial |
$8,721.89
|
| Rate for Payer: United Healthcare All Payer |
$7,995.06
|
|
|
COMPR RVS SHLDER GLENSPR 36M+3
|
Facility
|
OP
|
$9,085.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.09 |
| Max. Negotiated Rate |
$8,721.89 |
| Rate for Payer: Aetna Commercial |
$6,995.68
|
| Rate for Payer: Anthem Medicaid |
$3,124.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,086.53
|
| Rate for Payer: Cash Price |
$4,542.65
|
| Rate for Payer: Cigna Commercial |
$7,540.80
|
| Rate for Payer: First Health Commercial |
$8,631.04
|
| Rate for Payer: Humana Commercial |
$7,722.50
|
| Rate for Payer: Humana KY Medicaid |
$3,124.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3,156.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,449.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,704.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,725.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,187.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,995.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,813.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,817.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,181.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,816.44
|
| Rate for Payer: PHCS Commercial |
$8,721.89
|
| Rate for Payer: United Healthcare All Payer |
$7,995.06
|
|
|
COMPR RVS SHLDER GLENSPR 36M+6
|
Facility
|
OP
|
$9,085.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.09 |
| Max. Negotiated Rate |
$8,721.89 |
| Rate for Payer: Aetna Commercial |
$6,995.68
|
| Rate for Payer: Anthem Medicaid |
$3,124.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,086.53
|
| Rate for Payer: Cash Price |
$4,542.65
|
| Rate for Payer: Cigna Commercial |
$7,540.80
|
| Rate for Payer: First Health Commercial |
$8,631.04
|
| Rate for Payer: Humana Commercial |
$7,722.50
|
| Rate for Payer: Humana KY Medicaid |
$3,124.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3,156.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,449.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,704.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,725.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,187.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,995.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,813.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,817.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,181.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,816.44
|
| Rate for Payer: PHCS Commercial |
$8,721.89
|
| Rate for Payer: United Healthcare All Payer |
$7,995.06
|
|
|
COMPR RVS SHLDER GLENSPR 36M+6
|
Facility
|
IP
|
$9,085.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.09 |
| Max. Negotiated Rate |
$8,721.89 |
| Rate for Payer: Aetna Commercial |
$6,995.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,086.53
|
| Rate for Payer: Cash Price |
$4,542.65
|
| Rate for Payer: Cigna Commercial |
$7,540.80
|
| Rate for Payer: First Health Commercial |
$8,631.04
|
| Rate for Payer: Humana Commercial |
$7,722.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,449.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,704.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,725.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,995.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,813.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,817.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,181.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,816.44
|
| Rate for Payer: PHCS Commercial |
$8,721.89
|
| Rate for Payer: United Healthcare All Payer |
$7,995.06
|
|
|
COMPR RVS SHLDER GLENSPR 41M+3
|
Facility
|
IP
|
$9,085.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.09 |
| Max. Negotiated Rate |
$8,721.89 |
| Rate for Payer: Aetna Commercial |
$6,995.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,086.53
|
| Rate for Payer: Cash Price |
$4,542.65
|
| Rate for Payer: Cigna Commercial |
$7,540.80
|
| Rate for Payer: First Health Commercial |
$8,631.04
|
| Rate for Payer: Humana Commercial |
$7,722.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,449.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,704.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,725.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,995.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,813.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,817.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,181.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,816.44
|
| Rate for Payer: PHCS Commercial |
$8,721.89
|
| Rate for Payer: United Healthcare All Payer |
$7,995.06
|
|
|
COMPR RVS SHLDER GLENSPR 41M+3
|
Facility
|
OP
|
$9,085.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.09 |
| Max. Negotiated Rate |
$8,721.89 |
| Rate for Payer: Aetna Commercial |
$6,995.68
|
| Rate for Payer: Anthem Medicaid |
$3,124.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,086.53
|
| Rate for Payer: Cash Price |
$4,542.65
|
| Rate for Payer: Cigna Commercial |
$7,540.80
|
| Rate for Payer: First Health Commercial |
$8,631.04
|
| Rate for Payer: Humana Commercial |
$7,722.50
|
| Rate for Payer: Humana KY Medicaid |
$3,124.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3,156.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,449.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,704.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,725.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,187.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,995.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,813.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,817.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,181.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,816.44
|
| Rate for Payer: PHCS Commercial |
$8,721.89
|
| Rate for Payer: United Healthcare All Payer |
$7,995.06
|
|
|
COMPR RVS SHLDER GLENSPR 41M+6
|
Facility
|
IP
|
$9,085.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.09 |
| Max. Negotiated Rate |
$8,721.89 |
| Rate for Payer: Aetna Commercial |
$6,995.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,086.53
|
| Rate for Payer: Cash Price |
$4,542.65
|
| Rate for Payer: Cigna Commercial |
$7,540.80
|
| Rate for Payer: First Health Commercial |
$8,631.04
|
| Rate for Payer: Humana Commercial |
$7,722.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,449.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,704.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,725.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,995.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,813.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,817.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,181.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,816.44
|
| Rate for Payer: PHCS Commercial |
$8,721.89
|
| Rate for Payer: United Healthcare All Payer |
$7,995.06
|
|
|
COMPR RVS SHLDER GLENSPR 41M+6
|
Facility
|
OP
|
$9,085.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.09 |
| Max. Negotiated Rate |
$8,721.89 |
| Rate for Payer: Aetna Commercial |
$6,995.68
|
| Rate for Payer: Anthem Medicaid |
$3,124.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,086.53
|
| Rate for Payer: Cash Price |
$4,542.65
|
| Rate for Payer: Cigna Commercial |
$7,540.80
|
| Rate for Payer: First Health Commercial |
$8,631.04
|
| Rate for Payer: Humana Commercial |
$7,722.50
|
| Rate for Payer: Humana KY Medicaid |
$3,124.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3,156.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,449.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,704.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,725.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,187.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,995.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,813.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,817.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,181.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,816.44
|
| Rate for Payer: PHCS Commercial |
$8,721.89
|
| Rate for Payer: United Healthcare All Payer |
$7,995.06
|
|
|
COMPR RVS SHLDR GLEN BASEPLT
|
Facility
|
OP
|
$9,464.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,230.44 |
| Max. Negotiated Rate |
$9,086.30 |
| Rate for Payer: Aetna Commercial |
$7,287.97
|
| Rate for Payer: Anthem Medicaid |
$3,254.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,382.62
|
| Rate for Payer: Cash Price |
$4,732.45
|
| Rate for Payer: Cigna Commercial |
$7,855.87
|
| Rate for Payer: First Health Commercial |
$8,991.66
|
| Rate for Payer: Humana Commercial |
$8,045.16
|
| Rate for Payer: Humana KY Medicaid |
$3,254.98
|
| Rate for Payer: Kentucky WC Medicaid |
$3,288.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,761.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,985.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,839.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,320.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,329.11
|
| Rate for Payer: Ohio Health Group HMO |
$7,098.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,892.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,230.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,934.12
|
| Rate for Payer: PHCS Commercial |
$9,086.30
|
| Rate for Payer: United Healthcare All Payer |
$8,329.11
|
|
|
COMPR RVS SHLDR GLEN BASEPLT
|
Facility
|
IP
|
$9,464.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,230.44 |
| Max. Negotiated Rate |
$9,086.30 |
| Rate for Payer: Aetna Commercial |
$7,287.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,382.62
|
| Rate for Payer: Cash Price |
$4,732.45
|
| Rate for Payer: Cigna Commercial |
$7,855.87
|
| Rate for Payer: First Health Commercial |
$8,991.66
|
| Rate for Payer: Humana Commercial |
$8,045.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,761.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,985.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,839.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,329.11
|
| Rate for Payer: Ohio Health Group HMO |
$7,098.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,892.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,230.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,934.12
|
| Rate for Payer: PHCS Commercial |
$9,086.30
|
| Rate for Payer: United Healthcare All Payer |
$8,329.11
|
|
|
COMPR RVS SHLDR HMRL TRAY 44MM
|
Facility
|
IP
|
$10,067.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,308.73 |
| Max. Negotiated Rate |
$9,664.46 |
| Rate for Payer: Aetna Commercial |
$7,751.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,852.38
|
| Rate for Payer: Cash Price |
$5,033.58
|
| Rate for Payer: Cigna Commercial |
$8,355.73
|
| Rate for Payer: First Health Commercial |
$9,563.79
|
| Rate for Payer: Humana Commercial |
$8,557.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,255.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,429.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,020.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,859.09
|
| Rate for Payer: Ohio Health Group HMO |
$7,550.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,013.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,308.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,120.82
|
| Rate for Payer: PHCS Commercial |
$9,664.46
|
| Rate for Payer: United Healthcare All Payer |
$8,859.09
|
|
|
COMPR RVS SHLDR HMRL TRAY 44MM
|
Facility
|
OP
|
$10,067.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,308.73 |
| Max. Negotiated Rate |
$9,664.46 |
| Rate for Payer: Aetna Commercial |
$7,751.71
|
| Rate for Payer: Anthem Medicaid |
$3,462.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,852.38
|
| Rate for Payer: Cash Price |
$5,033.58
|
| Rate for Payer: Cigna Commercial |
$8,355.73
|
| Rate for Payer: First Health Commercial |
$9,563.79
|
| Rate for Payer: Humana Commercial |
$8,557.08
|
| Rate for Payer: Humana KY Medicaid |
$3,462.09
|
| Rate for Payer: Kentucky WC Medicaid |
$3,497.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,255.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,429.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,020.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,531.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,859.09
|
| Rate for Payer: Ohio Health Group HMO |
$7,550.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,013.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,308.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,120.82
|
| Rate for Payer: PHCS Commercial |
$9,664.46
|
| Rate for Payer: United Healthcare All Payer |
$8,859.09
|
|
|
COMPR RVS SHLDR HMRL TRY 44M+5
|
Facility
|
IP
|
$10,067.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,308.73 |
| Max. Negotiated Rate |
$9,664.46 |
| Rate for Payer: Aetna Commercial |
$7,751.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,852.38
|
| Rate for Payer: Cash Price |
$5,033.58
|
| Rate for Payer: Cigna Commercial |
$8,355.73
|
| Rate for Payer: First Health Commercial |
$9,563.79
|
| Rate for Payer: Humana Commercial |
$8,557.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,255.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,429.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,020.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,859.09
|
| Rate for Payer: Ohio Health Group HMO |
$7,550.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,013.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,308.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,120.82
|
| Rate for Payer: PHCS Commercial |
$9,664.46
|
| Rate for Payer: United Healthcare All Payer |
$8,859.09
|
|
|
COMPR RVS SHLDR HMRL TRY 44M+5
|
Facility
|
OP
|
$10,067.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,308.73 |
| Max. Negotiated Rate |
$9,664.46 |
| Rate for Payer: Aetna Commercial |
$7,751.71
|
| Rate for Payer: Anthem Medicaid |
$3,462.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,852.38
|
| Rate for Payer: Cash Price |
$5,033.58
|
| Rate for Payer: Cigna Commercial |
$8,355.73
|
| Rate for Payer: First Health Commercial |
$9,563.79
|
| Rate for Payer: Humana Commercial |
$8,557.08
|
| Rate for Payer: Humana KY Medicaid |
$3,462.09
|
| Rate for Payer: Kentucky WC Medicaid |
$3,497.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,255.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,429.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,020.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,531.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,859.09
|
| Rate for Payer: Ohio Health Group HMO |
$7,550.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,013.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,308.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,120.82
|
| Rate for Payer: PHCS Commercial |
$9,664.46
|
| Rate for Payer: United Healthcare All Payer |
$8,859.09
|
|
|
COMPR RVS SHLR HMRL TRY 44M+10
|
Facility
|
OP
|
$10,067.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,308.73 |
| Max. Negotiated Rate |
$9,664.46 |
| Rate for Payer: Aetna Commercial |
$7,751.71
|
| Rate for Payer: Anthem Medicaid |
$3,462.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,852.38
|
| Rate for Payer: Cash Price |
$5,033.58
|
| Rate for Payer: Cigna Commercial |
$8,355.73
|
| Rate for Payer: First Health Commercial |
$9,563.79
|
| Rate for Payer: Humana Commercial |
$8,557.08
|
| Rate for Payer: Humana KY Medicaid |
$3,462.09
|
| Rate for Payer: Kentucky WC Medicaid |
$3,497.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,255.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,429.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,020.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,531.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,859.09
|
| Rate for Payer: Ohio Health Group HMO |
$7,550.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,013.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,308.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,120.82
|
| Rate for Payer: PHCS Commercial |
$9,664.46
|
| Rate for Payer: United Healthcare All Payer |
$8,859.09
|
|
|
COMPR RVS SHLR HMRL TRY 44M+10
|
Facility
|
IP
|
$10,067.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,308.73 |
| Max. Negotiated Rate |
$9,664.46 |
| Rate for Payer: Aetna Commercial |
$7,751.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,852.38
|
| Rate for Payer: Cash Price |
$5,033.58
|
| Rate for Payer: Cigna Commercial |
$8,355.73
|
| Rate for Payer: First Health Commercial |
$9,563.79
|
| Rate for Payer: Humana Commercial |
$8,557.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,255.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,429.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,020.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,859.09
|
| Rate for Payer: Ohio Health Group HMO |
$7,550.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,013.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,308.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,120.82
|
| Rate for Payer: PHCS Commercial |
$9,664.46
|
| Rate for Payer: United Healthcare All Payer |
$8,859.09
|
|
|
COMPR RVS SHLR HUM TRY 44M STD
|
Facility
|
IP
|
$10,965.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.45 |
| Max. Negotiated Rate |
$10,526.40 |
| Rate for Payer: Aetna Commercial |
$8,443.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,552.70
|
| Rate for Payer: Cash Price |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$9,100.95
|
| Rate for Payer: First Health Commercial |
$10,416.75
|
| Rate for Payer: Humana Commercial |
$9,320.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,991.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,092.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,289.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,649.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,223.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,193.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,425.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,399.15
|
| Rate for Payer: PHCS Commercial |
$10,526.40
|
| Rate for Payer: United Healthcare All Payer |
$9,649.20
|
|
