COMPR RVS SHLR HUM TRY 44M STD
|
Facility
|
OP
|
$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 Medicaid |
$3,770.86
|
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: Humana KY Medicaid |
$3,770.86
|
Rate for Payer: Kentucky WC Medicaid |
$3,809.24
|
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: Molina Healthcare Medicaid |
$3,846.52
|
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
|
|
COMPR SRS 50MM DST HML BDY LT
|
Facility
|
OP
|
$27,386.20
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,560.21 |
Max. Negotiated Rate |
$26,290.75 |
Rate for Payer: Aetna Commercial |
$21,087.37
|
Rate for Payer: Anthem Medicaid |
$9,418.11
|
Rate for Payer: Anthem POS/PPO/Traditional |
$21,361.24
|
Rate for Payer: Cash Price |
$13,693.10
|
Rate for Payer: Cigna Commercial |
$22,730.55
|
Rate for Payer: First Health Commercial |
$26,016.89
|
Rate for Payer: Humana Commercial |
$23,278.27
|
Rate for Payer: Humana KY Medicaid |
$9,418.11
|
Rate for Payer: Kentucky WC Medicaid |
$9,513.97
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$22,456.68
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,211.02
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$8,215.86
|
Rate for Payer: Molina Healthcare Medicaid |
$9,607.08
|
Rate for Payer: Ohio Health Choice Commercial |
$24,099.86
|
Rate for Payer: Ohio Health Group HMO |
$20,539.65
|
Rate for Payer: Ohio Health Group PPO Differential |
$5,477.24
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3,560.21
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,489.72
|
Rate for Payer: PHCS Commercial |
$26,290.75
|
Rate for Payer: United Healthcare All Payer |
$24,099.86
|
|
COMPR SRS 50MM DST HML BDY LT
|
Facility
|
IP
|
$27,386.20
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,560.21 |
Max. Negotiated Rate |
$26,290.75 |
Rate for Payer: Aetna Commercial |
$21,087.37
|
Rate for Payer: Anthem POS/PPO/Traditional |
$21,361.24
|
Rate for Payer: Cash Price |
$13,693.10
|
Rate for Payer: Cigna Commercial |
$22,730.55
|
Rate for Payer: First Health Commercial |
$26,016.89
|
Rate for Payer: Humana Commercial |
$23,278.27
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$22,456.68
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,211.02
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$8,215.86
|
Rate for Payer: Ohio Health Choice Commercial |
$24,099.86
|
Rate for Payer: Ohio Health Group HMO |
$20,539.65
|
Rate for Payer: Ohio Health Group PPO Differential |
$5,477.24
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3,560.21
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,489.72
|
Rate for Payer: PHCS Commercial |
$26,290.75
|
Rate for Payer: United Healthcare All Payer |
$24,099.86
|
|
COMPR SRS 50MM DST HML BDY RT
|
Facility
|
OP
|
$27,386.20
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,560.21 |
Max. Negotiated Rate |
$26,290.75 |
Rate for Payer: Aetna Commercial |
$21,087.37
|
Rate for Payer: Anthem Medicaid |
$9,418.11
|
Rate for Payer: Anthem POS/PPO/Traditional |
$21,361.24
|
Rate for Payer: Cash Price |
$13,693.10
|
Rate for Payer: Cigna Commercial |
$22,730.55
|
Rate for Payer: First Health Commercial |
$26,016.89
|
Rate for Payer: Humana Commercial |
$23,278.27
|
Rate for Payer: Humana KY Medicaid |
$9,418.11
|
Rate for Payer: Kentucky WC Medicaid |
$9,513.97
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$22,456.68
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,211.02
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$8,215.86
|
Rate for Payer: Molina Healthcare Medicaid |
$9,607.08
|
Rate for Payer: Ohio Health Choice Commercial |
$24,099.86
|
Rate for Payer: Ohio Health Group HMO |
$20,539.65
|
Rate for Payer: Ohio Health Group PPO Differential |
$5,477.24
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3,560.21
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,489.72
|
Rate for Payer: PHCS Commercial |
$26,290.75
|
Rate for Payer: United Healthcare All Payer |
$24,099.86
|
|
COMPR SRS 50MM DST HML BDY RT
|
Facility
|
IP
|
$27,386.20
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,560.21 |
Max. Negotiated Rate |
$26,290.75 |
Rate for Payer: Aetna Commercial |
$21,087.37
|
Rate for Payer: Anthem POS/PPO/Traditional |
$21,361.24
|
Rate for Payer: Cash Price |
$13,693.10
|
Rate for Payer: Cigna Commercial |
$22,730.55
|
Rate for Payer: First Health Commercial |
$26,016.89
|
Rate for Payer: Humana Commercial |
$23,278.27
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$22,456.68
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,211.02
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$8,215.86
|
Rate for Payer: Ohio Health Choice Commercial |
$24,099.86
|
Rate for Payer: Ohio Health Group HMO |
$20,539.65
|
Rate for Payer: Ohio Health Group PPO Differential |
$5,477.24
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3,560.21
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,489.72
|
Rate for Payer: PHCS Commercial |
$26,290.75
|
Rate for Payer: United Healthcare All Payer |
$24,099.86
|
|
COMPR SRS 60MM DST HML BDY LT
|
Facility
|
OP
|
$27,386.20
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,560.21 |
Max. Negotiated Rate |
$26,290.75 |
Rate for Payer: Aetna Commercial |
$21,087.37
|
Rate for Payer: Anthem Medicaid |
$9,418.11
|
Rate for Payer: Anthem POS/PPO/Traditional |
$21,361.24
|
Rate for Payer: Cash Price |
$13,693.10
|
Rate for Payer: Cigna Commercial |
$22,730.55
|
Rate for Payer: First Health Commercial |
$26,016.89
|
Rate for Payer: Humana Commercial |
$23,278.27
|
Rate for Payer: Humana KY Medicaid |
$9,418.11
|
Rate for Payer: Kentucky WC Medicaid |
$9,513.97
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$22,456.68
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,211.02
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$8,215.86
|
Rate for Payer: Molina Healthcare Medicaid |
$9,607.08
|
Rate for Payer: Ohio Health Choice Commercial |
$24,099.86
|
Rate for Payer: Ohio Health Group HMO |
$20,539.65
|
Rate for Payer: Ohio Health Group PPO Differential |
$5,477.24
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3,560.21
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,489.72
|
Rate for Payer: PHCS Commercial |
$26,290.75
|
Rate for Payer: United Healthcare All Payer |
$24,099.86
|
|
COMPR SRS 60MM DST HML BDY LT
|
Facility
|
IP
|
$27,386.20
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,560.21 |
Max. Negotiated Rate |
$26,290.75 |
Rate for Payer: Aetna Commercial |
$21,087.37
|
Rate for Payer: Anthem POS/PPO/Traditional |
$21,361.24
|
Rate for Payer: Cash Price |
$13,693.10
|
Rate for Payer: Cigna Commercial |
$22,730.55
|
Rate for Payer: First Health Commercial |
$26,016.89
|
Rate for Payer: Humana Commercial |
$23,278.27
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$22,456.68
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,211.02
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$8,215.86
|
Rate for Payer: Ohio Health Choice Commercial |
$24,099.86
|
Rate for Payer: Ohio Health Group HMO |
$20,539.65
|
Rate for Payer: Ohio Health Group PPO Differential |
$5,477.24
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3,560.21
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,489.72
|
Rate for Payer: PHCS Commercial |
$26,290.75
|
Rate for Payer: United Healthcare All Payer |
$24,099.86
|
|
COMPR SRS 60MM DST HML BDY RT
|
Facility
|
IP
|
$27,386.20
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,560.21 |
Max. Negotiated Rate |
$26,290.75 |
Rate for Payer: Aetna Commercial |
$21,087.37
|
Rate for Payer: Anthem POS/PPO/Traditional |
$21,361.24
|
Rate for Payer: Cash Price |
$13,693.10
|
Rate for Payer: Cigna Commercial |
$22,730.55
|
Rate for Payer: First Health Commercial |
$26,016.89
|
Rate for Payer: Humana Commercial |
$23,278.27
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$22,456.68
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,211.02
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$8,215.86
|
Rate for Payer: Ohio Health Choice Commercial |
$24,099.86
|
Rate for Payer: Ohio Health Group HMO |
$20,539.65
|
Rate for Payer: Ohio Health Group PPO Differential |
$5,477.24
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3,560.21
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,489.72
|
Rate for Payer: PHCS Commercial |
$26,290.75
|
Rate for Payer: United Healthcare All Payer |
$24,099.86
|
|
COMPR SRS 60MM DST HML BDY RT
|
Facility
|
OP
|
$27,386.20
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,560.21 |
Max. Negotiated Rate |
$26,290.75 |
Rate for Payer: Aetna Commercial |
$21,087.37
|
Rate for Payer: Anthem Medicaid |
$9,418.11
|
Rate for Payer: Anthem POS/PPO/Traditional |
$21,361.24
|
Rate for Payer: Cash Price |
$13,693.10
|
Rate for Payer: Cigna Commercial |
$22,730.55
|
Rate for Payer: First Health Commercial |
$26,016.89
|
Rate for Payer: Humana Commercial |
$23,278.27
|
Rate for Payer: Humana KY Medicaid |
$9,418.11
|
Rate for Payer: Kentucky WC Medicaid |
$9,513.97
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$22,456.68
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,211.02
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$8,215.86
|
Rate for Payer: Molina Healthcare Medicaid |
$9,607.08
|
Rate for Payer: Ohio Health Choice Commercial |
$24,099.86
|
Rate for Payer: Ohio Health Group HMO |
$20,539.65
|
Rate for Payer: Ohio Health Group PPO Differential |
$5,477.24
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3,560.21
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,489.72
|
Rate for Payer: PHCS Commercial |
$26,290.75
|
Rate for Payer: United Healthcare All Payer |
$24,099.86
|
|
COMPR SRS 70MM DST HML BDY LT
|
Facility
|
IP
|
$27,386.20
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,560.21 |
Max. Negotiated Rate |
$26,290.75 |
Rate for Payer: Aetna Commercial |
$21,087.37
|
Rate for Payer: Anthem POS/PPO/Traditional |
$21,361.24
|
Rate for Payer: Cash Price |
$13,693.10
|
Rate for Payer: Cigna Commercial |
$22,730.55
|
Rate for Payer: First Health Commercial |
$26,016.89
|
Rate for Payer: Humana Commercial |
$23,278.27
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$22,456.68
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,211.02
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$8,215.86
|
Rate for Payer: Ohio Health Choice Commercial |
$24,099.86
|
Rate for Payer: Ohio Health Group HMO |
$20,539.65
|
Rate for Payer: Ohio Health Group PPO Differential |
$5,477.24
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3,560.21
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,489.72
|
Rate for Payer: PHCS Commercial |
$26,290.75
|
Rate for Payer: United Healthcare All Payer |
$24,099.86
|
|
COMPR SRS 70MM DST HML BDY LT
|
Facility
|
OP
|
$27,386.20
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,560.21 |
Max. Negotiated Rate |
$26,290.75 |
Rate for Payer: Aetna Commercial |
$21,087.37
|
Rate for Payer: Anthem Medicaid |
$9,418.11
|
Rate for Payer: Anthem POS/PPO/Traditional |
$21,361.24
|
Rate for Payer: Cash Price |
$13,693.10
|
Rate for Payer: Cigna Commercial |
$22,730.55
|
Rate for Payer: First Health Commercial |
$26,016.89
|
Rate for Payer: Humana Commercial |
$23,278.27
|
Rate for Payer: Humana KY Medicaid |
$9,418.11
|
Rate for Payer: Kentucky WC Medicaid |
$9,513.97
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$22,456.68
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,211.02
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$8,215.86
|
Rate for Payer: Molina Healthcare Medicaid |
$9,607.08
|
Rate for Payer: Ohio Health Choice Commercial |
$24,099.86
|
Rate for Payer: Ohio Health Group HMO |
$20,539.65
|
Rate for Payer: Ohio Health Group PPO Differential |
$5,477.24
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3,560.21
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,489.72
|
Rate for Payer: PHCS Commercial |
$26,290.75
|
Rate for Payer: United Healthcare All Payer |
$24,099.86
|
|
COMPR SRS 70MM DST HML BDY RT
|
Facility
|
OP
|
$27,386.20
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,560.21 |
Max. Negotiated Rate |
$26,290.75 |
Rate for Payer: Aetna Commercial |
$21,087.37
|
Rate for Payer: Anthem Medicaid |
$9,418.11
|
Rate for Payer: Anthem POS/PPO/Traditional |
$21,361.24
|
Rate for Payer: Cash Price |
$13,693.10
|
Rate for Payer: Cigna Commercial |
$22,730.55
|
Rate for Payer: First Health Commercial |
$26,016.89
|
Rate for Payer: Humana Commercial |
$23,278.27
|
Rate for Payer: Humana KY Medicaid |
$9,418.11
|
Rate for Payer: Kentucky WC Medicaid |
$9,513.97
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$22,456.68
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,211.02
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$8,215.86
|
Rate for Payer: Molina Healthcare Medicaid |
$9,607.08
|
Rate for Payer: Ohio Health Choice Commercial |
$24,099.86
|
Rate for Payer: Ohio Health Group HMO |
$20,539.65
|
Rate for Payer: Ohio Health Group PPO Differential |
$5,477.24
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3,560.21
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,489.72
|
Rate for Payer: PHCS Commercial |
$26,290.75
|
Rate for Payer: United Healthcare All Payer |
$24,099.86
|
|
COMPR SRS 70MM DST HML BDY RT
|
Facility
|
IP
|
$27,386.20
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,560.21 |
Max. Negotiated Rate |
$26,290.75 |
Rate for Payer: Aetna Commercial |
$21,087.37
|
Rate for Payer: Anthem POS/PPO/Traditional |
$21,361.24
|
Rate for Payer: Cash Price |
$13,693.10
|
Rate for Payer: Cigna Commercial |
$22,730.55
|
Rate for Payer: First Health Commercial |
$26,016.89
|
Rate for Payer: Humana Commercial |
$23,278.27
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$22,456.68
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,211.02
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$8,215.86
|
Rate for Payer: Ohio Health Choice Commercial |
$24,099.86
|
Rate for Payer: Ohio Health Group HMO |
$20,539.65
|
Rate for Payer: Ohio Health Group PPO Differential |
$5,477.24
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3,560.21
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,489.72
|
Rate for Payer: PHCS Commercial |
$26,290.75
|
Rate for Payer: United Healthcare All Payer |
$24,099.86
|
|
COMPR SRS ANTI ROT IC SEG 30MM
|
Facility
|
OP
|
$36,777.65
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4,781.09 |
Max. Negotiated Rate |
$35,306.54 |
Rate for Payer: Aetna Commercial |
$28,318.79
|
Rate for Payer: Anthem Medicaid |
$12,647.83
|
Rate for Payer: Anthem POS/PPO/Traditional |
$28,686.57
|
Rate for Payer: Cash Price |
$18,388.82
|
Rate for Payer: Cigna Commercial |
$30,525.45
|
Rate for Payer: First Health Commercial |
$34,938.77
|
Rate for Payer: Humana Commercial |
$31,261.00
|
Rate for Payer: Humana KY Medicaid |
$12,647.83
|
Rate for Payer: Kentucky WC Medicaid |
$12,776.56
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$30,157.67
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,141.91
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$11,033.30
|
Rate for Payer: Molina Healthcare Medicaid |
$12,901.60
|
Rate for Payer: Ohio Health Choice Commercial |
$32,364.33
|
Rate for Payer: Ohio Health Group HMO |
$27,583.24
|
Rate for Payer: Ohio Health Group PPO Differential |
$7,355.53
|
Rate for Payer: Ohio Health Group PPO No Differential |
$4,781.09
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,401.07
|
Rate for Payer: PHCS Commercial |
$35,306.54
|
Rate for Payer: United Healthcare All Payer |
$32,364.33
|
|
COMPR SRS ANTI ROT IC SEG 30MM
|
Facility
|
IP
|
$36,777.65
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4,781.09 |
Max. Negotiated Rate |
$35,306.54 |
Rate for Payer: Aetna Commercial |
$28,318.79
|
Rate for Payer: Anthem POS/PPO/Traditional |
$28,686.57
|
Rate for Payer: Cash Price |
$18,388.82
|
Rate for Payer: Cigna Commercial |
$30,525.45
|
Rate for Payer: First Health Commercial |
$34,938.77
|
Rate for Payer: Humana Commercial |
$31,261.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$30,157.67
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,141.91
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$11,033.30
|
Rate for Payer: Ohio Health Choice Commercial |
$32,364.33
|
Rate for Payer: Ohio Health Group HMO |
$27,583.24
|
Rate for Payer: Ohio Health Group PPO Differential |
$7,355.53
|
Rate for Payer: Ohio Health Group PPO No Differential |
$4,781.09
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,401.07
|
Rate for Payer: PHCS Commercial |
$35,306.54
|
Rate for Payer: United Healthcare All Payer |
$32,364.33
|
|
COMPR SRS EAS HMRL HEAD 40*15
|
Facility
|
OP
|
$14,228.10
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,849.65 |
Max. Negotiated Rate |
$13,658.98 |
Rate for Payer: Aetna Commercial |
$10,955.64
|
Rate for Payer: Anthem Medicaid |
$4,893.04
|
Rate for Payer: Anthem POS/PPO/Traditional |
$11,097.92
|
Rate for Payer: Cash Price |
$7,114.05
|
Rate for Payer: Cigna Commercial |
$11,809.32
|
Rate for Payer: First Health Commercial |
$13,516.70
|
Rate for Payer: Humana Commercial |
$12,093.88
|
Rate for Payer: Humana KY Medicaid |
$4,893.04
|
Rate for Payer: Kentucky WC Medicaid |
$4,942.84
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$11,667.04
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,500.34
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$4,268.43
|
Rate for Payer: Molina Healthcare Medicaid |
$4,991.22
|
Rate for Payer: Ohio Health Choice Commercial |
$12,520.73
|
Rate for Payer: Ohio Health Group HMO |
$10,671.08
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,845.62
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,849.65
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,410.71
|
Rate for Payer: PHCS Commercial |
$13,658.98
|
Rate for Payer: United Healthcare All Payer |
$12,520.73
|
|
COMPR SRS EAS HMRL HEAD 40*15
|
Facility
|
IP
|
$14,228.10
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,849.65 |
Max. Negotiated Rate |
$13,658.98 |
Rate for Payer: Aetna Commercial |
$10,955.64
|
Rate for Payer: Anthem POS/PPO/Traditional |
$11,097.92
|
Rate for Payer: Cash Price |
$7,114.05
|
Rate for Payer: Cigna Commercial |
$11,809.32
|
Rate for Payer: First Health Commercial |
$13,516.70
|
Rate for Payer: Humana Commercial |
$12,093.88
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$11,667.04
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,500.34
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$4,268.43
|
Rate for Payer: Ohio Health Choice Commercial |
$12,520.73
|
Rate for Payer: Ohio Health Group HMO |
$10,671.08
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,845.62
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,849.65
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,410.71
|
Rate for Payer: PHCS Commercial |
$13,658.98
|
Rate for Payer: United Healthcare All Payer |
$12,520.73
|
|
COMPR SRS EAS HMRL HEAD 44*17
|
Facility
|
IP
|
$14,228.10
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,849.65 |
Max. Negotiated Rate |
$13,658.98 |
Rate for Payer: Aetna Commercial |
$10,955.64
|
Rate for Payer: Anthem POS/PPO/Traditional |
$11,097.92
|
Rate for Payer: Cash Price |
$7,114.05
|
Rate for Payer: Cigna Commercial |
$11,809.32
|
Rate for Payer: First Health Commercial |
$13,516.70
|
Rate for Payer: Humana Commercial |
$12,093.88
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$11,667.04
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,500.34
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$4,268.43
|
Rate for Payer: Ohio Health Choice Commercial |
$12,520.73
|
Rate for Payer: Ohio Health Group HMO |
$10,671.08
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,845.62
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,849.65
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,410.71
|
Rate for Payer: PHCS Commercial |
$13,658.98
|
Rate for Payer: United Healthcare All Payer |
$12,520.73
|
|
COMPR SRS EAS HMRL HEAD 44*17
|
Facility
|
OP
|
$14,228.10
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,849.65 |
Max. Negotiated Rate |
$13,658.98 |
Rate for Payer: Aetna Commercial |
$10,955.64
|
Rate for Payer: Anthem Medicaid |
$4,893.04
|
Rate for Payer: Anthem POS/PPO/Traditional |
$11,097.92
|
Rate for Payer: Cash Price |
$7,114.05
|
Rate for Payer: Cigna Commercial |
$11,809.32
|
Rate for Payer: First Health Commercial |
$13,516.70
|
Rate for Payer: Humana Commercial |
$12,093.88
|
Rate for Payer: Humana KY Medicaid |
$4,893.04
|
Rate for Payer: Kentucky WC Medicaid |
$4,942.84
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$11,667.04
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,500.34
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$4,268.43
|
Rate for Payer: Molina Healthcare Medicaid |
$4,991.22
|
Rate for Payer: Ohio Health Choice Commercial |
$12,520.73
|
Rate for Payer: Ohio Health Group HMO |
$10,671.08
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,845.62
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,849.65
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,410.71
|
Rate for Payer: PHCS Commercial |
$13,658.98
|
Rate for Payer: United Healthcare All Payer |
$12,520.73
|
|
COMPR SRS EAS HMRL HEAD 48*19
|
Facility
|
IP
|
$14,228.10
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,849.65 |
Max. Negotiated Rate |
$13,658.98 |
Rate for Payer: Aetna Commercial |
$10,955.64
|
Rate for Payer: Anthem POS/PPO/Traditional |
$11,097.92
|
Rate for Payer: Cash Price |
$7,114.05
|
Rate for Payer: Cigna Commercial |
$11,809.32
|
Rate for Payer: First Health Commercial |
$13,516.70
|
Rate for Payer: Humana Commercial |
$12,093.88
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$11,667.04
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,500.34
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$4,268.43
|
Rate for Payer: Ohio Health Choice Commercial |
$12,520.73
|
Rate for Payer: Ohio Health Group HMO |
$10,671.08
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,845.62
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,849.65
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,410.71
|
Rate for Payer: PHCS Commercial |
$13,658.98
|
Rate for Payer: United Healthcare All Payer |
$12,520.73
|
|
COMPR SRS EAS HMRL HEAD 48*19
|
Facility
|
OP
|
$14,228.10
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,849.65 |
Max. Negotiated Rate |
$13,658.98 |
Rate for Payer: Aetna Commercial |
$10,955.64
|
Rate for Payer: Anthem Medicaid |
$4,893.04
|
Rate for Payer: Anthem POS/PPO/Traditional |
$11,097.92
|
Rate for Payer: Cash Price |
$7,114.05
|
Rate for Payer: Cigna Commercial |
$11,809.32
|
Rate for Payer: First Health Commercial |
$13,516.70
|
Rate for Payer: Humana Commercial |
$12,093.88
|
Rate for Payer: Humana KY Medicaid |
$4,893.04
|
Rate for Payer: Kentucky WC Medicaid |
$4,942.84
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$11,667.04
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,500.34
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$4,268.43
|
Rate for Payer: Molina Healthcare Medicaid |
$4,991.22
|
Rate for Payer: Ohio Health Choice Commercial |
$12,520.73
|
Rate for Payer: Ohio Health Group HMO |
$10,671.08
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,845.62
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,849.65
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,410.71
|
Rate for Payer: PHCS Commercial |
$13,658.98
|
Rate for Payer: United Healthcare All Payer |
$12,520.73
|
|
COMPR SRS EAS HMRL HEAD 54*22
|
Facility
|
OP
|
$14,228.10
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,849.65 |
Max. Negotiated Rate |
$13,658.98 |
Rate for Payer: Aetna Commercial |
$10,955.64
|
Rate for Payer: Anthem Medicaid |
$4,893.04
|
Rate for Payer: Anthem POS/PPO/Traditional |
$11,097.92
|
Rate for Payer: Cash Price |
$7,114.05
|
Rate for Payer: Cigna Commercial |
$11,809.32
|
Rate for Payer: First Health Commercial |
$13,516.70
|
Rate for Payer: Humana Commercial |
$12,093.88
|
Rate for Payer: Humana KY Medicaid |
$4,893.04
|
Rate for Payer: Kentucky WC Medicaid |
$4,942.84
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$11,667.04
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,500.34
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$4,268.43
|
Rate for Payer: Molina Healthcare Medicaid |
$4,991.22
|
Rate for Payer: Ohio Health Choice Commercial |
$12,520.73
|
Rate for Payer: Ohio Health Group HMO |
$10,671.08
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,845.62
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,849.65
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,410.71
|
Rate for Payer: PHCS Commercial |
$13,658.98
|
Rate for Payer: United Healthcare All Payer |
$12,520.73
|
|
COMPR SRS EAS HMRL HEAD 54*22
|
Facility
|
IP
|
$14,228.10
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,849.65 |
Max. Negotiated Rate |
$13,658.98 |
Rate for Payer: Aetna Commercial |
$10,955.64
|
Rate for Payer: Anthem POS/PPO/Traditional |
$11,097.92
|
Rate for Payer: Cash Price |
$7,114.05
|
Rate for Payer: Cigna Commercial |
$11,809.32
|
Rate for Payer: First Health Commercial |
$13,516.70
|
Rate for Payer: Humana Commercial |
$12,093.88
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$11,667.04
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,500.34
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$4,268.43
|
Rate for Payer: Ohio Health Choice Commercial |
$12,520.73
|
Rate for Payer: Ohio Health Group HMO |
$10,671.08
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,845.62
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,849.65
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,410.71
|
Rate for Payer: PHCS Commercial |
$13,658.98
|
Rate for Payer: United Healthcare All Payer |
$12,520.73
|
|
COMPR SRS HUMERAL COUPLER
|
Facility
|
IP
|
$66,018.40
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$8,582.39 |
Max. Negotiated Rate |
$63,377.66 |
Rate for Payer: Aetna Commercial |
$50,834.17
|
Rate for Payer: Anthem POS/PPO/Traditional |
$51,494.35
|
Rate for Payer: Cash Price |
$33,009.20
|
Rate for Payer: Cigna Commercial |
$54,795.27
|
Rate for Payer: First Health Commercial |
$62,717.48
|
Rate for Payer: Humana Commercial |
$56,115.64
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$54,135.09
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48,721.58
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$19,805.52
|
Rate for Payer: Ohio Health Choice Commercial |
$58,096.19
|
Rate for Payer: Ohio Health Group HMO |
$49,513.80
|
Rate for Payer: Ohio Health Group PPO Differential |
$13,203.68
|
Rate for Payer: Ohio Health Group PPO No Differential |
$8,582.39
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,465.70
|
Rate for Payer: PHCS Commercial |
$63,377.66
|
Rate for Payer: United Healthcare All Payer |
$58,096.19
|
|
COMPR SRS HUMERAL COUPLER
|
Facility
|
OP
|
$66,018.40
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$8,582.39 |
Max. Negotiated Rate |
$63,377.66 |
Rate for Payer: Aetna Commercial |
$50,834.17
|
Rate for Payer: Anthem Medicaid |
$22,703.73
|
Rate for Payer: Anthem POS/PPO/Traditional |
$51,494.35
|
Rate for Payer: Cash Price |
$33,009.20
|
Rate for Payer: Cigna Commercial |
$54,795.27
|
Rate for Payer: First Health Commercial |
$62,717.48
|
Rate for Payer: Humana Commercial |
$56,115.64
|
Rate for Payer: Humana KY Medicaid |
$22,703.73
|
Rate for Payer: Kentucky WC Medicaid |
$22,934.79
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$54,135.09
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48,721.58
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$19,805.52
|
Rate for Payer: Molina Healthcare Medicaid |
$23,159.25
|
Rate for Payer: Ohio Health Choice Commercial |
$58,096.19
|
Rate for Payer: Ohio Health Group HMO |
$49,513.80
|
Rate for Payer: Ohio Health Group PPO Differential |
$13,203.68
|
Rate for Payer: Ohio Health Group PPO No Differential |
$8,582.39
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,465.70
|
Rate for Payer: PHCS Commercial |
$63,377.66
|
Rate for Payer: United Healthcare All Payer |
$58,096.19
|
|