|
COMPR SRS IC SEG 120MM
|
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 IC SEG 120MM
|
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 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 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 IC SEG 60MM
|
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 IC SEG 60MM
|
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 IC SEG 90MM
|
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 IC SEG 90MM
|
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 LARGE FLANGE
|
Facility
|
OP
|
$6,519.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$847.52 |
| Max. Negotiated Rate |
$6,258.58 |
| Rate for Payer: Aetna Commercial |
$5,019.90
|
| Rate for Payer: Anthem Medicaid |
$2,242.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,085.09
|
| Rate for Payer: Cash Price |
$3,259.68
|
| Rate for Payer: Cigna Commercial |
$5,411.06
|
| Rate for Payer: First Health Commercial |
$6,193.38
|
| Rate for Payer: Humana Commercial |
$5,541.45
|
| Rate for Payer: Humana KY Medicaid |
$2,242.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,264.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,345.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,811.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,955.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,286.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,737.03
|
| Rate for Payer: Ohio Health Group HMO |
$4,889.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,303.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$847.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,021.00
|
| Rate for Payer: PHCS Commercial |
$6,258.58
|
| Rate for Payer: United Healthcare All Payer |
$5,737.03
|
|
|
COMPR SRS LARGE FLANGE
|
Facility
|
IP
|
$6,519.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$847.52 |
| Max. Negotiated Rate |
$6,258.58 |
| Rate for Payer: Aetna Commercial |
$5,019.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,085.09
|
| Rate for Payer: Cash Price |
$3,259.68
|
| Rate for Payer: Cigna Commercial |
$5,411.06
|
| Rate for Payer: First Health Commercial |
$6,193.38
|
| Rate for Payer: Humana Commercial |
$5,541.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,345.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,811.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,955.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,737.03
|
| Rate for Payer: Ohio Health Group HMO |
$4,889.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,303.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$847.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,021.00
|
| Rate for Payer: PHCS Commercial |
$6,258.58
|
| Rate for Payer: United Healthcare All Payer |
$5,737.03
|
|
|
COMPR SRS MOD RGX AUG LG
|
Facility
|
OP
|
$22,071.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,869.33 |
| Max. Negotiated Rate |
$21,188.93 |
| Rate for Payer: Aetna Commercial |
$16,995.29
|
| Rate for Payer: Anthem Medicaid |
$7,590.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,216.00
|
| Rate for Payer: Cash Price |
$11,035.90
|
| Rate for Payer: Cigna Commercial |
$18,319.59
|
| Rate for Payer: First Health Commercial |
$20,968.21
|
| Rate for Payer: Humana Commercial |
$18,761.03
|
| Rate for Payer: Humana KY Medicaid |
$7,590.49
|
| Rate for Payer: Kentucky WC Medicaid |
$7,667.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,098.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,288.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,621.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,742.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,423.18
|
| Rate for Payer: Ohio Health Group HMO |
$16,553.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,414.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,869.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,842.26
|
| Rate for Payer: PHCS Commercial |
$21,188.93
|
| Rate for Payer: United Healthcare All Payer |
$19,423.18
|
|
|
COMPR SRS MOD RGX AUG LG
|
Facility
|
IP
|
$22,071.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,869.33 |
| Max. Negotiated Rate |
$21,188.93 |
| Rate for Payer: Aetna Commercial |
$16,995.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,216.00
|
| Rate for Payer: Cash Price |
$11,035.90
|
| Rate for Payer: Cigna Commercial |
$18,319.59
|
| Rate for Payer: First Health Commercial |
$20,968.21
|
| Rate for Payer: Humana Commercial |
$18,761.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,098.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,288.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,621.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,423.18
|
| Rate for Payer: Ohio Health Group HMO |
$16,553.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,414.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,869.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,842.26
|
| Rate for Payer: PHCS Commercial |
$21,188.93
|
| Rate for Payer: United Healthcare All Payer |
$19,423.18
|
|
|
COMPR SRS MOD RGX AUG SM
|
Facility
|
OP
|
$22,071.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,869.33 |
| Max. Negotiated Rate |
$21,188.93 |
| Rate for Payer: Aetna Commercial |
$16,995.29
|
| Rate for Payer: Anthem Medicaid |
$7,590.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,216.00
|
| Rate for Payer: Cash Price |
$11,035.90
|
| Rate for Payer: Cigna Commercial |
$18,319.59
|
| Rate for Payer: First Health Commercial |
$20,968.21
|
| Rate for Payer: Humana Commercial |
$18,761.03
|
| Rate for Payer: Humana KY Medicaid |
$7,590.49
|
| Rate for Payer: Kentucky WC Medicaid |
$7,667.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,098.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,288.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,621.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,742.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,423.18
|
| Rate for Payer: Ohio Health Group HMO |
$16,553.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,414.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,869.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,842.26
|
| Rate for Payer: PHCS Commercial |
$21,188.93
|
| Rate for Payer: United Healthcare All Payer |
$19,423.18
|
|
|
COMPR SRS MOD RGX AUG SM
|
Facility
|
IP
|
$22,071.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,869.33 |
| Max. Negotiated Rate |
$21,188.93 |
| Rate for Payer: Aetna Commercial |
$16,995.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,216.00
|
| Rate for Payer: Cash Price |
$11,035.90
|
| Rate for Payer: Cigna Commercial |
$18,319.59
|
| Rate for Payer: First Health Commercial |
$20,968.21
|
| Rate for Payer: Humana Commercial |
$18,761.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,098.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,288.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,621.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,423.18
|
| Rate for Payer: Ohio Health Group HMO |
$16,553.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,414.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,869.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,842.26
|
| Rate for Payer: PHCS Commercial |
$21,188.93
|
| Rate for Payer: United Healthcare All Payer |
$19,423.18
|
|
|
COMPR SRS MOD STEM 10*100
|
Facility
|
IP
|
$21,969.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,856.05 |
| Max. Negotiated Rate |
$21,090.82 |
| Rate for Payer: Aetna Commercial |
$16,916.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,136.29
|
| Rate for Payer: Cash Price |
$10,984.80
|
| Rate for Payer: Cigna Commercial |
$18,234.77
|
| Rate for Payer: First Health Commercial |
$20,871.12
|
| Rate for Payer: Humana Commercial |
$18,674.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,015.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,213.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,590.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,333.25
|
| Rate for Payer: Ohio Health Group HMO |
$16,477.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,393.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,856.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,810.58
|
| Rate for Payer: PHCS Commercial |
$21,090.82
|
| Rate for Payer: United Healthcare All Payer |
$19,333.25
|
|
|
COMPR SRS MOD STEM 10*100
|
Facility
|
OP
|
$21,969.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,856.05 |
| Max. Negotiated Rate |
$21,090.82 |
| Rate for Payer: Aetna Commercial |
$16,916.59
|
| Rate for Payer: Anthem Medicaid |
$7,555.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,136.29
|
| Rate for Payer: Cash Price |
$10,984.80
|
| Rate for Payer: Cigna Commercial |
$18,234.77
|
| Rate for Payer: First Health Commercial |
$20,871.12
|
| Rate for Payer: Humana Commercial |
$18,674.16
|
| Rate for Payer: Humana KY Medicaid |
$7,555.35
|
| Rate for Payer: Kentucky WC Medicaid |
$7,632.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,015.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,213.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,590.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,706.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,333.25
|
| Rate for Payer: Ohio Health Group HMO |
$16,477.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,393.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,856.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,810.58
|
| Rate for Payer: PHCS Commercial |
$21,090.82
|
| Rate for Payer: United Healthcare All Payer |
$19,333.25
|
|
|
COMPR SRS MOD STEM 10*150
|
Facility
|
IP
|
$21,969.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,856.05 |
| Max. Negotiated Rate |
$21,090.82 |
| Rate for Payer: Aetna Commercial |
$16,916.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,136.29
|
| Rate for Payer: Cash Price |
$10,984.80
|
| Rate for Payer: Cigna Commercial |
$18,234.77
|
| Rate for Payer: First Health Commercial |
$20,871.12
|
| Rate for Payer: Humana Commercial |
$18,674.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,015.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,213.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,590.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,333.25
|
| Rate for Payer: Ohio Health Group HMO |
$16,477.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,393.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,856.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,810.58
|
| Rate for Payer: PHCS Commercial |
$21,090.82
|
| Rate for Payer: United Healthcare All Payer |
$19,333.25
|
|
|
COMPR SRS MOD STEM 10*150
|
Facility
|
OP
|
$21,969.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,856.05 |
| Max. Negotiated Rate |
$21,090.82 |
| Rate for Payer: Aetna Commercial |
$16,916.59
|
| Rate for Payer: Anthem Medicaid |
$7,555.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,136.29
|
| Rate for Payer: Cash Price |
$10,984.80
|
| Rate for Payer: Cigna Commercial |
$18,234.77
|
| Rate for Payer: First Health Commercial |
$20,871.12
|
| Rate for Payer: Humana Commercial |
$18,674.16
|
| Rate for Payer: Humana KY Medicaid |
$7,555.35
|
| Rate for Payer: Kentucky WC Medicaid |
$7,632.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,015.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,213.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,590.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,706.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,333.25
|
| Rate for Payer: Ohio Health Group HMO |
$16,477.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,393.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,856.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,810.58
|
| Rate for Payer: PHCS Commercial |
$21,090.82
|
| Rate for Payer: United Healthcare All Payer |
$19,333.25
|
|
|
COMPR SRS MOD STEM 10*200
|
Facility
|
OP
|
$21,969.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,856.05 |
| Max. Negotiated Rate |
$21,090.82 |
| Rate for Payer: Cigna Commercial |
$18,234.77
|
| Rate for Payer: Aetna Commercial |
$16,916.59
|
| Rate for Payer: Anthem Medicaid |
$7,555.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,136.29
|
| Rate for Payer: Cash Price |
$10,984.80
|
| Rate for Payer: First Health Commercial |
$20,871.12
|
| Rate for Payer: Humana Commercial |
$18,674.16
|
| Rate for Payer: Humana KY Medicaid |
$7,555.35
|
| Rate for Payer: Kentucky WC Medicaid |
$7,632.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,015.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,213.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,590.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,706.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,333.25
|
| Rate for Payer: Ohio Health Group HMO |
$16,477.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,393.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,856.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,810.58
|
| Rate for Payer: PHCS Commercial |
$21,090.82
|
| Rate for Payer: United Healthcare All Payer |
$19,333.25
|
|
|
COMPR SRS MOD STEM 10*200
|
Facility
|
IP
|
$21,969.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,856.05 |
| Max. Negotiated Rate |
$21,090.82 |
| Rate for Payer: Aetna Commercial |
$16,916.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,136.29
|
| Rate for Payer: Cash Price |
$10,984.80
|
| Rate for Payer: Cigna Commercial |
$18,234.77
|
| Rate for Payer: First Health Commercial |
$20,871.12
|
| Rate for Payer: Humana Commercial |
$18,674.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,015.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,213.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,590.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,333.25
|
| Rate for Payer: Ohio Health Group HMO |
$16,477.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,393.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,856.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,810.58
|
| Rate for Payer: PHCS Commercial |
$21,090.82
|
| Rate for Payer: United Healthcare All Payer |
$19,333.25
|
|
|
COMPR SRS MOD STEM 10*75
|
Facility
|
OP
|
$21,969.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,856.05 |
| Max. Negotiated Rate |
$21,090.82 |
| Rate for Payer: Aetna Commercial |
$16,916.59
|
| Rate for Payer: Anthem Medicaid |
$7,555.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,136.29
|
| Rate for Payer: Cash Price |
$10,984.80
|
| Rate for Payer: Cigna Commercial |
$18,234.77
|
| Rate for Payer: First Health Commercial |
$20,871.12
|
| Rate for Payer: Humana Commercial |
$18,674.16
|
| Rate for Payer: Humana KY Medicaid |
$7,555.35
|
| Rate for Payer: Kentucky WC Medicaid |
$7,632.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,015.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,213.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,590.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,706.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,333.25
|
| Rate for Payer: Ohio Health Group HMO |
$16,477.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,393.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,856.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,810.58
|
| Rate for Payer: PHCS Commercial |
$21,090.82
|
| Rate for Payer: United Healthcare All Payer |
$19,333.25
|
|
|
COMPR SRS MOD STEM 10*75
|
Facility
|
IP
|
$21,969.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,856.05 |
| Max. Negotiated Rate |
$21,090.82 |
| Rate for Payer: Aetna Commercial |
$16,916.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,136.29
|
| Rate for Payer: Cash Price |
$10,984.80
|
| Rate for Payer: Cigna Commercial |
$18,234.77
|
| Rate for Payer: First Health Commercial |
$20,871.12
|
| Rate for Payer: Humana Commercial |
$18,674.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,015.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,213.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,590.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,333.25
|
| Rate for Payer: Ohio Health Group HMO |
$16,477.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,393.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,856.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,810.58
|
| Rate for Payer: PHCS Commercial |
$21,090.82
|
| Rate for Payer: United Healthcare All Payer |
$19,333.25
|
|
|
COMPR SRS MOD STEM 11*100MM
|
Facility
|
OP
|
$21,969.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,856.05 |
| Max. Negotiated Rate |
$21,090.82 |
| Rate for Payer: Aetna Commercial |
$16,916.59
|
| Rate for Payer: Anthem Medicaid |
$7,555.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,136.29
|
| Rate for Payer: Cash Price |
$10,984.80
|
| Rate for Payer: Cigna Commercial |
$18,234.77
|
| Rate for Payer: First Health Commercial |
$20,871.12
|
| Rate for Payer: Humana Commercial |
$18,674.16
|
| Rate for Payer: Humana KY Medicaid |
$7,555.35
|
| Rate for Payer: Kentucky WC Medicaid |
$7,632.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,015.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,213.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,590.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,706.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,333.25
|
| Rate for Payer: Ohio Health Group HMO |
$16,477.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,393.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,856.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,810.58
|
| Rate for Payer: PHCS Commercial |
$21,090.82
|
| Rate for Payer: United Healthcare All Payer |
$19,333.25
|
|
|
COMPR SRS MOD STEM 11*100MM
|
Facility
|
IP
|
$21,969.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,856.05 |
| Max. Negotiated Rate |
$21,090.82 |
| Rate for Payer: Aetna Commercial |
$16,916.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,136.29
|
| Rate for Payer: Cash Price |
$10,984.80
|
| Rate for Payer: Cigna Commercial |
$18,234.77
|
| Rate for Payer: First Health Commercial |
$20,871.12
|
| Rate for Payer: Humana Commercial |
$18,674.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,015.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,213.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,590.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,333.25
|
| Rate for Payer: Ohio Health Group HMO |
$16,477.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,393.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,856.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,810.58
|
| Rate for Payer: PHCS Commercial |
$21,090.82
|
| Rate for Payer: United Healthcare All Payer |
$19,333.25
|
|
|
COMPR SRS MOD STEM 11*150MM
|
Facility
|
IP
|
$21,969.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,856.05 |
| Max. Negotiated Rate |
$21,090.82 |
| Rate for Payer: Aetna Commercial |
$16,916.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,136.29
|
| Rate for Payer: Cash Price |
$10,984.80
|
| Rate for Payer: Cigna Commercial |
$18,234.77
|
| Rate for Payer: First Health Commercial |
$20,871.12
|
| Rate for Payer: Humana Commercial |
$18,674.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,015.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,213.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,590.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,333.25
|
| Rate for Payer: Ohio Health Group HMO |
$16,477.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,393.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,856.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,810.58
|
| Rate for Payer: PHCS Commercial |
$21,090.82
|
| Rate for Payer: United Healthcare All Payer |
$19,333.25
|
|
