|
COMPR SRS MOD STEM 16*75MM
|
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 16*75MM
|
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 18*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 18*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 18*75MM
|
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 18*75MM
|
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 20*75MM
|
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 20*75MM
|
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 4*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 4*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 6*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 6*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 6*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 6*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 6*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: 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 6*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 6*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 6*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 8*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 8*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 8*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 8*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 8*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 8*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 8*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
|
|
