|
COMPR SRS MOD STEM 8*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 9*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 9*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 9*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
|
|
|
COMPR SRS MOD STEM 9*150MM
|
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 9*200MM
|
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 9*200MM
|
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 9*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 9*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 PROX BODY LG 42MM
|
Facility
|
OP
|
$26,455.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,439.21 |
| Max. Negotiated Rate |
$25,397.23 |
| Rate for Payer: Aetna Commercial |
$20,370.70
|
| Rate for Payer: Anthem Medicaid |
$9,098.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,635.25
|
| Rate for Payer: Cash Price |
$13,227.73
|
| Rate for Payer: Cigna Commercial |
$21,958.02
|
| Rate for Payer: First Health Commercial |
$25,132.68
|
| Rate for Payer: Humana Commercial |
$22,487.13
|
| Rate for Payer: Humana KY Medicaid |
$9,098.03
|
| Rate for Payer: Kentucky WC Medicaid |
$9,190.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,693.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,524.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,936.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,280.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,280.80
|
| Rate for Payer: Ohio Health Group HMO |
$19,841.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,291.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,439.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,201.19
|
| Rate for Payer: PHCS Commercial |
$25,397.23
|
| Rate for Payer: United Healthcare All Payer |
$23,280.80
|
|
|
COMPR SRS PROX BODY LG 42MM
|
Facility
|
IP
|
$26,455.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,439.21 |
| Max. Negotiated Rate |
$25,397.23 |
| Rate for Payer: Aetna Commercial |
$20,370.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,635.25
|
| Rate for Payer: Cash Price |
$13,227.73
|
| Rate for Payer: Cigna Commercial |
$21,958.02
|
| Rate for Payer: First Health Commercial |
$25,132.68
|
| Rate for Payer: Humana Commercial |
$22,487.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,693.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,524.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,936.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,280.80
|
| Rate for Payer: Ohio Health Group HMO |
$19,841.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,291.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,439.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,201.19
|
| Rate for Payer: PHCS Commercial |
$25,397.23
|
| Rate for Payer: United Healthcare All Payer |
$23,280.80
|
|
|
COMPR SRS PROX BODY LG 52MM
|
Facility
|
IP
|
$26,455.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,439.21 |
| Max. Negotiated Rate |
$25,397.23 |
| Rate for Payer: Aetna Commercial |
$20,370.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,635.25
|
| Rate for Payer: Cash Price |
$13,227.73
|
| Rate for Payer: Cigna Commercial |
$21,958.02
|
| Rate for Payer: First Health Commercial |
$25,132.68
|
| Rate for Payer: Humana Commercial |
$22,487.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,693.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,524.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,936.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,280.80
|
| Rate for Payer: Ohio Health Group HMO |
$19,841.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,291.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,439.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,201.19
|
| Rate for Payer: PHCS Commercial |
$25,397.23
|
| Rate for Payer: United Healthcare All Payer |
$23,280.80
|
|
|
COMPR SRS PROX BODY LG 52MM
|
Facility
|
OP
|
$26,455.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,439.21 |
| Max. Negotiated Rate |
$25,397.23 |
| Rate for Payer: Aetna Commercial |
$20,370.70
|
| Rate for Payer: Anthem Medicaid |
$9,098.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,635.25
|
| Rate for Payer: Cash Price |
$13,227.73
|
| Rate for Payer: Cigna Commercial |
$21,958.02
|
| Rate for Payer: First Health Commercial |
$25,132.68
|
| Rate for Payer: Humana Commercial |
$22,487.13
|
| Rate for Payer: Humana KY Medicaid |
$9,098.03
|
| Rate for Payer: Kentucky WC Medicaid |
$9,190.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,693.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,524.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,936.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,280.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,280.80
|
| Rate for Payer: Ohio Health Group HMO |
$19,841.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,291.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,439.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,201.19
|
| Rate for Payer: PHCS Commercial |
$25,397.23
|
| Rate for Payer: United Healthcare All Payer |
$23,280.80
|
|
|
COMPR SRS PROX BODY LG 62MM
|
Facility
|
IP
|
$26,455.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,439.21 |
| Max. Negotiated Rate |
$25,397.23 |
| Rate for Payer: Aetna Commercial |
$20,370.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,635.25
|
| Rate for Payer: Cash Price |
$13,227.73
|
| Rate for Payer: Cigna Commercial |
$21,958.02
|
| Rate for Payer: First Health Commercial |
$25,132.68
|
| Rate for Payer: Humana Commercial |
$22,487.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,693.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,524.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,936.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,280.80
|
| Rate for Payer: Ohio Health Group HMO |
$19,841.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,291.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,439.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,201.19
|
| Rate for Payer: PHCS Commercial |
$25,397.23
|
| Rate for Payer: United Healthcare All Payer |
$23,280.80
|
|
|
COMPR SRS PROX BODY LG 62MM
|
Facility
|
OP
|
$26,455.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,439.21 |
| Max. Negotiated Rate |
$25,397.23 |
| Rate for Payer: Aetna Commercial |
$20,370.70
|
| Rate for Payer: Anthem Medicaid |
$9,098.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,635.25
|
| Rate for Payer: Cash Price |
$13,227.73
|
| Rate for Payer: Cigna Commercial |
$21,958.02
|
| Rate for Payer: First Health Commercial |
$25,132.68
|
| Rate for Payer: Humana Commercial |
$22,487.13
|
| Rate for Payer: Humana KY Medicaid |
$9,098.03
|
| Rate for Payer: Kentucky WC Medicaid |
$9,190.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,693.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,524.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,936.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,280.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,280.80
|
| Rate for Payer: Ohio Health Group HMO |
$19,841.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,291.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,439.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,201.19
|
| Rate for Payer: PHCS Commercial |
$25,397.23
|
| Rate for Payer: United Healthcare All Payer |
$23,280.80
|
|
|
COMPR SRS PROX BODY SM 48MM
|
Facility
|
IP
|
$26,455.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,439.21 |
| Max. Negotiated Rate |
$25,397.23 |
| Rate for Payer: Aetna Commercial |
$20,370.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,635.25
|
| Rate for Payer: Cash Price |
$13,227.73
|
| Rate for Payer: Cigna Commercial |
$21,958.02
|
| Rate for Payer: First Health Commercial |
$25,132.68
|
| Rate for Payer: Humana Commercial |
$22,487.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,693.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,524.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,936.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,280.80
|
| Rate for Payer: Ohio Health Group HMO |
$19,841.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,291.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,439.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,201.19
|
| Rate for Payer: PHCS Commercial |
$25,397.23
|
| Rate for Payer: United Healthcare All Payer |
$23,280.80
|
|
|
COMPR SRS PROX BODY SM 48MM
|
Facility
|
OP
|
$26,455.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,439.21 |
| Max. Negotiated Rate |
$25,397.23 |
| Rate for Payer: Cigna Commercial |
$21,958.02
|
| Rate for Payer: Aetna Commercial |
$20,370.70
|
| Rate for Payer: Anthem Medicaid |
$9,098.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,635.25
|
| Rate for Payer: Cash Price |
$13,227.73
|
| Rate for Payer: First Health Commercial |
$25,132.68
|
| Rate for Payer: Humana Commercial |
$22,487.13
|
| Rate for Payer: Humana KY Medicaid |
$9,098.03
|
| Rate for Payer: Kentucky WC Medicaid |
$9,190.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,693.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,524.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,936.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,280.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,280.80
|
| Rate for Payer: Ohio Health Group HMO |
$19,841.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,291.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,439.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,201.19
|
| Rate for Payer: PHCS Commercial |
$25,397.23
|
| Rate for Payer: United Healthcare All Payer |
$23,280.80
|
|
|
COMPR SRS PROX BODY SM 58MM
|
Facility
|
IP
|
$26,455.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,439.21 |
| Max. Negotiated Rate |
$25,397.23 |
| Rate for Payer: Aetna Commercial |
$20,370.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,635.25
|
| Rate for Payer: Cash Price |
$13,227.73
|
| Rate for Payer: Cigna Commercial |
$21,958.02
|
| Rate for Payer: First Health Commercial |
$25,132.68
|
| Rate for Payer: Humana Commercial |
$22,487.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,693.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,524.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,936.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,280.80
|
| Rate for Payer: Ohio Health Group HMO |
$19,841.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,291.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,439.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,201.19
|
| Rate for Payer: PHCS Commercial |
$25,397.23
|
| Rate for Payer: United Healthcare All Payer |
$23,280.80
|
|
|
COMPR SRS PROX BODY SM 58MM
|
Facility
|
OP
|
$26,455.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,439.21 |
| Max. Negotiated Rate |
$25,397.23 |
| Rate for Payer: Aetna Commercial |
$20,370.70
|
| Rate for Payer: Anthem Medicaid |
$9,098.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,635.25
|
| Rate for Payer: Cash Price |
$13,227.73
|
| Rate for Payer: Cigna Commercial |
$21,958.02
|
| Rate for Payer: First Health Commercial |
$25,132.68
|
| Rate for Payer: Humana Commercial |
$22,487.13
|
| Rate for Payer: Humana KY Medicaid |
$9,098.03
|
| Rate for Payer: Kentucky WC Medicaid |
$9,190.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,693.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,524.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,936.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,280.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,280.80
|
| Rate for Payer: Ohio Health Group HMO |
$19,841.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,291.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,439.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,201.19
|
| Rate for Payer: PHCS Commercial |
$25,397.23
|
| Rate for Payer: United Healthcare All Payer |
$23,280.80
|
|
|
COMPR SRS PROX BODY SM 68MM
|
Facility
|
OP
|
$26,455.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,439.21 |
| Max. Negotiated Rate |
$25,397.23 |
| Rate for Payer: Aetna Commercial |
$20,370.70
|
| Rate for Payer: Anthem Medicaid |
$9,098.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,635.25
|
| Rate for Payer: Cash Price |
$13,227.73
|
| Rate for Payer: Cigna Commercial |
$21,958.02
|
| Rate for Payer: First Health Commercial |
$25,132.68
|
| Rate for Payer: Humana Commercial |
$22,487.13
|
| Rate for Payer: Humana KY Medicaid |
$9,098.03
|
| Rate for Payer: Kentucky WC Medicaid |
$9,190.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,693.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,524.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,936.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,280.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,280.80
|
| Rate for Payer: Ohio Health Group HMO |
$19,841.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,291.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,439.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,201.19
|
| Rate for Payer: PHCS Commercial |
$25,397.23
|
| Rate for Payer: United Healthcare All Payer |
$23,280.80
|
|
|
COMPR SRS PROX BODY SM 68MM
|
Facility
|
IP
|
$26,455.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,439.21 |
| Max. Negotiated Rate |
$25,397.23 |
| Rate for Payer: Aetna Commercial |
$20,370.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,635.25
|
| Rate for Payer: Cash Price |
$13,227.73
|
| Rate for Payer: Cigna Commercial |
$21,958.02
|
| Rate for Payer: First Health Commercial |
$25,132.68
|
| Rate for Payer: Humana Commercial |
$22,487.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,693.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,524.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,936.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,280.80
|
| Rate for Payer: Ohio Health Group HMO |
$19,841.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,291.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,439.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,201.19
|
| Rate for Payer: PHCS Commercial |
$25,397.23
|
| Rate for Payer: United Healthcare All Payer |
$23,280.80
|
|
|
COMPR SRS SMALL 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 SMALL 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 TUMOR BODY 51MM
|
Facility
|
IP
|
$26,455.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,439.21 |
| Max. Negotiated Rate |
$25,397.23 |
| Rate for Payer: Aetna Commercial |
$20,370.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,635.25
|
| Rate for Payer: Cash Price |
$13,227.73
|
| Rate for Payer: Cigna Commercial |
$21,958.02
|
| Rate for Payer: First Health Commercial |
$25,132.68
|
| Rate for Payer: Humana Commercial |
$22,487.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,693.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,524.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,936.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,280.80
|
| Rate for Payer: Ohio Health Group HMO |
$19,841.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,291.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,439.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,201.19
|
| Rate for Payer: PHCS Commercial |
$25,397.23
|
| Rate for Payer: United Healthcare All Payer |
$23,280.80
|
|
|
COMPR SRS TUMOR BODY 51MM
|
Facility
|
OP
|
$26,455.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,439.21 |
| Max. Negotiated Rate |
$25,397.23 |
| Rate for Payer: Aetna Commercial |
$20,370.70
|
| Rate for Payer: Anthem Medicaid |
$9,098.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,635.25
|
| Rate for Payer: Cash Price |
$13,227.73
|
| Rate for Payer: Cigna Commercial |
$21,958.02
|
| Rate for Payer: First Health Commercial |
$25,132.68
|
| Rate for Payer: Humana Commercial |
$22,487.13
|
| Rate for Payer: Humana KY Medicaid |
$9,098.03
|
| Rate for Payer: Kentucky WC Medicaid |
$9,190.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,693.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,524.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,936.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,280.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,280.80
|
| Rate for Payer: Ohio Health Group HMO |
$19,841.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,291.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,439.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,201.19
|
| Rate for Payer: PHCS Commercial |
$25,397.23
|
| Rate for Payer: United Healthcare All Payer |
$23,280.80
|
|
