|
COMP 35M ART 6.0*7.0 HUM HEDCE
|
Facility
|
IP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
COMP 35M ART 6.0*7.0 HUM HEDCE
|
Facility
|
OP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem Medicaid |
$8,453.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Humana KY Medicaid |
$8,453.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,539.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,623.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
COMP 35M ART 6.5*6.5 HUM HEDCE
|
Facility
|
OP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem Medicaid |
$8,453.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Humana KY Medicaid |
$8,453.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,539.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,623.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
COMP 35M ART 6.5*6.5 HUM HEDCE
|
Facility
|
IP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
COMP 35M ART 7.0*7.0 HUM HEDCE
|
Facility
|
IP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
COMP 35M ART 7.0*7.0 HUM HEDCE
|
Facility
|
OP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem Medicaid |
$8,453.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Humana KY Medicaid |
$8,453.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,539.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,623.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
COMP 35M ART 7.0*8.0 HUM HEDCE
|
Facility
|
IP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
COMP 35M ART 7.0*8.0 HUM HEDCE
|
Facility
|
OP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem Medicaid |
$8,453.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Humana KY Medicaid |
$8,453.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,539.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,623.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
COMP 35M ART 7.5*7.5 HUM HEDCE
|
Facility
|
IP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
COMP 35M ART 7.5*7.5 HUM HEDCE
|
Facility
|
OP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem Medicaid |
$8,453.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Humana KY Medicaid |
$8,453.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,539.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,623.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
COMP 35M ART 8.0*8.0 HUM HEDCE
|
Facility
|
OP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem Medicaid |
$8,453.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Humana KY Medicaid |
$8,453.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,539.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,623.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
COMP 35M ART 8.0*8.0 HUM HEDCE
|
Facility
|
IP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
COMP 35M ART 8.0*9.0 HUM HEDCE
|
Facility
|
IP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
COMP 35M ART 8.0*9.0 HUM HEDCE
|
Facility
|
OP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem Medicaid |
$8,453.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Humana KY Medicaid |
$8,453.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,539.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,623.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
COMP 35M ART 8.5*8.5 HUM HEDCE
|
Facility
|
IP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
COMP 35M ART 8.5*8.5 HUM HEDCE
|
Facility
|
OP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem Medicaid |
$8,453.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Humana KY Medicaid |
$8,453.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,539.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,623.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
COMP 35M ART 9.0*10. HUM HEDCE
|
Facility
|
OP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem Medicaid |
$8,453.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Humana KY Medicaid |
$8,453.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,539.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,623.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
COMP 35M ART 9.0*10. HUM HEDCE
|
Facility
|
IP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
COMP 35M ART 9.0*9.0 HUM HEDCE
|
Facility
|
OP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem Medicaid |
$8,453.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Humana KY Medicaid |
$8,453.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,539.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,623.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
COMP 35M ART 9.0*9.0 HUM HEDCE
|
Facility
|
IP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
COMP 35M ART 9.5*9.5 HUM HEDCE
|
Facility
|
OP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem Medicaid |
$8,453.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Humana KY Medicaid |
$8,453.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,539.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,623.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
COMP 35M ART 9.5*9.5 HUM HEDCE
|
Facility
|
IP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
COMPART SYNDROME MEASURING
|
Professional
|
Both
|
$1,379.00
|
|
|
Service Code
|
HCPCS 20950
|
| Hospital Charge Code |
76100358
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$47.33 |
| Max. Negotiated Rate |
$827.40 |
| Rate for Payer: Aetna Commercial |
$135.14
|
| Rate for Payer: Ambetter Exchange |
$83.80
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$47.33
|
| Rate for Payer: Anthem Medicaid |
$70.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$83.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$83.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$100.56
|
| Rate for Payer: Cash Price |
$689.50
|
| Rate for Payer: Cash Price |
$689.50
|
| Rate for Payer: Cigna Commercial |
$148.09
|
| Rate for Payer: Healthspan PPO |
$305.66
|
| Rate for Payer: Humana Medicaid |
$70.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$112.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$83.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$83.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.75
|
| Rate for Payer: Molina Healthcare Passport |
$70.34
|
| Rate for Payer: Multiplan PHCS |
$827.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$108.94
|
| Rate for Payer: UHCCP Medicaid |
$49.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$83.80
|
|
|
COMPART SYNDROME MEASURING
|
Facility
|
IP
|
$1,379.00
|
|
|
Service Code
|
HCPCS 20950
|
| Hospital Charge Code |
76100358
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$413.70 |
| Max. Negotiated Rate |
$1,323.84 |
| Rate for Payer: Aetna Commercial |
$1,061.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,075.62
|
| Rate for Payer: Cash Price |
$689.50
|
| Rate for Payer: Cigna Commercial |
$1,144.57
|
| Rate for Payer: First Health Commercial |
$1,310.05
|
| Rate for Payer: Humana Commercial |
$1,172.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,130.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,017.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,213.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,034.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,103.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$951.51
|
| Rate for Payer: PHCS Commercial |
$1,323.84
|
| Rate for Payer: United Healthcare All Payer |
$1,213.52
|
|
|
COMPART SYNDROME MEASURING
|
Facility
|
OP
|
$1,379.00
|
|
|
Service Code
|
HCPCS 20950
|
| Hospital Charge Code |
76100358
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$474.24 |
| Max. Negotiated Rate |
$1,323.84 |
| Rate for Payer: Aetna Commercial |
$1,061.83
|
| Rate for Payer: Anthem Medicaid |
$474.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,075.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$689.50
|
| Rate for Payer: Cash Price |
$689.50
|
| Rate for Payer: Cigna Commercial |
$1,144.57
|
| Rate for Payer: First Health Commercial |
$1,310.05
|
| Rate for Payer: Humana Commercial |
$1,172.15
|
| Rate for Payer: Humana KY Medicaid |
$474.24
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$479.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,130.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,017.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$483.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,213.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,034.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,103.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$951.51
|
| Rate for Payer: PHCS Commercial |
$1,323.84
|
| Rate for Payer: United Healthcare All Payer |
$1,213.52
|
|
