|
COMPREHENSIVE REV STEM 6MM
|
Facility
|
IP
|
$22,197.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,659.25 |
| Max. Negotiated Rate |
$21,309.60 |
| Rate for Payer: Aetna Commercial |
$17,092.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,314.05
|
| Rate for Payer: Cash Price |
$11,098.75
|
| Rate for Payer: Cigna Commercial |
$18,423.92
|
| Rate for Payer: First Health Commercial |
$21,087.62
|
| Rate for Payer: Humana Commercial |
$18,867.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,201.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,381.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,659.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,533.80
|
| Rate for Payer: Ohio Health Group HMO |
$16,648.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,758.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,311.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,316.27
|
| Rate for Payer: PHCS Commercial |
$21,309.60
|
| Rate for Payer: United Healthcare All Payer |
$19,533.80
|
|
|
COMPREHENSIVE REV STEM 8MM
|
Facility
|
IP
|
$27,972.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,391.75 |
| Max. Negotiated Rate |
$26,853.60 |
| Rate for Payer: Aetna Commercial |
$21,538.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,818.55
|
| Rate for Payer: Cash Price |
$13,986.25
|
| Rate for Payer: Cigna Commercial |
$23,217.17
|
| Rate for Payer: First Health Commercial |
$26,573.88
|
| Rate for Payer: Humana Commercial |
$23,776.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,937.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,643.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,391.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,615.80
|
| Rate for Payer: Ohio Health Group HMO |
$20,979.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,378.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,336.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,301.03
|
| Rate for Payer: PHCS Commercial |
$26,853.60
|
| Rate for Payer: United Healthcare All Payer |
$24,615.80
|
|
|
COMPREHENSIVE REV STEM 8MM
|
Facility
|
OP
|
$27,972.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,391.75 |
| Max. Negotiated Rate |
$26,853.60 |
| Rate for Payer: Aetna Commercial |
$21,538.83
|
| Rate for Payer: Anthem Medicaid |
$9,619.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,818.55
|
| Rate for Payer: Cash Price |
$13,986.25
|
| Rate for Payer: Cigna Commercial |
$23,217.17
|
| Rate for Payer: First Health Commercial |
$26,573.88
|
| Rate for Payer: Humana Commercial |
$23,776.62
|
| Rate for Payer: Humana KY Medicaid |
$9,619.74
|
| Rate for Payer: Kentucky WC Medicaid |
$9,717.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,937.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,643.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,391.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,812.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,615.80
|
| Rate for Payer: Ohio Health Group HMO |
$20,979.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,378.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,336.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,301.03
|
| Rate for Payer: PHCS Commercial |
$26,853.60
|
| Rate for Payer: United Healthcare All Payer |
$24,615.80
|
|
|
COMPRES.3 FINGR JACK DISP DISC
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$436.80 |
| Rate for Payer: Aetna Commercial |
$350.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$354.90
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: Cigna Commercial |
$377.65
|
| Rate for Payer: First Health Commercial |
$432.25
|
| Rate for Payer: Humana Commercial |
$386.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$373.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$335.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$136.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$400.40
|
| Rate for Payer: Ohio Health Group HMO |
$341.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$364.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$395.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$313.95
|
| Rate for Payer: PHCS Commercial |
$436.80
|
| Rate for Payer: United Healthcare All Payer |
$400.40
|
|
|
COMPRES.3 FINGR JACK DISP DISC
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$436.80 |
| Rate for Payer: Aetna Commercial |
$350.35
|
| Rate for Payer: Anthem Medicaid |
$156.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$354.90
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: Cigna Commercial |
$377.65
|
| Rate for Payer: First Health Commercial |
$432.25
|
| Rate for Payer: Humana Commercial |
$386.75
|
| Rate for Payer: Humana KY Medicaid |
$156.47
|
| Rate for Payer: Kentucky WC Medicaid |
$158.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$373.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$335.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$136.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$159.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$400.40
|
| Rate for Payer: Ohio Health Group HMO |
$341.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$364.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$395.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$313.95
|
| Rate for Payer: PHCS Commercial |
$436.80
|
| Rate for Payer: United Healthcare All Payer |
$400.40
|
|
|
COMPRES ELPSH SPDL W PINS 400F
|
Facility
|
OP
|
$27,239.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,171.70 |
| Max. Negotiated Rate |
$26,149.44 |
| Rate for Payer: Aetna Commercial |
$20,974.03
|
| Rate for Payer: Anthem Medicaid |
$9,367.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,246.42
|
| Rate for Payer: Cash Price |
$13,619.50
|
| Rate for Payer: Cigna Commercial |
$22,608.37
|
| Rate for Payer: First Health Commercial |
$25,877.05
|
| Rate for Payer: Humana Commercial |
$23,153.15
|
| Rate for Payer: Humana KY Medicaid |
$9,367.49
|
| Rate for Payer: Kentucky WC Medicaid |
$9,462.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,335.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,102.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,171.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,555.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,970.32
|
| Rate for Payer: Ohio Health Group HMO |
$20,429.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,791.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,697.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,794.91
|
| Rate for Payer: PHCS Commercial |
$26,149.44
|
| Rate for Payer: United Healthcare All Payer |
$23,970.32
|
|
|
COMPRES ELPSH SPDL W PINS 400F
|
Facility
|
IP
|
$27,239.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,171.70 |
| Max. Negotiated Rate |
$26,149.44 |
| Rate for Payer: Aetna Commercial |
$20,974.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,246.42
|
| Rate for Payer: Cash Price |
$13,619.50
|
| Rate for Payer: Cigna Commercial |
$22,608.37
|
| Rate for Payer: First Health Commercial |
$25,877.05
|
| Rate for Payer: Humana Commercial |
$23,153.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,335.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,102.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,171.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,970.32
|
| Rate for Payer: Ohio Health Group HMO |
$20,429.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,791.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,697.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,794.91
|
| Rate for Payer: PHCS Commercial |
$26,149.44
|
| Rate for Payer: United Healthcare All Payer |
$23,970.32
|
|
|
COMPRES ELPSH SPDL W PINS 600F
|
Facility
|
IP
|
$27,239.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,171.70 |
| Max. Negotiated Rate |
$26,149.44 |
| Rate for Payer: Aetna Commercial |
$20,974.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,246.42
|
| Rate for Payer: Cash Price |
$13,619.50
|
| Rate for Payer: Cigna Commercial |
$22,608.37
|
| Rate for Payer: First Health Commercial |
$25,877.05
|
| Rate for Payer: Humana Commercial |
$23,153.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,335.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,102.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,171.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,970.32
|
| Rate for Payer: Ohio Health Group HMO |
$20,429.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,791.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,697.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,794.91
|
| Rate for Payer: PHCS Commercial |
$26,149.44
|
| Rate for Payer: United Healthcare All Payer |
$23,970.32
|
|
|
COMPRES ELPSH SPDL W PINS 600F
|
Facility
|
OP
|
$27,239.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,171.70 |
| Max. Negotiated Rate |
$26,149.44 |
| Rate for Payer: Aetna Commercial |
$20,974.03
|
| Rate for Payer: Anthem Medicaid |
$9,367.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,246.42
|
| Rate for Payer: Cash Price |
$13,619.50
|
| Rate for Payer: Cigna Commercial |
$22,608.37
|
| Rate for Payer: First Health Commercial |
$25,877.05
|
| Rate for Payer: Humana Commercial |
$23,153.15
|
| Rate for Payer: Humana KY Medicaid |
$9,367.49
|
| Rate for Payer: Kentucky WC Medicaid |
$9,462.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,335.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,102.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,171.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,555.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,970.32
|
| Rate for Payer: Ohio Health Group HMO |
$20,429.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,791.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,697.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,794.91
|
| Rate for Payer: PHCS Commercial |
$26,149.44
|
| Rate for Payer: United Healthcare All Payer |
$23,970.32
|
|
|
COMPRES ELPSH SPDL W PINS 800F
|
Facility
|
IP
|
$27,239.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,171.70 |
| Max. Negotiated Rate |
$26,149.44 |
| Rate for Payer: Aetna Commercial |
$20,974.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,246.42
|
| Rate for Payer: Cash Price |
$13,619.50
|
| Rate for Payer: Cigna Commercial |
$22,608.37
|
| Rate for Payer: First Health Commercial |
$25,877.05
|
| Rate for Payer: Humana Commercial |
$23,153.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,335.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,102.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,171.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,970.32
|
| Rate for Payer: Ohio Health Group HMO |
$20,429.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,791.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,697.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,794.91
|
| Rate for Payer: PHCS Commercial |
$26,149.44
|
| Rate for Payer: United Healthcare All Payer |
$23,970.32
|
|
|
COMPRES ELPSH SPDL W PINS 800F
|
Facility
|
OP
|
$27,239.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,171.70 |
| Max. Negotiated Rate |
$26,149.44 |
| Rate for Payer: Aetna Commercial |
$20,974.03
|
| Rate for Payer: Anthem Medicaid |
$9,367.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,246.42
|
| Rate for Payer: Cash Price |
$13,619.50
|
| Rate for Payer: Cigna Commercial |
$22,608.37
|
| Rate for Payer: First Health Commercial |
$25,877.05
|
| Rate for Payer: Humana Commercial |
$23,153.15
|
| Rate for Payer: Humana KY Medicaid |
$9,367.49
|
| Rate for Payer: Kentucky WC Medicaid |
$9,462.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,335.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,102.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,171.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,555.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,970.32
|
| Rate for Payer: Ohio Health Group HMO |
$20,429.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,791.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,697.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,794.91
|
| Rate for Payer: PHCS Commercial |
$26,149.44
|
| Rate for Payer: United Healthcare All Payer |
$23,970.32
|
|
|
COMPRES LG SH SPDL W PINS 400F
|
Facility
|
OP
|
$27,239.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,171.70 |
| Max. Negotiated Rate |
$26,149.44 |
| Rate for Payer: Aetna Commercial |
$20,974.03
|
| Rate for Payer: Anthem Medicaid |
$9,367.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,246.42
|
| Rate for Payer: Cash Price |
$13,619.50
|
| Rate for Payer: Cigna Commercial |
$22,608.37
|
| Rate for Payer: First Health Commercial |
$25,877.05
|
| Rate for Payer: Humana Commercial |
$23,153.15
|
| Rate for Payer: Humana KY Medicaid |
$9,367.49
|
| Rate for Payer: Kentucky WC Medicaid |
$9,462.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,335.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,102.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,171.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,555.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,970.32
|
| Rate for Payer: Ohio Health Group HMO |
$20,429.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,791.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,697.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,794.91
|
| Rate for Payer: PHCS Commercial |
$26,149.44
|
| Rate for Payer: United Healthcare All Payer |
$23,970.32
|
|
|
COMPRES LG SH SPDL W PINS 400F
|
Facility
|
IP
|
$27,239.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,171.70 |
| Max. Negotiated Rate |
$26,149.44 |
| Rate for Payer: Aetna Commercial |
$20,974.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,246.42
|
| Rate for Payer: Cash Price |
$13,619.50
|
| Rate for Payer: Cigna Commercial |
$22,608.37
|
| Rate for Payer: First Health Commercial |
$25,877.05
|
| Rate for Payer: Humana Commercial |
$23,153.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,335.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,102.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,171.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,970.32
|
| Rate for Payer: Ohio Health Group HMO |
$20,429.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,791.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,697.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,794.91
|
| Rate for Payer: PHCS Commercial |
$26,149.44
|
| Rate for Payer: United Healthcare All Payer |
$23,970.32
|
|
|
COMPRES LG SH SPDL W PINS 600F
|
Facility
|
OP
|
$27,239.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,171.70 |
| Max. Negotiated Rate |
$26,149.44 |
| Rate for Payer: Aetna Commercial |
$20,974.03
|
| Rate for Payer: Anthem Medicaid |
$9,367.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,246.42
|
| Rate for Payer: Cash Price |
$13,619.50
|
| Rate for Payer: Cigna Commercial |
$22,608.37
|
| Rate for Payer: First Health Commercial |
$25,877.05
|
| Rate for Payer: Humana Commercial |
$23,153.15
|
| Rate for Payer: Humana KY Medicaid |
$9,367.49
|
| Rate for Payer: Kentucky WC Medicaid |
$9,462.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,335.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,102.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,171.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,555.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,970.32
|
| Rate for Payer: Ohio Health Group HMO |
$20,429.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,791.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,697.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,794.91
|
| Rate for Payer: PHCS Commercial |
$26,149.44
|
| Rate for Payer: United Healthcare All Payer |
$23,970.32
|
|
|
COMPRES LG SH SPDL W PINS 600F
|
Facility
|
IP
|
$27,239.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,171.70 |
| Max. Negotiated Rate |
$26,149.44 |
| Rate for Payer: Aetna Commercial |
$20,974.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,246.42
|
| Rate for Payer: Cash Price |
$13,619.50
|
| Rate for Payer: Cigna Commercial |
$22,608.37
|
| Rate for Payer: First Health Commercial |
$25,877.05
|
| Rate for Payer: Humana Commercial |
$23,153.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,335.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,102.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,171.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,970.32
|
| Rate for Payer: Ohio Health Group HMO |
$20,429.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,791.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,697.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,794.91
|
| Rate for Payer: PHCS Commercial |
$26,149.44
|
| Rate for Payer: United Healthcare All Payer |
$23,970.32
|
|
|
COMPRES LG SH SPDL W PINS 800F
|
Facility
|
OP
|
$27,239.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,171.70 |
| Max. Negotiated Rate |
$26,149.44 |
| Rate for Payer: Aetna Commercial |
$20,974.03
|
| Rate for Payer: Anthem Medicaid |
$9,367.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,246.42
|
| Rate for Payer: Cash Price |
$13,619.50
|
| Rate for Payer: Cigna Commercial |
$22,608.37
|
| Rate for Payer: First Health Commercial |
$25,877.05
|
| Rate for Payer: Humana Commercial |
$23,153.15
|
| Rate for Payer: Humana KY Medicaid |
$9,367.49
|
| Rate for Payer: Kentucky WC Medicaid |
$9,462.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,335.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,102.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,171.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,555.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,970.32
|
| Rate for Payer: Ohio Health Group HMO |
$20,429.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,791.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,697.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,794.91
|
| Rate for Payer: PHCS Commercial |
$26,149.44
|
| Rate for Payer: United Healthcare All Payer |
$23,970.32
|
|
|
COMPRES LG SH SPDL W PINS 800F
|
Facility
|
IP
|
$27,239.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,171.70 |
| Max. Negotiated Rate |
$26,149.44 |
| Rate for Payer: Aetna Commercial |
$20,974.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,246.42
|
| Rate for Payer: Cash Price |
$13,619.50
|
| Rate for Payer: Cigna Commercial |
$22,608.37
|
| Rate for Payer: First Health Commercial |
$25,877.05
|
| Rate for Payer: Humana Commercial |
$23,153.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,335.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,102.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,171.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,970.32
|
| Rate for Payer: Ohio Health Group HMO |
$20,429.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,791.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,697.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,794.91
|
| Rate for Payer: PHCS Commercial |
$26,149.44
|
| Rate for Payer: United Healthcare All Payer |
$23,970.32
|
|
|
COMPRESSION STAPLE 13I*11L
|
Facility
|
IP
|
$3,743.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.12 |
| Max. Negotiated Rate |
$3,594.00 |
| Rate for Payer: Aetna Commercial |
$2,882.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,920.12
|
| Rate for Payer: Cash Price |
$1,871.88
|
| Rate for Payer: Cigna Commercial |
$3,107.31
|
| Rate for Payer: First Health Commercial |
$3,556.56
|
| Rate for Payer: Humana Commercial |
$3,182.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,069.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,762.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,123.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,294.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,807.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,995.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,257.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,583.19
|
| Rate for Payer: PHCS Commercial |
$3,594.00
|
| Rate for Payer: United Healthcare All Payer |
$3,294.50
|
|
|
COMPRESSION STAPLE 13I*11L
|
Facility
|
OP
|
$3,743.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.12 |
| Max. Negotiated Rate |
$3,594.00 |
| Rate for Payer: Aetna Commercial |
$2,882.69
|
| Rate for Payer: Anthem Medicaid |
$1,287.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,920.12
|
| Rate for Payer: Cash Price |
$1,871.88
|
| Rate for Payer: Cigna Commercial |
$3,107.31
|
| Rate for Payer: First Health Commercial |
$3,556.56
|
| Rate for Payer: Humana Commercial |
$3,182.19
|
| Rate for Payer: Humana KY Medicaid |
$1,287.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,300.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,069.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,762.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,123.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,313.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,294.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,807.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,995.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,257.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,583.19
|
| Rate for Payer: PHCS Commercial |
$3,594.00
|
| Rate for Payer: United Healthcare All Payer |
$3,294.50
|
|
|
COMPRES SM SH SPDL W PINS 400F
|
Facility
|
IP
|
$27,239.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,171.70 |
| Max. Negotiated Rate |
$26,149.44 |
| Rate for Payer: Aetna Commercial |
$20,974.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,246.42
|
| Rate for Payer: Cash Price |
$13,619.50
|
| Rate for Payer: Cigna Commercial |
$22,608.37
|
| Rate for Payer: First Health Commercial |
$25,877.05
|
| Rate for Payer: Humana Commercial |
$23,153.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,335.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,102.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,171.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,970.32
|
| Rate for Payer: Ohio Health Group HMO |
$20,429.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,791.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,697.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,794.91
|
| Rate for Payer: PHCS Commercial |
$26,149.44
|
| Rate for Payer: United Healthcare All Payer |
$23,970.32
|
|
|
COMPRES SM SH SPDL W PINS 400F
|
Facility
|
OP
|
$27,239.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,171.70 |
| Max. Negotiated Rate |
$26,149.44 |
| Rate for Payer: Aetna Commercial |
$20,974.03
|
| Rate for Payer: Anthem Medicaid |
$9,367.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,246.42
|
| Rate for Payer: Cash Price |
$13,619.50
|
| Rate for Payer: Cigna Commercial |
$22,608.37
|
| Rate for Payer: First Health Commercial |
$25,877.05
|
| Rate for Payer: Humana Commercial |
$23,153.15
|
| Rate for Payer: Humana KY Medicaid |
$9,367.49
|
| Rate for Payer: Kentucky WC Medicaid |
$9,462.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,335.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,102.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,171.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,555.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,970.32
|
| Rate for Payer: Ohio Health Group HMO |
$20,429.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,791.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,697.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,794.91
|
| Rate for Payer: PHCS Commercial |
$26,149.44
|
| Rate for Payer: United Healthcare All Payer |
$23,970.32
|
|
|
COMPRES SM SH SPDL W PINS 600F
|
Facility
|
IP
|
$27,239.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,171.70 |
| Max. Negotiated Rate |
$26,149.44 |
| Rate for Payer: Aetna Commercial |
$20,974.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,246.42
|
| Rate for Payer: Cash Price |
$13,619.50
|
| Rate for Payer: Cigna Commercial |
$22,608.37
|
| Rate for Payer: First Health Commercial |
$25,877.05
|
| Rate for Payer: Humana Commercial |
$23,153.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,335.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,102.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,171.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,970.32
|
| Rate for Payer: Ohio Health Group HMO |
$20,429.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,791.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,697.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,794.91
|
| Rate for Payer: PHCS Commercial |
$26,149.44
|
| Rate for Payer: United Healthcare All Payer |
$23,970.32
|
|
|
COMPRES SM SH SPDL W PINS 600F
|
Facility
|
OP
|
$27,239.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,171.70 |
| Max. Negotiated Rate |
$26,149.44 |
| Rate for Payer: Aetna Commercial |
$20,974.03
|
| Rate for Payer: Anthem Medicaid |
$9,367.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,246.42
|
| Rate for Payer: Cash Price |
$13,619.50
|
| Rate for Payer: Cigna Commercial |
$22,608.37
|
| Rate for Payer: First Health Commercial |
$25,877.05
|
| Rate for Payer: Humana Commercial |
$23,153.15
|
| Rate for Payer: Humana KY Medicaid |
$9,367.49
|
| Rate for Payer: Kentucky WC Medicaid |
$9,462.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,335.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,102.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,171.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,555.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,970.32
|
| Rate for Payer: Ohio Health Group HMO |
$20,429.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,791.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,697.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,794.91
|
| Rate for Payer: PHCS Commercial |
$26,149.44
|
| Rate for Payer: United Healthcare All Payer |
$23,970.32
|
|
|
COMPRES SM SH SPDL W PINS 800F
|
Facility
|
OP
|
$27,239.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,171.70 |
| Max. Negotiated Rate |
$26,149.44 |
| Rate for Payer: Aetna Commercial |
$20,974.03
|
| Rate for Payer: Anthem Medicaid |
$9,367.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,246.42
|
| Rate for Payer: Cash Price |
$13,619.50
|
| Rate for Payer: Cigna Commercial |
$22,608.37
|
| Rate for Payer: First Health Commercial |
$25,877.05
|
| Rate for Payer: Humana Commercial |
$23,153.15
|
| Rate for Payer: Humana KY Medicaid |
$9,367.49
|
| Rate for Payer: Kentucky WC Medicaid |
$9,462.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,335.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,102.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,171.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,555.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,970.32
|
| Rate for Payer: Ohio Health Group HMO |
$20,429.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,791.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,697.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,794.91
|
| Rate for Payer: PHCS Commercial |
$26,149.44
|
| Rate for Payer: United Healthcare All Payer |
$23,970.32
|
|
|
COMPRES SM SH SPDL W PINS 800F
|
Facility
|
IP
|
$27,239.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,171.70 |
| Max. Negotiated Rate |
$26,149.44 |
| Rate for Payer: Aetna Commercial |
$20,974.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,246.42
|
| Rate for Payer: Cash Price |
$13,619.50
|
| Rate for Payer: Cigna Commercial |
$22,608.37
|
| Rate for Payer: First Health Commercial |
$25,877.05
|
| Rate for Payer: Humana Commercial |
$23,153.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,335.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,102.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,171.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,970.32
|
| Rate for Payer: Ohio Health Group HMO |
$20,429.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,791.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,697.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,794.91
|
| Rate for Payer: PHCS Commercial |
$26,149.44
|
| Rate for Payer: United Healthcare All Payer |
$23,970.32
|
|
