|
COMPRES XS 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 XS 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 XS 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 XS 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 XS 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
|
|
|
COMPRES XS 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
|
|
|
COMPR FX HMRL POS SLV 10*12MM
|
Facility
|
IP
|
$2,208.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$662.46 |
| Max. Negotiated Rate |
$2,119.87 |
| Rate for Payer: Aetna Commercial |
$1,700.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,722.40
|
| Rate for Payer: Cash Price |
$1,104.10
|
| Rate for Payer: Cigna Commercial |
$1,832.81
|
| Rate for Payer: First Health Commercial |
$2,097.79
|
| Rate for Payer: Humana Commercial |
$1,876.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,810.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,629.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$662.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,943.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,656.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,766.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,921.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.66
|
| Rate for Payer: PHCS Commercial |
$2,119.87
|
| Rate for Payer: United Healthcare All Payer |
$1,943.22
|
|
|
COMPR FX HMRL POS SLV 10*12MM
|
Facility
|
OP
|
$2,208.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$662.46 |
| Max. Negotiated Rate |
$2,119.87 |
| Rate for Payer: Aetna Commercial |
$1,700.31
|
| Rate for Payer: Anthem Medicaid |
$759.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,722.40
|
| Rate for Payer: Cash Price |
$1,104.10
|
| Rate for Payer: Cigna Commercial |
$1,832.81
|
| Rate for Payer: First Health Commercial |
$2,097.79
|
| Rate for Payer: Humana Commercial |
$1,876.97
|
| Rate for Payer: Humana KY Medicaid |
$759.40
|
| Rate for Payer: Kentucky WC Medicaid |
$767.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,810.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,629.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$662.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$774.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,943.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,656.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,766.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,921.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.66
|
| Rate for Payer: PHCS Commercial |
$2,119.87
|
| Rate for Payer: United Healthcare All Payer |
$1,943.22
|
|
|
COMPR FX HMRL POS SLV 10*13MM
|
Facility
|
IP
|
$2,208.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$662.46 |
| Max. Negotiated Rate |
$2,119.87 |
| Rate for Payer: Aetna Commercial |
$1,700.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,722.40
|
| Rate for Payer: Cash Price |
$1,104.10
|
| Rate for Payer: Cigna Commercial |
$1,832.81
|
| Rate for Payer: First Health Commercial |
$2,097.79
|
| Rate for Payer: Humana Commercial |
$1,876.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,810.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,629.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$662.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,943.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,656.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,766.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,921.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.66
|
| Rate for Payer: PHCS Commercial |
$2,119.87
|
| Rate for Payer: United Healthcare All Payer |
$1,943.22
|
|
|
COMPR FX HMRL POS SLV 10*13MM
|
Facility
|
OP
|
$2,208.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$662.46 |
| Max. Negotiated Rate |
$2,119.87 |
| Rate for Payer: Aetna Commercial |
$1,700.31
|
| Rate for Payer: Anthem Medicaid |
$759.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,722.40
|
| Rate for Payer: Cash Price |
$1,104.10
|
| Rate for Payer: Cigna Commercial |
$1,832.81
|
| Rate for Payer: First Health Commercial |
$2,097.79
|
| Rate for Payer: Humana Commercial |
$1,876.97
|
| Rate for Payer: Humana KY Medicaid |
$759.40
|
| Rate for Payer: Kentucky WC Medicaid |
$767.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,810.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,629.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$662.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$774.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,943.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,656.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,766.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,921.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.66
|
| Rate for Payer: PHCS Commercial |
$2,119.87
|
| Rate for Payer: United Healthcare All Payer |
$1,943.22
|
|
|
COMPR FX HMRL POS SLV 12*14MM
|
Facility
|
IP
|
$2,208.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$662.46 |
| Max. Negotiated Rate |
$2,119.87 |
| Rate for Payer: Aetna Commercial |
$1,700.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,722.40
|
| Rate for Payer: Cash Price |
$1,104.10
|
| Rate for Payer: Cigna Commercial |
$1,832.81
|
| Rate for Payer: First Health Commercial |
$2,097.79
|
| Rate for Payer: Humana Commercial |
$1,876.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,810.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,629.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$662.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,943.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,656.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,766.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,921.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.66
|
| Rate for Payer: PHCS Commercial |
$2,119.87
|
| Rate for Payer: United Healthcare All Payer |
$1,943.22
|
|
|
COMPR FX HMRL POS SLV 12*14MM
|
Facility
|
OP
|
$2,208.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$662.46 |
| Max. Negotiated Rate |
$2,119.87 |
| Rate for Payer: Aetna Commercial |
$1,700.31
|
| Rate for Payer: Anthem Medicaid |
$759.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,722.40
|
| Rate for Payer: Cash Price |
$1,104.10
|
| Rate for Payer: Cigna Commercial |
$1,832.81
|
| Rate for Payer: First Health Commercial |
$2,097.79
|
| Rate for Payer: Humana Commercial |
$1,876.97
|
| Rate for Payer: Humana KY Medicaid |
$759.40
|
| Rate for Payer: Kentucky WC Medicaid |
$767.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,810.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,629.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$662.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$774.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,943.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,656.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,766.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,921.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.66
|
| Rate for Payer: PHCS Commercial |
$2,119.87
|
| Rate for Payer: United Healthcare All Payer |
$1,943.22
|
|
|
COMPR FX HMRL POS SLV 12*15MM
|
Facility
|
IP
|
$2,208.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$662.46 |
| Max. Negotiated Rate |
$2,119.87 |
| Rate for Payer: Aetna Commercial |
$1,700.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,722.40
|
| Rate for Payer: Cash Price |
$1,104.10
|
| Rate for Payer: Cigna Commercial |
$1,832.81
|
| Rate for Payer: First Health Commercial |
$2,097.79
|
| Rate for Payer: Humana Commercial |
$1,876.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,810.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,629.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$662.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,943.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,656.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,766.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,921.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.66
|
| Rate for Payer: PHCS Commercial |
$2,119.87
|
| Rate for Payer: United Healthcare All Payer |
$1,943.22
|
|
|
COMPR FX HMRL POS SLV 12*15MM
|
Facility
|
OP
|
$2,208.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$662.46 |
| Max. Negotiated Rate |
$2,119.87 |
| Rate for Payer: Aetna Commercial |
$1,700.31
|
| Rate for Payer: Anthem Medicaid |
$759.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,722.40
|
| Rate for Payer: Cash Price |
$1,104.10
|
| Rate for Payer: Cigna Commercial |
$1,832.81
|
| Rate for Payer: First Health Commercial |
$2,097.79
|
| Rate for Payer: Humana Commercial |
$1,876.97
|
| Rate for Payer: Humana KY Medicaid |
$759.40
|
| Rate for Payer: Kentucky WC Medicaid |
$767.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,810.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,629.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$662.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$774.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,943.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,656.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,766.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,921.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.66
|
| Rate for Payer: PHCS Commercial |
$2,119.87
|
| Rate for Payer: United Healthcare All Payer |
$1,943.22
|
|
|
COMPR FX HMRL POS SLV 14*16MM
|
Facility
|
IP
|
$2,208.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$662.46 |
| Max. Negotiated Rate |
$2,119.87 |
| Rate for Payer: Aetna Commercial |
$1,700.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,722.40
|
| Rate for Payer: Cash Price |
$1,104.10
|
| Rate for Payer: Cigna Commercial |
$1,832.81
|
| Rate for Payer: First Health Commercial |
$2,097.79
|
| Rate for Payer: Humana Commercial |
$1,876.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,810.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,629.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$662.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,943.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,656.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,766.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,921.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.66
|
| Rate for Payer: PHCS Commercial |
$2,119.87
|
| Rate for Payer: United Healthcare All Payer |
$1,943.22
|
|
|
COMPR FX HMRL POS SLV 14*16MM
|
Facility
|
OP
|
$2,208.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$662.46 |
| Max. Negotiated Rate |
$2,119.87 |
| Rate for Payer: Aetna Commercial |
$1,700.31
|
| Rate for Payer: Anthem Medicaid |
$759.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,722.40
|
| Rate for Payer: Cash Price |
$1,104.10
|
| Rate for Payer: Cigna Commercial |
$1,832.81
|
| Rate for Payer: First Health Commercial |
$2,097.79
|
| Rate for Payer: Humana Commercial |
$1,876.97
|
| Rate for Payer: Humana KY Medicaid |
$759.40
|
| Rate for Payer: Kentucky WC Medicaid |
$767.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,810.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,629.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$662.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$774.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,943.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,656.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,766.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,921.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.66
|
| Rate for Payer: PHCS Commercial |
$2,119.87
|
| Rate for Payer: United Healthcare All Payer |
$1,943.22
|
|
|
COMPR FX HMRL POS SLV 14*17MM
|
Facility
|
OP
|
$2,208.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$662.46 |
| Max. Negotiated Rate |
$2,119.87 |
| Rate for Payer: Aetna Commercial |
$1,700.31
|
| Rate for Payer: Anthem Medicaid |
$759.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,722.40
|
| Rate for Payer: Cash Price |
$1,104.10
|
| Rate for Payer: Cigna Commercial |
$1,832.81
|
| Rate for Payer: First Health Commercial |
$2,097.79
|
| Rate for Payer: Humana Commercial |
$1,876.97
|
| Rate for Payer: Humana KY Medicaid |
$759.40
|
| Rate for Payer: Kentucky WC Medicaid |
$767.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,810.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,629.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$662.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$774.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,943.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,656.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,766.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,921.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.66
|
| Rate for Payer: PHCS Commercial |
$2,119.87
|
| Rate for Payer: United Healthcare All Payer |
$1,943.22
|
|
|
COMPR FX HMRL POS SLV 14*17MM
|
Facility
|
IP
|
$2,208.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$662.46 |
| Max. Negotiated Rate |
$2,119.87 |
| Rate for Payer: Aetna Commercial |
$1,700.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,722.40
|
| Rate for Payer: Cash Price |
$1,104.10
|
| Rate for Payer: Cigna Commercial |
$1,832.81
|
| Rate for Payer: First Health Commercial |
$2,097.79
|
| Rate for Payer: Humana Commercial |
$1,876.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,810.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,629.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$662.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,943.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,656.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,766.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,921.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.66
|
| Rate for Payer: PHCS Commercial |
$2,119.87
|
| Rate for Payer: United Healthcare All Payer |
$1,943.22
|
|
|
COMPR FX HMRL POS SLV 4*6MM
|
Facility
|
OP
|
$2,208.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$662.46 |
| Max. Negotiated Rate |
$2,119.87 |
| Rate for Payer: Aetna Commercial |
$1,700.31
|
| Rate for Payer: Anthem Medicaid |
$759.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,722.40
|
| Rate for Payer: Cash Price |
$1,104.10
|
| Rate for Payer: Cigna Commercial |
$1,832.81
|
| Rate for Payer: First Health Commercial |
$2,097.79
|
| Rate for Payer: Humana Commercial |
$1,876.97
|
| Rate for Payer: Humana KY Medicaid |
$759.40
|
| Rate for Payer: Kentucky WC Medicaid |
$767.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,810.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,629.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$662.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$774.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,943.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,656.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,766.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,921.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.66
|
| Rate for Payer: PHCS Commercial |
$2,119.87
|
| Rate for Payer: United Healthcare All Payer |
$1,943.22
|
|
|
COMPR FX HMRL POS SLV 4*6MM
|
Facility
|
IP
|
$2,208.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$662.46 |
| Max. Negotiated Rate |
$2,119.87 |
| Rate for Payer: Aetna Commercial |
$1,700.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,722.40
|
| Rate for Payer: Cash Price |
$1,104.10
|
| Rate for Payer: Cigna Commercial |
$1,832.81
|
| Rate for Payer: First Health Commercial |
$2,097.79
|
| Rate for Payer: Humana Commercial |
$1,876.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,810.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,629.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$662.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,943.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,656.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,766.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,921.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.66
|
| Rate for Payer: PHCS Commercial |
$2,119.87
|
| Rate for Payer: United Healthcare All Payer |
$1,943.22
|
|
|
COMPR FX HMRL POS SLV 4*7MM
|
Facility
|
IP
|
$2,208.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$662.46 |
| Max. Negotiated Rate |
$2,119.87 |
| Rate for Payer: Aetna Commercial |
$1,700.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,722.40
|
| Rate for Payer: Cash Price |
$1,104.10
|
| Rate for Payer: Cigna Commercial |
$1,832.81
|
| Rate for Payer: First Health Commercial |
$2,097.79
|
| Rate for Payer: Humana Commercial |
$1,876.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,810.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,629.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$662.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,943.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,656.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,766.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,921.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.66
|
| Rate for Payer: PHCS Commercial |
$2,119.87
|
| Rate for Payer: United Healthcare All Payer |
$1,943.22
|
|
|
COMPR FX HMRL POS SLV 4*7MM
|
Facility
|
OP
|
$2,208.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$662.46 |
| Max. Negotiated Rate |
$2,119.87 |
| Rate for Payer: Aetna Commercial |
$1,700.31
|
| Rate for Payer: Anthem Medicaid |
$759.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,722.40
|
| Rate for Payer: Cash Price |
$1,104.10
|
| Rate for Payer: Cigna Commercial |
$1,832.81
|
| Rate for Payer: First Health Commercial |
$2,097.79
|
| Rate for Payer: Humana Commercial |
$1,876.97
|
| Rate for Payer: Humana KY Medicaid |
$759.40
|
| Rate for Payer: Kentucky WC Medicaid |
$767.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,810.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,629.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$662.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$774.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,943.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,656.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,766.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,921.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.66
|
| Rate for Payer: PHCS Commercial |
$2,119.87
|
| Rate for Payer: United Healthcare All Payer |
$1,943.22
|
|
|
COMPR FX HMRL POS SLV 6*8MM
|
Facility
|
OP
|
$2,208.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$662.46 |
| Max. Negotiated Rate |
$2,119.87 |
| Rate for Payer: Aetna Commercial |
$1,700.31
|
| Rate for Payer: Anthem Medicaid |
$759.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,722.40
|
| Rate for Payer: Cash Price |
$1,104.10
|
| Rate for Payer: Cigna Commercial |
$1,832.81
|
| Rate for Payer: First Health Commercial |
$2,097.79
|
| Rate for Payer: Humana Commercial |
$1,876.97
|
| Rate for Payer: Humana KY Medicaid |
$759.40
|
| Rate for Payer: Kentucky WC Medicaid |
$767.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,810.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,629.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$662.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$774.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,943.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,656.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,766.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,921.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.66
|
| Rate for Payer: PHCS Commercial |
$2,119.87
|
| Rate for Payer: United Healthcare All Payer |
$1,943.22
|
|
|
COMPR FX HMRL POS SLV 6*8MM
|
Facility
|
IP
|
$2,208.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$662.46 |
| Max. Negotiated Rate |
$2,119.87 |
| Rate for Payer: Aetna Commercial |
$1,700.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,722.40
|
| Rate for Payer: Cash Price |
$1,104.10
|
| Rate for Payer: Cigna Commercial |
$1,832.81
|
| Rate for Payer: First Health Commercial |
$2,097.79
|
| Rate for Payer: Humana Commercial |
$1,876.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,810.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,629.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$662.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,943.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,656.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,766.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,921.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.66
|
| Rate for Payer: PHCS Commercial |
$2,119.87
|
| Rate for Payer: United Healthcare All Payer |
$1,943.22
|
|
|
COMPR FX HMRL POS SLV 6*9MM
|
Facility
|
OP
|
$2,208.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$662.46 |
| Max. Negotiated Rate |
$2,119.87 |
| Rate for Payer: Aetna Commercial |
$1,700.31
|
| Rate for Payer: Anthem Medicaid |
$759.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,722.40
|
| Rate for Payer: Cash Price |
$1,104.10
|
| Rate for Payer: Cigna Commercial |
$1,832.81
|
| Rate for Payer: First Health Commercial |
$2,097.79
|
| Rate for Payer: Humana Commercial |
$1,876.97
|
| Rate for Payer: Humana KY Medicaid |
$759.40
|
| Rate for Payer: Kentucky WC Medicaid |
$767.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,810.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,629.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$662.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$774.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,943.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,656.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,766.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,921.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.66
|
| Rate for Payer: PHCS Commercial |
$2,119.87
|
| Rate for Payer: United Healthcare All Payer |
$1,943.22
|
|
