|
COMPR RVS SHLDR GLEN BASEPLT
|
Facility
|
OP
|
$9,664.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,899.47 |
| Max. Negotiated Rate |
$9,278.30 |
| Rate for Payer: Aetna Commercial |
$7,441.97
|
| Rate for Payer: Anthem Medicaid |
$3,323.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,538.62
|
| Rate for Payer: Cash Price |
$4,832.45
|
| Rate for Payer: Cigna Commercial |
$8,021.87
|
| Rate for Payer: First Health Commercial |
$9,181.66
|
| Rate for Payer: Humana Commercial |
$8,215.17
|
| Rate for Payer: Humana KY Medicaid |
$3,323.76
|
| Rate for Payer: Kentucky WC Medicaid |
$3,357.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,925.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,132.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,899.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,390.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,505.11
|
| Rate for Payer: Ohio Health Group HMO |
$7,248.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,731.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,408.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,668.78
|
| Rate for Payer: PHCS Commercial |
$9,278.30
|
| Rate for Payer: United Healthcare All Payer |
$8,505.11
|
|
|
COMPR RVS SHLDR GLEN BASEPLT
|
Facility
|
IP
|
$9,664.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,899.47 |
| Max. Negotiated Rate |
$9,278.30 |
| Rate for Payer: Aetna Commercial |
$7,441.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,538.62
|
| Rate for Payer: Cash Price |
$4,832.45
|
| Rate for Payer: Cigna Commercial |
$8,021.87
|
| Rate for Payer: First Health Commercial |
$9,181.66
|
| Rate for Payer: Humana Commercial |
$8,215.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,925.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,132.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,899.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,505.11
|
| Rate for Payer: Ohio Health Group HMO |
$7,248.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,731.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,408.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,668.78
|
| Rate for Payer: PHCS Commercial |
$9,278.30
|
| Rate for Payer: United Healthcare All Payer |
$8,505.11
|
|
|
COMPR RVS SHLDR HMRL TRAY 44MM
|
Facility
|
IP
|
$10,267.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,080.14 |
| Max. Negotiated Rate |
$9,856.46 |
| Rate for Payer: Aetna Commercial |
$7,905.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,008.38
|
| Rate for Payer: Cash Price |
$5,133.58
|
| Rate for Payer: Cigna Commercial |
$8,521.73
|
| Rate for Payer: First Health Commercial |
$9,753.79
|
| Rate for Payer: Humana Commercial |
$8,727.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,419.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,577.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,080.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,035.09
|
| Rate for Payer: Ohio Health Group HMO |
$7,700.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,213.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,932.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,084.33
|
| Rate for Payer: PHCS Commercial |
$9,856.46
|
| Rate for Payer: United Healthcare All Payer |
$9,035.09
|
|
|
COMPR RVS SHLDR HMRL TRAY 44MM
|
Facility
|
OP
|
$10,267.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,080.14 |
| Max. Negotiated Rate |
$9,856.46 |
| Rate for Payer: Aetna Commercial |
$7,905.71
|
| Rate for Payer: Anthem Medicaid |
$3,530.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,008.38
|
| Rate for Payer: Cash Price |
$5,133.58
|
| Rate for Payer: Cigna Commercial |
$8,521.73
|
| Rate for Payer: First Health Commercial |
$9,753.79
|
| Rate for Payer: Humana Commercial |
$8,727.08
|
| Rate for Payer: Humana KY Medicaid |
$3,530.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,566.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,419.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,577.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,080.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,601.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,035.09
|
| Rate for Payer: Ohio Health Group HMO |
$7,700.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,213.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,932.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,084.33
|
| Rate for Payer: PHCS Commercial |
$9,856.46
|
| Rate for Payer: United Healthcare All Payer |
$9,035.09
|
|
|
COMPR RVS SHLDR HMRL TRY 44M+5
|
Facility
|
IP
|
$10,267.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,080.14 |
| Max. Negotiated Rate |
$9,856.46 |
| Rate for Payer: Aetna Commercial |
$7,905.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,008.38
|
| Rate for Payer: Cash Price |
$5,133.58
|
| Rate for Payer: Cigna Commercial |
$8,521.73
|
| Rate for Payer: First Health Commercial |
$9,753.79
|
| Rate for Payer: Humana Commercial |
$8,727.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,419.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,577.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,080.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,035.09
|
| Rate for Payer: Ohio Health Group HMO |
$7,700.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,213.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,932.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,084.33
|
| Rate for Payer: PHCS Commercial |
$9,856.46
|
| Rate for Payer: United Healthcare All Payer |
$9,035.09
|
|
|
COMPR RVS SHLDR HMRL TRY 44M+5
|
Facility
|
OP
|
$10,267.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,080.14 |
| Max. Negotiated Rate |
$9,856.46 |
| Rate for Payer: Aetna Commercial |
$7,905.71
|
| Rate for Payer: Anthem Medicaid |
$3,530.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,008.38
|
| Rate for Payer: Cash Price |
$5,133.58
|
| Rate for Payer: Cigna Commercial |
$8,521.73
|
| Rate for Payer: First Health Commercial |
$9,753.79
|
| Rate for Payer: Humana Commercial |
$8,727.08
|
| Rate for Payer: Humana KY Medicaid |
$3,530.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,566.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,419.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,577.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,080.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,601.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,035.09
|
| Rate for Payer: Ohio Health Group HMO |
$7,700.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,213.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,932.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,084.33
|
| Rate for Payer: PHCS Commercial |
$9,856.46
|
| Rate for Payer: United Healthcare All Payer |
$9,035.09
|
|
|
COMPR RVS SHLR HMRL TRY 44M+10
|
Facility
|
IP
|
$10,267.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,080.14 |
| Max. Negotiated Rate |
$9,856.46 |
| Rate for Payer: Aetna Commercial |
$7,905.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,008.38
|
| Rate for Payer: Cash Price |
$5,133.58
|
| Rate for Payer: Cigna Commercial |
$8,521.73
|
| Rate for Payer: First Health Commercial |
$9,753.79
|
| Rate for Payer: Humana Commercial |
$8,727.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,419.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,577.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,080.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,035.09
|
| Rate for Payer: Ohio Health Group HMO |
$7,700.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,213.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,932.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,084.33
|
| Rate for Payer: PHCS Commercial |
$9,856.46
|
| Rate for Payer: United Healthcare All Payer |
$9,035.09
|
|
|
COMPR RVS SHLR HMRL TRY 44M+10
|
Facility
|
OP
|
$10,267.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,080.14 |
| Max. Negotiated Rate |
$9,856.46 |
| Rate for Payer: Aetna Commercial |
$7,905.71
|
| Rate for Payer: Anthem Medicaid |
$3,530.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,008.38
|
| Rate for Payer: Cash Price |
$5,133.58
|
| Rate for Payer: Cigna Commercial |
$8,521.73
|
| Rate for Payer: First Health Commercial |
$9,753.79
|
| Rate for Payer: Humana Commercial |
$8,727.08
|
| Rate for Payer: Humana KY Medicaid |
$3,530.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,566.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,419.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,577.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,080.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,601.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,035.09
|
| Rate for Payer: Ohio Health Group HMO |
$7,700.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,213.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,932.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,084.33
|
| Rate for Payer: PHCS Commercial |
$9,856.46
|
| Rate for Payer: United Healthcare All Payer |
$9,035.09
|
|
|
COMPR RVS SHLR HUM TRY 44M STD
|
Facility
|
IP
|
$11,207.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,362.10 |
| Max. Negotiated Rate |
$10,758.72 |
| Rate for Payer: Aetna Commercial |
$8,629.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,741.46
|
| Rate for Payer: Cash Price |
$5,603.50
|
| Rate for Payer: Cigna Commercial |
$9,301.81
|
| Rate for Payer: First Health Commercial |
$10,646.65
|
| Rate for Payer: Humana Commercial |
$9,525.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,189.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,270.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,362.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,862.16
|
| Rate for Payer: Ohio Health Group HMO |
$8,405.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,965.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,750.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,732.83
|
| Rate for Payer: PHCS Commercial |
$10,758.72
|
| Rate for Payer: United Healthcare All Payer |
$9,862.16
|
|
|
COMPR RVS SHLR HUM TRY 44M STD
|
Facility
|
OP
|
$11,207.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,362.10 |
| Max. Negotiated Rate |
$10,758.72 |
| Rate for Payer: Aetna Commercial |
$8,629.39
|
| Rate for Payer: Anthem Medicaid |
$3,854.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,741.46
|
| Rate for Payer: Cash Price |
$5,603.50
|
| Rate for Payer: Cigna Commercial |
$9,301.81
|
| Rate for Payer: First Health Commercial |
$10,646.65
|
| Rate for Payer: Humana Commercial |
$9,525.95
|
| Rate for Payer: Humana KY Medicaid |
$3,854.09
|
| Rate for Payer: Kentucky WC Medicaid |
$3,893.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,189.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,270.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,362.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,931.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,862.16
|
| Rate for Payer: Ohio Health Group HMO |
$8,405.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,965.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,750.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,732.83
|
| Rate for Payer: PHCS Commercial |
$10,758.72
|
| Rate for Payer: United Healthcare All Payer |
$9,862.16
|
|
|
COMPR SRS 50MM DST HML BDY LT
|
Facility
|
IP
|
$28,205.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,461.50 |
| Max. Negotiated Rate |
$27,076.80 |
| Rate for Payer: Aetna Commercial |
$21,717.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,999.90
|
| Rate for Payer: Cash Price |
$14,102.50
|
| Rate for Payer: Cigna Commercial |
$23,410.15
|
| Rate for Payer: First Health Commercial |
$26,794.75
|
| Rate for Payer: Humana Commercial |
$23,974.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,128.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,815.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,461.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,820.40
|
| Rate for Payer: Ohio Health Group HMO |
$21,153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,564.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,538.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,461.45
|
| Rate for Payer: PHCS Commercial |
$27,076.80
|
| Rate for Payer: United Healthcare All Payer |
$24,820.40
|
|
|
COMPR SRS 50MM DST HML BDY LT
|
Facility
|
OP
|
$28,205.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,461.50 |
| Max. Negotiated Rate |
$27,076.80 |
| Rate for Payer: Aetna Commercial |
$21,717.85
|
| Rate for Payer: Anthem Medicaid |
$9,699.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,999.90
|
| Rate for Payer: Cash Price |
$14,102.50
|
| Rate for Payer: Cigna Commercial |
$23,410.15
|
| Rate for Payer: First Health Commercial |
$26,794.75
|
| Rate for Payer: Humana Commercial |
$23,974.25
|
| Rate for Payer: Humana KY Medicaid |
$9,699.70
|
| Rate for Payer: Kentucky WC Medicaid |
$9,798.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,128.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,815.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,461.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,894.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,820.40
|
| Rate for Payer: Ohio Health Group HMO |
$21,153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,564.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,538.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,461.45
|
| Rate for Payer: PHCS Commercial |
$27,076.80
|
| Rate for Payer: United Healthcare All Payer |
$24,820.40
|
|
|
COMPR SRS 50MM DST HML BDY RT
|
Facility
|
OP
|
$28,205.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,461.50 |
| Max. Negotiated Rate |
$27,076.80 |
| Rate for Payer: Aetna Commercial |
$21,717.85
|
| Rate for Payer: Anthem Medicaid |
$9,699.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,999.90
|
| Rate for Payer: Cash Price |
$14,102.50
|
| Rate for Payer: Cigna Commercial |
$23,410.15
|
| Rate for Payer: First Health Commercial |
$26,794.75
|
| Rate for Payer: Humana Commercial |
$23,974.25
|
| Rate for Payer: Humana KY Medicaid |
$9,699.70
|
| Rate for Payer: Kentucky WC Medicaid |
$9,798.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,128.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,815.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,461.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,894.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,820.40
|
| Rate for Payer: Ohio Health Group HMO |
$21,153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,564.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,538.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,461.45
|
| Rate for Payer: PHCS Commercial |
$27,076.80
|
| Rate for Payer: United Healthcare All Payer |
$24,820.40
|
|
|
COMPR SRS 50MM DST HML BDY RT
|
Facility
|
IP
|
$28,205.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,461.50 |
| Max. Negotiated Rate |
$27,076.80 |
| Rate for Payer: Aetna Commercial |
$21,717.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,999.90
|
| Rate for Payer: Cash Price |
$14,102.50
|
| Rate for Payer: Cigna Commercial |
$23,410.15
|
| Rate for Payer: First Health Commercial |
$26,794.75
|
| Rate for Payer: Humana Commercial |
$23,974.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,128.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,815.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,461.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,820.40
|
| Rate for Payer: Ohio Health Group HMO |
$21,153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,564.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,538.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,461.45
|
| Rate for Payer: PHCS Commercial |
$27,076.80
|
| Rate for Payer: United Healthcare All Payer |
$24,820.40
|
|
|
COMPR SRS 60MM DST HML BDY LT
|
Facility
|
IP
|
$28,205.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,461.50 |
| Max. Negotiated Rate |
$27,076.80 |
| Rate for Payer: Aetna Commercial |
$21,717.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,999.90
|
| Rate for Payer: Cash Price |
$14,102.50
|
| Rate for Payer: Cigna Commercial |
$23,410.15
|
| Rate for Payer: First Health Commercial |
$26,794.75
|
| Rate for Payer: Humana Commercial |
$23,974.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,128.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,815.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,461.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,820.40
|
| Rate for Payer: Ohio Health Group HMO |
$21,153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,564.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,538.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,461.45
|
| Rate for Payer: PHCS Commercial |
$27,076.80
|
| Rate for Payer: United Healthcare All Payer |
$24,820.40
|
|
|
COMPR SRS 60MM DST HML BDY LT
|
Facility
|
OP
|
$28,205.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,461.50 |
| Max. Negotiated Rate |
$27,076.80 |
| Rate for Payer: Aetna Commercial |
$21,717.85
|
| Rate for Payer: Anthem Medicaid |
$9,699.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,999.90
|
| Rate for Payer: Cash Price |
$14,102.50
|
| Rate for Payer: Cigna Commercial |
$23,410.15
|
| Rate for Payer: First Health Commercial |
$26,794.75
|
| Rate for Payer: Humana Commercial |
$23,974.25
|
| Rate for Payer: Humana KY Medicaid |
$9,699.70
|
| Rate for Payer: Kentucky WC Medicaid |
$9,798.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,128.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,815.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,461.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,894.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,820.40
|
| Rate for Payer: Ohio Health Group HMO |
$21,153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,564.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,538.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,461.45
|
| Rate for Payer: PHCS Commercial |
$27,076.80
|
| Rate for Payer: United Healthcare All Payer |
$24,820.40
|
|
|
COMPR SRS 60MM DST HML BDY RT
|
Facility
|
OP
|
$28,205.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,461.50 |
| Max. Negotiated Rate |
$27,076.80 |
| Rate for Payer: Aetna Commercial |
$21,717.85
|
| Rate for Payer: Anthem Medicaid |
$9,699.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,999.90
|
| Rate for Payer: Cash Price |
$14,102.50
|
| Rate for Payer: Cigna Commercial |
$23,410.15
|
| Rate for Payer: First Health Commercial |
$26,794.75
|
| Rate for Payer: Humana Commercial |
$23,974.25
|
| Rate for Payer: Humana KY Medicaid |
$9,699.70
|
| Rate for Payer: Kentucky WC Medicaid |
$9,798.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,128.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,815.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,461.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,894.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,820.40
|
| Rate for Payer: Ohio Health Group HMO |
$21,153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,564.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,538.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,461.45
|
| Rate for Payer: PHCS Commercial |
$27,076.80
|
| Rate for Payer: United Healthcare All Payer |
$24,820.40
|
|
|
COMPR SRS 60MM DST HML BDY RT
|
Facility
|
IP
|
$28,205.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,461.50 |
| Max. Negotiated Rate |
$27,076.80 |
| Rate for Payer: Aetna Commercial |
$21,717.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,999.90
|
| Rate for Payer: Cash Price |
$14,102.50
|
| Rate for Payer: Cigna Commercial |
$23,410.15
|
| Rate for Payer: First Health Commercial |
$26,794.75
|
| Rate for Payer: Humana Commercial |
$23,974.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,128.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,815.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,461.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,820.40
|
| Rate for Payer: Ohio Health Group HMO |
$21,153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,564.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,538.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,461.45
|
| Rate for Payer: PHCS Commercial |
$27,076.80
|
| Rate for Payer: United Healthcare All Payer |
$24,820.40
|
|
|
COMPR SRS 70MM DST HML BDY LT
|
Facility
|
OP
|
$28,205.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,461.50 |
| Max. Negotiated Rate |
$27,076.80 |
| Rate for Payer: Aetna Commercial |
$21,717.85
|
| Rate for Payer: Anthem Medicaid |
$9,699.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,999.90
|
| Rate for Payer: Cash Price |
$14,102.50
|
| Rate for Payer: Cigna Commercial |
$23,410.15
|
| Rate for Payer: First Health Commercial |
$26,794.75
|
| Rate for Payer: Humana Commercial |
$23,974.25
|
| Rate for Payer: Humana KY Medicaid |
$9,699.70
|
| Rate for Payer: Kentucky WC Medicaid |
$9,798.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,128.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,815.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,461.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,894.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,820.40
|
| Rate for Payer: Ohio Health Group HMO |
$21,153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,564.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,538.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,461.45
|
| Rate for Payer: PHCS Commercial |
$27,076.80
|
| Rate for Payer: United Healthcare All Payer |
$24,820.40
|
|
|
COMPR SRS 70MM DST HML BDY LT
|
Facility
|
IP
|
$28,205.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,461.50 |
| Max. Negotiated Rate |
$27,076.80 |
| Rate for Payer: Aetna Commercial |
$21,717.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,999.90
|
| Rate for Payer: Cash Price |
$14,102.50
|
| Rate for Payer: Cigna Commercial |
$23,410.15
|
| Rate for Payer: First Health Commercial |
$26,794.75
|
| Rate for Payer: Humana Commercial |
$23,974.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,128.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,815.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,461.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,820.40
|
| Rate for Payer: Ohio Health Group HMO |
$21,153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,564.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,538.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,461.45
|
| Rate for Payer: PHCS Commercial |
$27,076.80
|
| Rate for Payer: United Healthcare All Payer |
$24,820.40
|
|
|
COMPR SRS 70MM DST HML BDY RT
|
Facility
|
IP
|
$28,205.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,461.50 |
| Max. Negotiated Rate |
$27,076.80 |
| Rate for Payer: Aetna Commercial |
$21,717.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,999.90
|
| Rate for Payer: Cash Price |
$14,102.50
|
| Rate for Payer: Cigna Commercial |
$23,410.15
|
| Rate for Payer: First Health Commercial |
$26,794.75
|
| Rate for Payer: Humana Commercial |
$23,974.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,128.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,815.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,461.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,820.40
|
| Rate for Payer: Ohio Health Group HMO |
$21,153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,564.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,538.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,461.45
|
| Rate for Payer: PHCS Commercial |
$27,076.80
|
| Rate for Payer: United Healthcare All Payer |
$24,820.40
|
|
|
COMPR SRS 70MM DST HML BDY RT
|
Facility
|
OP
|
$28,205.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,461.50 |
| Max. Negotiated Rate |
$27,076.80 |
| Rate for Payer: Aetna Commercial |
$21,717.85
|
| Rate for Payer: Anthem Medicaid |
$9,699.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,999.90
|
| Rate for Payer: Cash Price |
$14,102.50
|
| Rate for Payer: Cigna Commercial |
$23,410.15
|
| Rate for Payer: First Health Commercial |
$26,794.75
|
| Rate for Payer: Humana Commercial |
$23,974.25
|
| Rate for Payer: Humana KY Medicaid |
$9,699.70
|
| Rate for Payer: Kentucky WC Medicaid |
$9,798.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,128.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,815.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,461.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,894.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,820.40
|
| Rate for Payer: Ohio Health Group HMO |
$21,153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,564.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,538.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,461.45
|
| Rate for Payer: PHCS Commercial |
$27,076.80
|
| Rate for Payer: United Healthcare All Payer |
$24,820.40
|
|
|
COMPR SRS ANTI ROT IC SEG 30MM
|
Facility
|
OP
|
$37,853.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,356.12 |
| Max. Negotiated Rate |
$36,339.60 |
| Rate for Payer: Aetna Commercial |
$29,147.39
|
| Rate for Payer: Anthem Medicaid |
$13,017.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,525.92
|
| Rate for Payer: Cash Price |
$18,926.88
|
| Rate for Payer: Cigna Commercial |
$31,418.61
|
| Rate for Payer: First Health Commercial |
$35,961.06
|
| Rate for Payer: Humana Commercial |
$32,175.69
|
| Rate for Payer: Humana KY Medicaid |
$13,017.90
|
| Rate for Payer: Kentucky WC Medicaid |
$13,150.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,040.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,936.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,356.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,279.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,311.30
|
| Rate for Payer: Ohio Health Group HMO |
$28,390.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,283.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,932.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,119.09
|
| Rate for Payer: PHCS Commercial |
$36,339.60
|
| Rate for Payer: United Healthcare All Payer |
$33,311.30
|
|
|
COMPR SRS ANTI ROT IC SEG 30MM
|
Facility
|
IP
|
$37,853.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,356.12 |
| Max. Negotiated Rate |
$36,339.60 |
| Rate for Payer: Aetna Commercial |
$29,147.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29,525.92
|
| Rate for Payer: Cash Price |
$18,926.88
|
| Rate for Payer: Cigna Commercial |
$31,418.61
|
| Rate for Payer: First Health Commercial |
$35,961.06
|
| Rate for Payer: Humana Commercial |
$32,175.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31,040.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27,936.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,356.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$33,311.30
|
| Rate for Payer: Ohio Health Group HMO |
$28,390.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30,283.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32,932.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26,119.09
|
| Rate for Payer: PHCS Commercial |
$36,339.60
|
| Rate for Payer: United Healthcare All Payer |
$33,311.30
|
|
|
COMPR SRS EAS HMRL HEAD 40*15
|
Facility
|
OP
|
$14,487.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,346.39 |
| Max. Negotiated Rate |
$13,908.46 |
| Rate for Payer: Aetna Commercial |
$11,155.74
|
| Rate for Payer: Anthem Medicaid |
$4,982.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,300.62
|
| Rate for Payer: Cash Price |
$7,243.99
|
| Rate for Payer: Cigna Commercial |
$12,025.02
|
| Rate for Payer: First Health Commercial |
$13,763.58
|
| Rate for Payer: Humana Commercial |
$12,314.78
|
| Rate for Payer: Humana KY Medicaid |
$4,982.42
|
| Rate for Payer: Kentucky WC Medicaid |
$5,033.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,880.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,692.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,346.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,082.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,749.42
|
| Rate for Payer: Ohio Health Group HMO |
$10,865.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,590.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,604.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,996.71
|
| Rate for Payer: PHCS Commercial |
$13,908.46
|
| Rate for Payer: United Healthcare All Payer |
$12,749.42
|
|
