|
COMPR SRS EAS HMRL HEAD 40*15
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
COMPR SRS EAS HMRL HEAD 44*17
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
COMPR SRS EAS HMRL HEAD 44*17
|
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
|
|
|
COMPR SRS EAS HMRL HEAD 48*19
|
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
|
|
|
COMPR SRS EAS HMRL HEAD 48*19
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
COMPR SRS EAS HMRL HEAD 54*22
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
COMPR SRS EAS HMRL HEAD 54*22
|
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
|
|
|
COMPR SRS HUMERAL COUPLER
|
Facility
|
IP
|
$68,047.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,414.16 |
| Max. Negotiated Rate |
$65,325.31 |
| Rate for Payer: Aetna Commercial |
$52,396.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,076.82
|
| Rate for Payer: Cash Price |
$34,023.60
|
| Rate for Payer: Cigna Commercial |
$56,479.18
|
| Rate for Payer: First Health Commercial |
$64,644.84
|
| Rate for Payer: Humana Commercial |
$57,840.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55,798.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,218.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,414.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$59,881.54
|
| Rate for Payer: Ohio Health Group HMO |
$51,035.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54,437.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59,201.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46,952.57
|
| Rate for Payer: PHCS Commercial |
$65,325.31
|
| Rate for Payer: United Healthcare All Payer |
$59,881.54
|
|
|
COMPR SRS HUMERAL COUPLER
|
Facility
|
OP
|
$68,047.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,414.16 |
| Max. Negotiated Rate |
$65,325.31 |
| Rate for Payer: Aetna Commercial |
$52,396.34
|
| Rate for Payer: Anthem Medicaid |
$23,401.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,076.82
|
| Rate for Payer: Cash Price |
$34,023.60
|
| Rate for Payer: Cigna Commercial |
$56,479.18
|
| Rate for Payer: First Health Commercial |
$64,644.84
|
| Rate for Payer: Humana Commercial |
$57,840.12
|
| Rate for Payer: Humana KY Medicaid |
$23,401.43
|
| Rate for Payer: Kentucky WC Medicaid |
$23,639.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55,798.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,218.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,414.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,870.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$59,881.54
|
| Rate for Payer: Ohio Health Group HMO |
$51,035.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54,437.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59,201.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46,952.57
|
| Rate for Payer: PHCS Commercial |
$65,325.31
|
| Rate for Payer: United Healthcare All Payer |
$59,881.54
|
|
|
COMPR SRS IC SEG 120MM
|
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 IC SEG 120MM
|
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 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 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 IC SEG 60MM
|
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 IC SEG 60MM
|
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 IC SEG 90MM
|
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 IC SEG 90MM
|
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 LARGE FLANGE
|
Facility
|
IP
|
$6,719.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,015.81 |
| Max. Negotiated Rate |
$6,450.58 |
| Rate for Payer: Aetna Commercial |
$5,173.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,241.09
|
| Rate for Payer: Cash Price |
$3,359.68
|
| Rate for Payer: Cigna Commercial |
$5,577.06
|
| Rate for Payer: First Health Commercial |
$6,383.38
|
| Rate for Payer: Humana Commercial |
$5,711.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,509.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,958.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,015.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,913.03
|
| Rate for Payer: Ohio Health Group HMO |
$5,039.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,375.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,845.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,636.35
|
| Rate for Payer: PHCS Commercial |
$6,450.58
|
| Rate for Payer: United Healthcare All Payer |
$5,913.03
|
|
|
COMPR SRS LARGE FLANGE
|
Facility
|
OP
|
$6,719.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,015.81 |
| Max. Negotiated Rate |
$6,450.58 |
| Rate for Payer: Aetna Commercial |
$5,173.90
|
| Rate for Payer: Anthem Medicaid |
$2,310.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,241.09
|
| Rate for Payer: Cash Price |
$3,359.68
|
| Rate for Payer: Cigna Commercial |
$5,577.06
|
| Rate for Payer: First Health Commercial |
$6,383.38
|
| Rate for Payer: Humana Commercial |
$5,711.45
|
| Rate for Payer: Humana KY Medicaid |
$2,310.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,334.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,509.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,958.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,015.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,357.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,913.03
|
| Rate for Payer: Ohio Health Group HMO |
$5,039.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,375.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,845.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,636.35
|
| Rate for Payer: PHCS Commercial |
$6,450.58
|
| Rate for Payer: United Healthcare All Payer |
$5,913.03
|
|
|
COMPR SRS MOD RGX AUG LG
|
Facility
|
IP
|
$22,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,823.50 |
| Max. Negotiated Rate |
$21,835.20 |
| Rate for Payer: Aetna Commercial |
$17,513.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,741.10
|
| Rate for Payer: Cash Price |
$11,372.50
|
| Rate for Payer: Cigna Commercial |
$18,878.35
|
| Rate for Payer: First Health Commercial |
$21,607.75
|
| Rate for Payer: Humana Commercial |
$19,333.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,650.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,785.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,823.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,015.60
|
| Rate for Payer: Ohio Health Group HMO |
$17,058.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,788.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,694.05
|
| Rate for Payer: PHCS Commercial |
$21,835.20
|
| Rate for Payer: United Healthcare All Payer |
$20,015.60
|
|
|
COMPR SRS MOD RGX AUG LG
|
Facility
|
OP
|
$22,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,823.50 |
| Max. Negotiated Rate |
$21,835.20 |
| Rate for Payer: Aetna Commercial |
$17,513.65
|
| Rate for Payer: Anthem Medicaid |
$7,822.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,741.10
|
| Rate for Payer: Cash Price |
$11,372.50
|
| Rate for Payer: Cigna Commercial |
$18,878.35
|
| Rate for Payer: First Health Commercial |
$21,607.75
|
| Rate for Payer: Humana Commercial |
$19,333.25
|
| Rate for Payer: Humana KY Medicaid |
$7,822.01
|
| Rate for Payer: Kentucky WC Medicaid |
$7,901.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,650.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,785.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,823.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,978.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,015.60
|
| Rate for Payer: Ohio Health Group HMO |
$17,058.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,788.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,694.05
|
| Rate for Payer: PHCS Commercial |
$21,835.20
|
| Rate for Payer: United Healthcare All Payer |
$20,015.60
|
|
|
COMPR SRS MOD RGX AUG SM
|
Facility
|
OP
|
$22,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,823.50 |
| Max. Negotiated Rate |
$21,835.20 |
| Rate for Payer: Aetna Commercial |
$17,513.65
|
| Rate for Payer: Anthem Medicaid |
$7,822.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,741.10
|
| Rate for Payer: Cash Price |
$11,372.50
|
| Rate for Payer: Cigna Commercial |
$18,878.35
|
| Rate for Payer: First Health Commercial |
$21,607.75
|
| Rate for Payer: Humana Commercial |
$19,333.25
|
| Rate for Payer: Humana KY Medicaid |
$7,822.01
|
| Rate for Payer: Kentucky WC Medicaid |
$7,901.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,650.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,785.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,823.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,978.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,015.60
|
| Rate for Payer: Ohio Health Group HMO |
$17,058.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,788.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,694.05
|
| Rate for Payer: PHCS Commercial |
$21,835.20
|
| Rate for Payer: United Healthcare All Payer |
$20,015.60
|
|
|
COMPR SRS MOD RGX AUG SM
|
Facility
|
IP
|
$22,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,823.50 |
| Max. Negotiated Rate |
$21,835.20 |
| Rate for Payer: Aetna Commercial |
$17,513.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,741.10
|
| Rate for Payer: Cash Price |
$11,372.50
|
| Rate for Payer: Cigna Commercial |
$18,878.35
|
| Rate for Payer: First Health Commercial |
$21,607.75
|
| Rate for Payer: Humana Commercial |
$19,333.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,650.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,785.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,823.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,015.60
|
| Rate for Payer: Ohio Health Group HMO |
$17,058.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,788.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,694.05
|
| Rate for Payer: PHCS Commercial |
$21,835.20
|
| Rate for Payer: United Healthcare All Payer |
$20,015.60
|
|
|
COMPR SRS MOD STEM 10*100
|
Facility
|
IP
|
$22,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,792.00 |
| Max. Negotiated Rate |
$21,734.40 |
| Rate for Payer: Aetna Commercial |
$17,432.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,659.20
|
| Rate for Payer: Cash Price |
$11,320.00
|
| Rate for Payer: Cigna Commercial |
$18,791.20
|
| Rate for Payer: First Health Commercial |
$21,508.00
|
| Rate for Payer: Humana Commercial |
$19,244.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,564.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,708.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,792.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,923.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,980.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,696.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,621.60
|
| Rate for Payer: PHCS Commercial |
$21,734.40
|
| Rate for Payer: United Healthcare All Payer |
$19,923.20
|
|
|
COMPR SRS MOD STEM 10*100
|
Facility
|
OP
|
$22,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,792.00 |
| Max. Negotiated Rate |
$21,734.40 |
| Rate for Payer: Aetna Commercial |
$17,432.80
|
| Rate for Payer: Anthem Medicaid |
$7,785.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,659.20
|
| Rate for Payer: Cash Price |
$11,320.00
|
| Rate for Payer: Cigna Commercial |
$18,791.20
|
| Rate for Payer: First Health Commercial |
$21,508.00
|
| Rate for Payer: Humana Commercial |
$19,244.00
|
| Rate for Payer: Humana KY Medicaid |
$7,785.90
|
| Rate for Payer: Kentucky WC Medicaid |
$7,865.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,564.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,708.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,792.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,942.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,923.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,980.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,696.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,621.60
|
| Rate for Payer: PHCS Commercial |
$21,734.40
|
| Rate for Payer: United Healthcare All Payer |
$19,923.20
|
|
