|
COMPR SRS MOD STEM 14*150MM
|
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 14*200MM
|
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
|
|
|
COMPR SRS MOD STEM 14*200MM
|
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 14*75
|
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
|
|
|
COMPR SRS MOD STEM 14*75
|
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 16*100MM
|
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 16*100MM
|
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
|
|
|
COMPR SRS MOD STEM 16*150MM
|
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 16*150MM
|
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
|
|
|
COMPR SRS MOD STEM 16*75MM
|
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
|
|
|
COMPR SRS MOD STEM 16*75MM
|
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 18*100MM
|
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
|
|
|
COMPR SRS MOD STEM 18*100MM
|
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 18*75MM
|
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
|
|
|
COMPR SRS MOD STEM 18*75MM
|
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 20*75MM
|
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 20*75MM
|
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
|
|
|
COMPR SRS MOD STEM 4*150
|
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 4*150
|
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
|
|
|
COMPR SRS MOD STEM 6*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 6*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
|
|
|
COMPR SRS MOD STEM 6*150
|
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
|
|
|
COMPR SRS MOD STEM 6*150
|
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 6*200
|
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
|
|
|
COMPR SRS MOD STEM 6*200
|
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
|
|
