|
COMPR SRS PROX BODY SM 48MM
|
Facility
|
OP
|
$27,248.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,174.62 |
| Max. Negotiated Rate |
$26,158.80 |
| Rate for Payer: Aetna Commercial |
$20,981.54
|
| Rate for Payer: Anthem Medicaid |
$9,370.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,254.03
|
| Rate for Payer: Cash Price |
$13,624.38
|
| Rate for Payer: Cigna Commercial |
$22,616.46
|
| Rate for Payer: First Health Commercial |
$25,886.31
|
| Rate for Payer: Humana Commercial |
$23,161.44
|
| Rate for Payer: Humana KY Medicaid |
$9,370.85
|
| Rate for Payer: Kentucky WC Medicaid |
$9,466.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,343.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,109.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,174.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,558.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,978.90
|
| Rate for Payer: Ohio Health Group HMO |
$20,436.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,799.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,706.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,801.64
|
| Rate for Payer: PHCS Commercial |
$26,158.80
|
| Rate for Payer: United Healthcare All Payer |
$23,978.90
|
|
|
COMPR SRS PROX BODY SM 58MM
|
Facility
|
OP
|
$27,248.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,174.62 |
| Max. Negotiated Rate |
$26,158.80 |
| Rate for Payer: Aetna Commercial |
$20,981.54
|
| Rate for Payer: Anthem Medicaid |
$9,370.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,254.03
|
| Rate for Payer: Cash Price |
$13,624.38
|
| Rate for Payer: Cigna Commercial |
$22,616.46
|
| Rate for Payer: First Health Commercial |
$25,886.31
|
| Rate for Payer: Humana Commercial |
$23,161.44
|
| Rate for Payer: Humana KY Medicaid |
$9,370.85
|
| Rate for Payer: Kentucky WC Medicaid |
$9,466.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,343.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,109.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,174.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,558.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,978.90
|
| Rate for Payer: Ohio Health Group HMO |
$20,436.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,799.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,706.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,801.64
|
| Rate for Payer: PHCS Commercial |
$26,158.80
|
| Rate for Payer: United Healthcare All Payer |
$23,978.90
|
|
|
COMPR SRS PROX BODY SM 58MM
|
Facility
|
IP
|
$27,248.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,174.62 |
| Max. Negotiated Rate |
$26,158.80 |
| Rate for Payer: Aetna Commercial |
$20,981.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,254.03
|
| Rate for Payer: Cash Price |
$13,624.38
|
| Rate for Payer: Cigna Commercial |
$22,616.46
|
| Rate for Payer: First Health Commercial |
$25,886.31
|
| Rate for Payer: Humana Commercial |
$23,161.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,343.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,109.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,174.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,978.90
|
| Rate for Payer: Ohio Health Group HMO |
$20,436.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,799.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,706.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,801.64
|
| Rate for Payer: PHCS Commercial |
$26,158.80
|
| Rate for Payer: United Healthcare All Payer |
$23,978.90
|
|
|
COMPR SRS PROX BODY SM 68MM
|
Facility
|
IP
|
$27,248.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,174.62 |
| Max. Negotiated Rate |
$26,158.80 |
| Rate for Payer: Aetna Commercial |
$20,981.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,254.03
|
| Rate for Payer: Cash Price |
$13,624.38
|
| Rate for Payer: Cigna Commercial |
$22,616.46
|
| Rate for Payer: First Health Commercial |
$25,886.31
|
| Rate for Payer: Humana Commercial |
$23,161.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,343.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,109.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,174.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,978.90
|
| Rate for Payer: Ohio Health Group HMO |
$20,436.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,799.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,706.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,801.64
|
| Rate for Payer: PHCS Commercial |
$26,158.80
|
| Rate for Payer: United Healthcare All Payer |
$23,978.90
|
|
|
COMPR SRS PROX BODY SM 68MM
|
Facility
|
OP
|
$27,248.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,174.62 |
| Max. Negotiated Rate |
$26,158.80 |
| Rate for Payer: Aetna Commercial |
$20,981.54
|
| Rate for Payer: Anthem Medicaid |
$9,370.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,254.03
|
| Rate for Payer: Cash Price |
$13,624.38
|
| Rate for Payer: Cigna Commercial |
$22,616.46
|
| Rate for Payer: First Health Commercial |
$25,886.31
|
| Rate for Payer: Humana Commercial |
$23,161.44
|
| Rate for Payer: Humana KY Medicaid |
$9,370.85
|
| Rate for Payer: Kentucky WC Medicaid |
$9,466.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,343.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,109.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,174.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,558.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,978.90
|
| Rate for Payer: Ohio Health Group HMO |
$20,436.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,799.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,706.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,801.64
|
| Rate for Payer: PHCS Commercial |
$26,158.80
|
| Rate for Payer: United Healthcare All Payer |
$23,978.90
|
|
|
COMPR SRS SMALL 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 SMALL 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 TUMOR BODY 51MM
|
Facility
|
IP
|
$27,248.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,174.62 |
| Max. Negotiated Rate |
$26,158.80 |
| Rate for Payer: Aetna Commercial |
$20,981.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,254.03
|
| Rate for Payer: Cash Price |
$13,624.38
|
| Rate for Payer: Cigna Commercial |
$22,616.46
|
| Rate for Payer: First Health Commercial |
$25,886.31
|
| Rate for Payer: Humana Commercial |
$23,161.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,343.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,109.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,174.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,978.90
|
| Rate for Payer: Ohio Health Group HMO |
$20,436.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,799.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,706.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,801.64
|
| Rate for Payer: PHCS Commercial |
$26,158.80
|
| Rate for Payer: United Healthcare All Payer |
$23,978.90
|
|
|
COMPR SRS TUMOR BODY 51MM
|
Facility
|
OP
|
$27,248.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,174.62 |
| Max. Negotiated Rate |
$26,158.80 |
| Rate for Payer: Aetna Commercial |
$20,981.54
|
| Rate for Payer: Anthem Medicaid |
$9,370.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,254.03
|
| Rate for Payer: Cash Price |
$13,624.38
|
| Rate for Payer: Cigna Commercial |
$22,616.46
|
| Rate for Payer: First Health Commercial |
$25,886.31
|
| Rate for Payer: Humana Commercial |
$23,161.44
|
| Rate for Payer: Humana KY Medicaid |
$9,370.85
|
| Rate for Payer: Kentucky WC Medicaid |
$9,466.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,343.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,109.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,174.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,558.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,978.90
|
| Rate for Payer: Ohio Health Group HMO |
$20,436.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,799.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,706.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,801.64
|
| Rate for Payer: PHCS Commercial |
$26,158.80
|
| Rate for Payer: United Healthcare All Payer |
$23,978.90
|
|
|
COMPR SRS TUMOR BODY 61MM
|
Facility
|
IP
|
$27,248.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,174.62 |
| Max. Negotiated Rate |
$26,158.80 |
| Rate for Payer: Aetna Commercial |
$20,981.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,254.03
|
| Rate for Payer: Cash Price |
$13,624.38
|
| Rate for Payer: Cigna Commercial |
$22,616.46
|
| Rate for Payer: First Health Commercial |
$25,886.31
|
| Rate for Payer: Humana Commercial |
$23,161.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,343.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,109.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,174.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,978.90
|
| Rate for Payer: Ohio Health Group HMO |
$20,436.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,799.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,706.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,801.64
|
| Rate for Payer: PHCS Commercial |
$26,158.80
|
| Rate for Payer: United Healthcare All Payer |
$23,978.90
|
|
|
COMPR SRS TUMOR BODY 61MM
|
Facility
|
OP
|
$27,248.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,174.62 |
| Max. Negotiated Rate |
$26,158.80 |
| Rate for Payer: Aetna Commercial |
$20,981.54
|
| Rate for Payer: Anthem Medicaid |
$9,370.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,254.03
|
| Rate for Payer: Cash Price |
$13,624.38
|
| Rate for Payer: Cigna Commercial |
$22,616.46
|
| Rate for Payer: First Health Commercial |
$25,886.31
|
| Rate for Payer: Humana Commercial |
$23,161.44
|
| Rate for Payer: Humana KY Medicaid |
$9,370.85
|
| Rate for Payer: Kentucky WC Medicaid |
$9,466.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,343.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,109.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,174.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,558.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,978.90
|
| Rate for Payer: Ohio Health Group HMO |
$20,436.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,799.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,706.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,801.64
|
| Rate for Payer: PHCS Commercial |
$26,158.80
|
| Rate for Payer: United Healthcare All Payer |
$23,978.90
|
|
|
COMPR SRS TUMOR BODY 71MM
|
Facility
|
OP
|
$27,248.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,174.62 |
| Max. Negotiated Rate |
$26,158.80 |
| Rate for Payer: Aetna Commercial |
$20,981.54
|
| Rate for Payer: Anthem Medicaid |
$9,370.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,254.03
|
| Rate for Payer: Cash Price |
$13,624.38
|
| Rate for Payer: Cigna Commercial |
$22,616.46
|
| Rate for Payer: First Health Commercial |
$25,886.31
|
| Rate for Payer: Humana Commercial |
$23,161.44
|
| Rate for Payer: Humana KY Medicaid |
$9,370.85
|
| Rate for Payer: Kentucky WC Medicaid |
$9,466.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,343.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,109.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,174.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,558.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,978.90
|
| Rate for Payer: Ohio Health Group HMO |
$20,436.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,799.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,706.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,801.64
|
| Rate for Payer: PHCS Commercial |
$26,158.80
|
| Rate for Payer: United Healthcare All Payer |
$23,978.90
|
|
|
COMPR SRS TUMOR BODY 71MM
|
Facility
|
IP
|
$27,248.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,174.62 |
| Max. Negotiated Rate |
$26,158.80 |
| Rate for Payer: Aetna Commercial |
$20,981.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,254.03
|
| Rate for Payer: Cash Price |
$13,624.38
|
| Rate for Payer: Cigna Commercial |
$22,616.46
|
| Rate for Payer: First Health Commercial |
$25,886.31
|
| Rate for Payer: Humana Commercial |
$23,161.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,343.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,109.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,174.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,978.90
|
| Rate for Payer: Ohio Health Group HMO |
$20,436.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,799.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,706.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,801.64
|
| Rate for Payer: PHCS Commercial |
$26,158.80
|
| Rate for Payer: United Healthcare All Payer |
$23,978.90
|
|
|
COMPR STEM 10MM MICRO
|
Facility
|
IP
|
$20,078.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,023.62 |
| Max. Negotiated Rate |
$19,275.60 |
| Rate for Payer: Aetna Commercial |
$15,460.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,661.42
|
| Rate for Payer: Cash Price |
$10,039.38
|
| Rate for Payer: Cigna Commercial |
$16,665.36
|
| Rate for Payer: First Health Commercial |
$19,074.81
|
| Rate for Payer: Humana Commercial |
$17,066.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,464.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,023.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,669.30
|
| Rate for Payer: Ohio Health Group HMO |
$15,059.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,063.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,468.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,854.34
|
| Rate for Payer: PHCS Commercial |
$19,275.60
|
| Rate for Payer: United Healthcare All Payer |
$17,669.30
|
|
|
COMPR STEM 10MM MICRO
|
Facility
|
OP
|
$20,078.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,023.62 |
| Max. Negotiated Rate |
$19,275.60 |
| Rate for Payer: Aetna Commercial |
$15,460.64
|
| Rate for Payer: Anthem Medicaid |
$6,905.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,661.42
|
| Rate for Payer: Cash Price |
$10,039.38
|
| Rate for Payer: Cigna Commercial |
$16,665.36
|
| Rate for Payer: First Health Commercial |
$19,074.81
|
| Rate for Payer: Humana Commercial |
$17,066.94
|
| Rate for Payer: Humana KY Medicaid |
$6,905.08
|
| Rate for Payer: Kentucky WC Medicaid |
$6,975.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,464.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,023.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,043.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,669.30
|
| Rate for Payer: Ohio Health Group HMO |
$15,059.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,063.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,468.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,854.34
|
| Rate for Payer: PHCS Commercial |
$19,275.60
|
| Rate for Payer: United Healthcare All Payer |
$17,669.30
|
|
|
COMPR STEM 10MM MINI
|
Facility
|
IP
|
$20,078.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,023.62 |
| Max. Negotiated Rate |
$19,275.60 |
| Rate for Payer: Aetna Commercial |
$15,460.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,661.42
|
| Rate for Payer: Cash Price |
$10,039.38
|
| Rate for Payer: Cigna Commercial |
$16,665.36
|
| Rate for Payer: First Health Commercial |
$19,074.81
|
| Rate for Payer: Humana Commercial |
$17,066.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,464.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,023.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,669.30
|
| Rate for Payer: Ohio Health Group HMO |
$15,059.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,063.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,468.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,854.34
|
| Rate for Payer: PHCS Commercial |
$19,275.60
|
| Rate for Payer: United Healthcare All Payer |
$17,669.30
|
|
|
COMPR STEM 10MM MINI
|
Facility
|
OP
|
$20,078.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,023.62 |
| Max. Negotiated Rate |
$19,275.60 |
| Rate for Payer: Aetna Commercial |
$15,460.64
|
| Rate for Payer: Anthem Medicaid |
$6,905.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,661.42
|
| Rate for Payer: Cash Price |
$10,039.38
|
| Rate for Payer: Cigna Commercial |
$16,665.36
|
| Rate for Payer: First Health Commercial |
$19,074.81
|
| Rate for Payer: Humana Commercial |
$17,066.94
|
| Rate for Payer: Humana KY Medicaid |
$6,905.08
|
| Rate for Payer: Kentucky WC Medicaid |
$6,975.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,464.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,023.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,043.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,669.30
|
| Rate for Payer: Ohio Health Group HMO |
$15,059.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,063.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,468.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,854.34
|
| Rate for Payer: PHCS Commercial |
$19,275.60
|
| Rate for Payer: United Healthcare All Payer |
$17,669.30
|
|
|
COMPR STEM 10MM STD
|
Facility
|
OP
|
$17,479.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,243.85 |
| Max. Negotiated Rate |
$16,780.32 |
| Rate for Payer: Aetna Commercial |
$13,459.22
|
| Rate for Payer: Anthem Medicaid |
$6,011.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,634.01
|
| Rate for Payer: Cash Price |
$8,739.75
|
| Rate for Payer: Cigna Commercial |
$14,507.99
|
| Rate for Payer: First Health Commercial |
$16,605.53
|
| Rate for Payer: Humana Commercial |
$14,857.58
|
| Rate for Payer: Humana KY Medicaid |
$6,011.20
|
| Rate for Payer: Kentucky WC Medicaid |
$6,072.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,333.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,899.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,243.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,131.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,381.96
|
| Rate for Payer: Ohio Health Group HMO |
$13,109.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,983.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,207.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,060.85
|
| Rate for Payer: PHCS Commercial |
$16,780.32
|
| Rate for Payer: United Healthcare All Payer |
$15,381.96
|
|
|
COMPR STEM 10MM STD
|
Facility
|
IP
|
$17,479.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,243.85 |
| Max. Negotiated Rate |
$16,780.32 |
| Rate for Payer: Aetna Commercial |
$13,459.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,634.01
|
| Rate for Payer: Cash Price |
$8,739.75
|
| Rate for Payer: Cigna Commercial |
$14,507.99
|
| Rate for Payer: First Health Commercial |
$16,605.53
|
| Rate for Payer: Humana Commercial |
$14,857.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,333.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,899.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,243.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,381.96
|
| Rate for Payer: Ohio Health Group HMO |
$13,109.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,983.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,207.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,060.85
|
| Rate for Payer: PHCS Commercial |
$16,780.32
|
| Rate for Payer: United Healthcare All Payer |
$15,381.96
|
|
|
COMPR STEM 11MM MICRO
|
Facility
|
IP
|
$20,078.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,023.62 |
| Max. Negotiated Rate |
$19,275.60 |
| Rate for Payer: Aetna Commercial |
$15,460.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,661.42
|
| Rate for Payer: Cash Price |
$10,039.38
|
| Rate for Payer: Cigna Commercial |
$16,665.36
|
| Rate for Payer: First Health Commercial |
$19,074.81
|
| Rate for Payer: Humana Commercial |
$17,066.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,464.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,023.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,669.30
|
| Rate for Payer: Ohio Health Group HMO |
$15,059.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,063.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,468.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,854.34
|
| Rate for Payer: PHCS Commercial |
$19,275.60
|
| Rate for Payer: United Healthcare All Payer |
$17,669.30
|
|
|
COMPR STEM 11MM MICRO
|
Facility
|
OP
|
$20,078.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,023.62 |
| Max. Negotiated Rate |
$19,275.60 |
| Rate for Payer: Aetna Commercial |
$15,460.64
|
| Rate for Payer: Anthem Medicaid |
$6,905.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,661.42
|
| Rate for Payer: Cash Price |
$10,039.38
|
| Rate for Payer: Cigna Commercial |
$16,665.36
|
| Rate for Payer: First Health Commercial |
$19,074.81
|
| Rate for Payer: Humana Commercial |
$17,066.94
|
| Rate for Payer: Humana KY Medicaid |
$6,905.08
|
| Rate for Payer: Kentucky WC Medicaid |
$6,975.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,464.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,023.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,043.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,669.30
|
| Rate for Payer: Ohio Health Group HMO |
$15,059.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,063.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,468.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,854.34
|
| Rate for Payer: PHCS Commercial |
$19,275.60
|
| Rate for Payer: United Healthcare All Payer |
$17,669.30
|
|
|
COMPR STEM 11MM MINI
|
Facility
|
OP
|
$20,078.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,023.62 |
| Max. Negotiated Rate |
$19,275.60 |
| Rate for Payer: Aetna Commercial |
$15,460.64
|
| Rate for Payer: Anthem Medicaid |
$6,905.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,661.42
|
| Rate for Payer: Cash Price |
$10,039.38
|
| Rate for Payer: Cigna Commercial |
$16,665.36
|
| Rate for Payer: First Health Commercial |
$19,074.81
|
| Rate for Payer: Humana Commercial |
$17,066.94
|
| Rate for Payer: Humana KY Medicaid |
$6,905.08
|
| Rate for Payer: Kentucky WC Medicaid |
$6,975.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,464.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,023.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,043.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,669.30
|
| Rate for Payer: Ohio Health Group HMO |
$15,059.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,063.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,468.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,854.34
|
| Rate for Payer: PHCS Commercial |
$19,275.60
|
| Rate for Payer: United Healthcare All Payer |
$17,669.30
|
|
|
COMPR STEM 11MM MINI
|
Facility
|
IP
|
$20,078.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,023.62 |
| Max. Negotiated Rate |
$19,275.60 |
| Rate for Payer: Aetna Commercial |
$15,460.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,661.42
|
| Rate for Payer: Cash Price |
$10,039.38
|
| Rate for Payer: Cigna Commercial |
$16,665.36
|
| Rate for Payer: First Health Commercial |
$19,074.81
|
| Rate for Payer: Humana Commercial |
$17,066.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,464.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,023.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,669.30
|
| Rate for Payer: Ohio Health Group HMO |
$15,059.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,063.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,468.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,854.34
|
| Rate for Payer: PHCS Commercial |
$19,275.60
|
| Rate for Payer: United Healthcare All Payer |
$17,669.30
|
|
|
COMPR STEM 11MM STD
|
Facility
|
IP
|
$17,479.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,243.85 |
| Max. Negotiated Rate |
$16,780.32 |
| Rate for Payer: Aetna Commercial |
$13,459.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,634.01
|
| Rate for Payer: Cash Price |
$8,739.75
|
| Rate for Payer: Cigna Commercial |
$14,507.99
|
| Rate for Payer: First Health Commercial |
$16,605.53
|
| Rate for Payer: Humana Commercial |
$14,857.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,333.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,899.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,243.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,381.96
|
| Rate for Payer: Ohio Health Group HMO |
$13,109.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,983.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,207.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,060.85
|
| Rate for Payer: PHCS Commercial |
$16,780.32
|
| Rate for Payer: United Healthcare All Payer |
$15,381.96
|
|
|
COMPR STEM 11MM STD
|
Facility
|
OP
|
$17,479.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,243.85 |
| Max. Negotiated Rate |
$16,780.32 |
| Rate for Payer: Aetna Commercial |
$13,459.22
|
| Rate for Payer: Anthem Medicaid |
$6,011.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,634.01
|
| Rate for Payer: Cash Price |
$8,739.75
|
| Rate for Payer: Cigna Commercial |
$14,507.99
|
| Rate for Payer: First Health Commercial |
$16,605.53
|
| Rate for Payer: Humana Commercial |
$14,857.58
|
| Rate for Payer: Humana KY Medicaid |
$6,011.20
|
| Rate for Payer: Kentucky WC Medicaid |
$6,072.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,333.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,899.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,243.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,131.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,381.96
|
| Rate for Payer: Ohio Health Group HMO |
$13,109.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,983.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,207.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,060.85
|
| Rate for Payer: PHCS Commercial |
$16,780.32
|
| Rate for Payer: United Healthcare All Payer |
$15,381.96
|
|
