|
11 FR SHEATH
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
11 LNG REV POL+20 L IMPLT STEM
|
Facility
|
IP
|
$28,711.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,613.54 |
| Max. Negotiated Rate |
$27,563.34 |
| Rate for Payer: Aetna Commercial |
$22,108.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,395.21
|
| Rate for Payer: Cash Price |
$14,355.91
|
| Rate for Payer: Cigna Commercial |
$23,830.80
|
| Rate for Payer: First Health Commercial |
$27,276.22
|
| Rate for Payer: Humana Commercial |
$24,405.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,543.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,189.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,613.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,266.39
|
| Rate for Payer: Ohio Health Group HMO |
$21,533.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,969.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,979.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,811.15
|
| Rate for Payer: PHCS Commercial |
$27,563.34
|
| Rate for Payer: United Healthcare All Payer |
$25,266.39
|
|
|
11 LNG REV POL+20 L IMPLT STEM
|
Facility
|
OP
|
$28,711.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,613.54 |
| Max. Negotiated Rate |
$27,563.34 |
| Rate for Payer: Aetna Commercial |
$22,108.09
|
| Rate for Payer: Anthem Medicaid |
$9,873.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,395.21
|
| Rate for Payer: Cash Price |
$14,355.91
|
| Rate for Payer: Cigna Commercial |
$23,830.80
|
| Rate for Payer: First Health Commercial |
$27,276.22
|
| Rate for Payer: Humana Commercial |
$24,405.04
|
| Rate for Payer: Humana KY Medicaid |
$9,873.99
|
| Rate for Payer: Kentucky WC Medicaid |
$9,974.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,543.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,189.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,613.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,072.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,266.39
|
| Rate for Payer: Ohio Health Group HMO |
$21,533.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,969.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,979.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,811.15
|
| Rate for Payer: PHCS Commercial |
$27,563.34
|
| Rate for Payer: United Healthcare All Payer |
$25,266.39
|
|
|
11 LNG REV POL+20 R IMPLT STEM
|
Facility
|
OP
|
$28,711.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,613.54 |
| Max. Negotiated Rate |
$27,563.34 |
| Rate for Payer: Aetna Commercial |
$22,108.09
|
| Rate for Payer: Anthem Medicaid |
$9,873.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,395.21
|
| Rate for Payer: Cash Price |
$14,355.91
|
| Rate for Payer: Cigna Commercial |
$23,830.80
|
| Rate for Payer: First Health Commercial |
$27,276.22
|
| Rate for Payer: Humana Commercial |
$24,405.04
|
| Rate for Payer: Humana KY Medicaid |
$9,873.99
|
| Rate for Payer: Kentucky WC Medicaid |
$9,974.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,543.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,189.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,613.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,072.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,266.39
|
| Rate for Payer: Ohio Health Group HMO |
$21,533.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,969.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,979.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,811.15
|
| Rate for Payer: PHCS Commercial |
$27,563.34
|
| Rate for Payer: United Healthcare All Payer |
$25,266.39
|
|
|
11 LNG REV POL+20 R IMPLT STEM
|
Facility
|
IP
|
$28,711.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,613.54 |
| Max. Negotiated Rate |
$27,563.34 |
| Rate for Payer: Aetna Commercial |
$22,108.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,395.21
|
| Rate for Payer: Cash Price |
$14,355.91
|
| Rate for Payer: Cigna Commercial |
$23,830.80
|
| Rate for Payer: First Health Commercial |
$27,276.22
|
| Rate for Payer: Humana Commercial |
$24,405.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,543.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,189.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,613.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,266.39
|
| Rate for Payer: Ohio Health Group HMO |
$21,533.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,969.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,979.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,811.15
|
| Rate for Payer: PHCS Commercial |
$27,563.34
|
| Rate for Payer: United Healthcare All Payer |
$25,266.39
|
|
|
11 STEM PRIMARY HO
|
Facility
|
IP
|
$18,583.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,575.19 |
| Max. Negotiated Rate |
$17,840.59 |
| Rate for Payer: Aetna Commercial |
$14,309.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,495.48
|
| Rate for Payer: Cash Price |
$9,291.98
|
| Rate for Payer: Cigna Commercial |
$15,424.68
|
| Rate for Payer: First Health Commercial |
$17,654.75
|
| Rate for Payer: Humana Commercial |
$15,796.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,238.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,714.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,575.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,353.88
|
| Rate for Payer: Ohio Health Group HMO |
$13,937.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,867.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,168.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,822.93
|
| Rate for Payer: PHCS Commercial |
$17,840.59
|
| Rate for Payer: United Healthcare All Payer |
$16,353.88
|
|
|
11 STEM PRIMARY HO
|
Facility
|
OP
|
$18,583.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,575.19 |
| Max. Negotiated Rate |
$17,840.59 |
| Rate for Payer: Aetna Commercial |
$14,309.64
|
| Rate for Payer: Anthem Medicaid |
$6,391.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,495.48
|
| Rate for Payer: Cash Price |
$9,291.98
|
| Rate for Payer: Cigna Commercial |
$15,424.68
|
| Rate for Payer: First Health Commercial |
$17,654.75
|
| Rate for Payer: Humana Commercial |
$15,796.36
|
| Rate for Payer: Humana KY Medicaid |
$6,391.02
|
| Rate for Payer: Kentucky WC Medicaid |
$6,456.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,238.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,714.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,575.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,519.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,353.88
|
| Rate for Payer: Ohio Health Group HMO |
$13,937.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,867.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,168.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,822.93
|
| Rate for Payer: PHCS Commercial |
$17,840.59
|
| Rate for Payer: United Healthcare All Payer |
$16,353.88
|
|
|
11 STEM PRIMARY SO
|
Facility
|
IP
|
$18,253.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,476.12 |
| Max. Negotiated Rate |
$17,523.57 |
| Rate for Payer: Aetna Commercial |
$14,055.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,237.90
|
| Rate for Payer: Cash Price |
$9,126.86
|
| Rate for Payer: Cigna Commercial |
$15,150.59
|
| Rate for Payer: First Health Commercial |
$17,341.03
|
| Rate for Payer: Humana Commercial |
$15,515.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,968.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,471.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,476.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,063.27
|
| Rate for Payer: Ohio Health Group HMO |
$13,690.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,602.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,880.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,595.07
|
| Rate for Payer: PHCS Commercial |
$17,523.57
|
| Rate for Payer: United Healthcare All Payer |
$16,063.27
|
|
|
11 STEM PRIMARY SO
|
Facility
|
OP
|
$18,253.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,476.12 |
| Max. Negotiated Rate |
$17,523.57 |
| Rate for Payer: Aetna Commercial |
$14,055.36
|
| Rate for Payer: Anthem Medicaid |
$6,277.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,237.90
|
| Rate for Payer: Cash Price |
$9,126.86
|
| Rate for Payer: Cigna Commercial |
$15,150.59
|
| Rate for Payer: First Health Commercial |
$17,341.03
|
| Rate for Payer: Humana Commercial |
$15,515.66
|
| Rate for Payer: Humana KY Medicaid |
$6,277.45
|
| Rate for Payer: Kentucky WC Medicaid |
$6,341.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,968.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,471.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,476.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,403.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,063.27
|
| Rate for Payer: Ohio Health Group HMO |
$13,690.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,602.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,880.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,595.07
|
| Rate for Payer: PHCS Commercial |
$17,523.57
|
| Rate for Payer: United Healthcare All Payer |
$16,063.27
|
|
|
1.2100805E7
|
Facility
|
OP
|
$1,699.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$509.70 |
| Max. Negotiated Rate |
$1,631.04 |
| Rate for Payer: Aetna Commercial |
$1,308.23
|
| Rate for Payer: Anthem Medicaid |
$584.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,325.22
|
| Rate for Payer: Cash Price |
$849.50
|
| Rate for Payer: Cigna Commercial |
$1,410.17
|
| Rate for Payer: First Health Commercial |
$1,614.05
|
| Rate for Payer: Humana Commercial |
$1,444.15
|
| Rate for Payer: Humana KY Medicaid |
$584.29
|
| Rate for Payer: Kentucky WC Medicaid |
$590.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,393.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,253.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$509.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,495.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,274.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,359.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,478.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,172.31
|
| Rate for Payer: PHCS Commercial |
$1,631.04
|
| Rate for Payer: United Healthcare All Payer |
$1,495.12
|
|
|
1.2100805E7
|
Facility
|
IP
|
$1,699.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$509.70 |
| Max. Negotiated Rate |
$1,631.04 |
| Rate for Payer: Aetna Commercial |
$1,308.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,325.22
|
| Rate for Payer: Cash Price |
$849.50
|
| Rate for Payer: Cigna Commercial |
$1,410.17
|
| Rate for Payer: First Health Commercial |
$1,614.05
|
| Rate for Payer: Humana Commercial |
$1,444.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,393.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,253.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$509.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,495.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,274.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,359.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,478.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,172.31
|
| Rate for Payer: PHCS Commercial |
$1,631.04
|
| Rate for Payer: United Healthcare All Payer |
$1,495.12
|
|
|
12X120MM OVATION IX
|
Facility
|
OP
|
$26,371.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,911.38 |
| Max. Negotiated Rate |
$25,316.40 |
| Rate for Payer: Aetna Commercial |
$20,305.86
|
| Rate for Payer: Anthem Medicaid |
$9,069.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,569.58
|
| Rate for Payer: Cash Price |
$13,185.62
|
| Rate for Payer: Cigna Commercial |
$21,888.14
|
| Rate for Payer: First Health Commercial |
$25,052.69
|
| Rate for Payer: Humana Commercial |
$22,415.56
|
| Rate for Payer: Humana KY Medicaid |
$9,069.07
|
| Rate for Payer: Kentucky WC Medicaid |
$9,161.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,624.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,461.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,911.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,251.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,206.70
|
| Rate for Payer: Ohio Health Group HMO |
$19,778.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,097.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,942.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,196.16
|
| Rate for Payer: PHCS Commercial |
$25,316.40
|
| Rate for Payer: United Healthcare All Payer |
$23,206.70
|
|
|
12X120MM OVATION IX
|
Facility
|
IP
|
$26,371.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,911.38 |
| Max. Negotiated Rate |
$25,316.40 |
| Rate for Payer: Aetna Commercial |
$20,305.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,569.58
|
| Rate for Payer: Cash Price |
$13,185.62
|
| Rate for Payer: Cigna Commercial |
$21,888.14
|
| Rate for Payer: First Health Commercial |
$25,052.69
|
| Rate for Payer: Humana Commercial |
$22,415.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,624.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,461.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,911.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,206.70
|
| Rate for Payer: Ohio Health Group HMO |
$19,778.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,097.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,942.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,196.16
|
| Rate for Payer: PHCS Commercial |
$25,316.40
|
| Rate for Payer: United Healthcare All Payer |
$23,206.70
|
|
|
13 SLV MD CONE 1 SPT TALL SLOT
|
Facility
|
IP
|
$18,253.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,476.12 |
| Max. Negotiated Rate |
$17,523.57 |
| Rate for Payer: Aetna Commercial |
$14,055.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,237.90
|
| Rate for Payer: Cash Price |
$9,126.86
|
| Rate for Payer: Cigna Commercial |
$15,150.59
|
| Rate for Payer: First Health Commercial |
$17,341.03
|
| Rate for Payer: Humana Commercial |
$15,515.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,968.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,471.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,476.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,063.27
|
| Rate for Payer: Ohio Health Group HMO |
$13,690.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,602.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,880.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,595.07
|
| Rate for Payer: PHCS Commercial |
$17,523.57
|
| Rate for Payer: United Healthcare All Payer |
$16,063.27
|
|
|
13 SLV MD CONE 1 SPT TALL SLOT
|
Facility
|
OP
|
$18,253.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,476.12 |
| Max. Negotiated Rate |
$17,523.57 |
| Rate for Payer: Aetna Commercial |
$14,055.36
|
| Rate for Payer: Anthem Medicaid |
$6,277.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,237.90
|
| Rate for Payer: Cash Price |
$9,126.86
|
| Rate for Payer: Cigna Commercial |
$15,150.59
|
| Rate for Payer: First Health Commercial |
$17,341.03
|
| Rate for Payer: Humana Commercial |
$15,515.66
|
| Rate for Payer: Humana KY Medicaid |
$6,277.45
|
| Rate for Payer: Kentucky WC Medicaid |
$6,341.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,968.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,471.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,476.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,403.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,063.27
|
| Rate for Payer: Ohio Health Group HMO |
$13,690.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,602.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,880.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,595.07
|
| Rate for Payer: PHCS Commercial |
$17,523.57
|
| Rate for Payer: United Healthcare All Payer |
$16,063.27
|
|
|
13 SLV MD CONE 2 SPT TALL SLOT
|
Facility
|
OP
|
$18,253.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,476.12 |
| Max. Negotiated Rate |
$17,523.57 |
| Rate for Payer: Aetna Commercial |
$14,055.36
|
| Rate for Payer: Anthem Medicaid |
$6,277.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,237.90
|
| Rate for Payer: Cash Price |
$9,126.86
|
| Rate for Payer: Cigna Commercial |
$15,150.59
|
| Rate for Payer: First Health Commercial |
$17,341.03
|
| Rate for Payer: Humana Commercial |
$15,515.66
|
| Rate for Payer: Humana KY Medicaid |
$6,277.45
|
| Rate for Payer: Kentucky WC Medicaid |
$6,341.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,968.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,471.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,476.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,403.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,063.27
|
| Rate for Payer: Ohio Health Group HMO |
$13,690.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,602.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,880.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,595.07
|
| Rate for Payer: PHCS Commercial |
$17,523.57
|
| Rate for Payer: United Healthcare All Payer |
$16,063.27
|
|
|
13 SLV MD CONE 2 SPT TALL SLOT
|
Facility
|
IP
|
$18,253.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,476.12 |
| Max. Negotiated Rate |
$17,523.57 |
| Rate for Payer: Aetna Commercial |
$14,055.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,237.90
|
| Rate for Payer: Cash Price |
$9,126.86
|
| Rate for Payer: Cigna Commercial |
$15,150.59
|
| Rate for Payer: First Health Commercial |
$17,341.03
|
| Rate for Payer: Humana Commercial |
$15,515.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,968.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,471.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,476.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,063.27
|
| Rate for Payer: Ohio Health Group HMO |
$13,690.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,602.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,880.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,595.07
|
| Rate for Payer: PHCS Commercial |
$17,523.57
|
| Rate for Payer: United Healthcare All Payer |
$16,063.27
|
|
|
13 SLV SM CONE 1 SPOU TALL SLT
|
Facility
|
IP
|
$13,098.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,929.61 |
| Max. Negotiated Rate |
$12,574.75 |
| Rate for Payer: Aetna Commercial |
$10,086.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,216.99
|
| Rate for Payer: Cash Price |
$6,549.35
|
| Rate for Payer: Cigna Commercial |
$10,871.92
|
| Rate for Payer: First Health Commercial |
$12,443.76
|
| Rate for Payer: Humana Commercial |
$11,133.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,740.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,666.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,929.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,526.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,824.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,478.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,395.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,038.10
|
| Rate for Payer: PHCS Commercial |
$12,574.75
|
| Rate for Payer: United Healthcare All Payer |
$11,526.86
|
|
|
13 SLV SM CONE 1 SPOU TALL SLT
|
Facility
|
OP
|
$13,098.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,929.61 |
| Max. Negotiated Rate |
$12,574.75 |
| Rate for Payer: Aetna Commercial |
$10,086.00
|
| Rate for Payer: Anthem Medicaid |
$4,504.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,216.99
|
| Rate for Payer: Cash Price |
$6,549.35
|
| Rate for Payer: Cigna Commercial |
$10,871.92
|
| Rate for Payer: First Health Commercial |
$12,443.76
|
| Rate for Payer: Humana Commercial |
$11,133.90
|
| Rate for Payer: Humana KY Medicaid |
$4,504.64
|
| Rate for Payer: Kentucky WC Medicaid |
$4,550.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,740.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,666.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,929.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,595.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,526.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,824.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,478.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,395.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,038.10
|
| Rate for Payer: PHCS Commercial |
$12,574.75
|
| Rate for Payer: United Healthcare All Payer |
$11,526.86
|
|
|
13 SLV SM CONE 2 SPT TALL SLOT
|
Facility
|
OP
|
$18,253.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,476.12 |
| Max. Negotiated Rate |
$17,523.57 |
| Rate for Payer: Aetna Commercial |
$14,055.36
|
| Rate for Payer: Anthem Medicaid |
$6,277.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,237.90
|
| Rate for Payer: Cash Price |
$9,126.86
|
| Rate for Payer: Cigna Commercial |
$15,150.59
|
| Rate for Payer: First Health Commercial |
$17,341.03
|
| Rate for Payer: Humana Commercial |
$15,515.66
|
| Rate for Payer: Humana KY Medicaid |
$6,277.45
|
| Rate for Payer: Kentucky WC Medicaid |
$6,341.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,968.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,471.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,476.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,403.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,063.27
|
| Rate for Payer: Ohio Health Group HMO |
$13,690.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,602.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,880.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,595.07
|
| Rate for Payer: PHCS Commercial |
$17,523.57
|
| Rate for Payer: United Healthcare All Payer |
$16,063.27
|
|
|
13 SLV SM CONE 2 SPT TALL SLOT
|
Facility
|
IP
|
$18,253.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,476.12 |
| Max. Negotiated Rate |
$17,523.57 |
| Rate for Payer: Aetna Commercial |
$14,055.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,237.90
|
| Rate for Payer: Cash Price |
$9,126.86
|
| Rate for Payer: Cigna Commercial |
$15,150.59
|
| Rate for Payer: First Health Commercial |
$17,341.03
|
| Rate for Payer: Humana Commercial |
$15,515.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,968.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,471.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,476.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,063.27
|
| Rate for Payer: Ohio Health Group HMO |
$13,690.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,602.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,880.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,595.07
|
| Rate for Payer: PHCS Commercial |
$17,523.57
|
| Rate for Payer: United Healthcare All Payer |
$16,063.27
|
|
|
13 STEM LNG REV POL +0 L
|
Facility
|
OP
|
$20,746.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,223.88 |
| Max. Negotiated Rate |
$19,916.40 |
| Rate for Payer: Aetna Commercial |
$15,974.61
|
| Rate for Payer: Anthem Medicaid |
$7,134.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,182.08
|
| Rate for Payer: Cash Price |
$10,373.12
|
| Rate for Payer: Cigna Commercial |
$17,219.39
|
| Rate for Payer: First Health Commercial |
$19,708.94
|
| Rate for Payer: Humana Commercial |
$17,634.31
|
| Rate for Payer: Humana KY Medicaid |
$7,134.64
|
| Rate for Payer: Kentucky WC Medicaid |
$7,207.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,011.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,310.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,223.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,277.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,256.70
|
| Rate for Payer: Ohio Health Group HMO |
$15,559.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,597.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,049.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,314.91
|
| Rate for Payer: PHCS Commercial |
$19,916.40
|
| Rate for Payer: United Healthcare All Payer |
$18,256.70
|
|
|
13 STEM LNG REV POL +0 L
|
Facility
|
IP
|
$20,746.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,223.88 |
| Max. Negotiated Rate |
$19,916.40 |
| Rate for Payer: Aetna Commercial |
$15,974.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,182.08
|
| Rate for Payer: Cash Price |
$10,373.12
|
| Rate for Payer: Cigna Commercial |
$17,219.39
|
| Rate for Payer: First Health Commercial |
$19,708.94
|
| Rate for Payer: Humana Commercial |
$17,634.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,011.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,310.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,223.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,256.70
|
| Rate for Payer: Ohio Health Group HMO |
$15,559.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,597.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,049.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,314.91
|
| Rate for Payer: PHCS Commercial |
$19,916.40
|
| Rate for Payer: United Healthcare All Payer |
$18,256.70
|
|
|
13 STEM LNG REV POL +0 R
|
Facility
|
OP
|
$20,746.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,223.88 |
| Max. Negotiated Rate |
$19,916.40 |
| Rate for Payer: Aetna Commercial |
$15,974.61
|
| Rate for Payer: Anthem Medicaid |
$7,134.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,182.08
|
| Rate for Payer: Cash Price |
$10,373.12
|
| Rate for Payer: Cigna Commercial |
$17,219.39
|
| Rate for Payer: First Health Commercial |
$19,708.94
|
| Rate for Payer: Humana Commercial |
$17,634.31
|
| Rate for Payer: Humana KY Medicaid |
$7,134.64
|
| Rate for Payer: Kentucky WC Medicaid |
$7,207.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,011.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,310.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,223.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,277.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,256.70
|
| Rate for Payer: Ohio Health Group HMO |
$15,559.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,597.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,049.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,314.91
|
| Rate for Payer: PHCS Commercial |
$19,916.40
|
| Rate for Payer: United Healthcare All Payer |
$18,256.70
|
|
|
13 STEM LNG REV POL +0 R
|
Facility
|
IP
|
$20,746.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,223.88 |
| Max. Negotiated Rate |
$19,916.40 |
| Rate for Payer: Aetna Commercial |
$15,974.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,182.08
|
| Rate for Payer: Cash Price |
$10,373.12
|
| Rate for Payer: Cigna Commercial |
$17,219.39
|
| Rate for Payer: First Health Commercial |
$19,708.94
|
| Rate for Payer: Humana Commercial |
$17,634.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,011.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,310.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,223.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,256.70
|
| Rate for Payer: Ohio Health Group HMO |
$15,559.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,597.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,049.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,314.91
|
| Rate for Payer: PHCS Commercial |
$19,916.40
|
| Rate for Payer: United Healthcare All Payer |
$18,256.70
|
|
