|
15 SLV SM CONE 1 SPOU TALL SLT
|
Facility
OP
|
$12,846.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$9,891.72
|
| Rate for Payer: Anthem Medicaid |
$4,417.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,020.18
|
| Rate for Payer: Cash Price |
$6,423.20
|
| Rate for Payer: Cigna Commercial |
$10,662.50
|
| Rate for Payer: First Health Commercial |
$12,204.07
|
| Rate for Payer: Humana Commercial |
$10,919.43
|
| Rate for Payer: Humana KY Medicaid |
$4,417.87
|
| Rate for Payer: Kentucky WC Medicaid |
$4,462.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,534.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,480.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,853.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,506.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,304.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,634.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,569.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,670.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,982.38
|
| Rate for Payer: PHCS Commercial |
$12,332.53
|
| Rate for Payer: United Healthcare All Payer |
$11,304.82
|
|
|
15 SLV SM CONE 1 SPOU TALL SLT
|
Facility
IP
|
$12,846.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$9,891.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,020.18
|
| Rate for Payer: Cash Price |
$6,423.20
|
| Rate for Payer: Cigna Commercial |
$10,662.50
|
| Rate for Payer: First Health Commercial |
$12,204.07
|
| Rate for Payer: Humana Commercial |
$10,919.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,534.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,480.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,853.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,304.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,634.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,569.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,670.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,982.38
|
| Rate for Payer: PHCS Commercial |
$12,332.53
|
|
|
15 SLV SM CONE 2 SPOU TALL SLT
|
Facility
IP
|
$12,846.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$9,891.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,020.18
|
| Rate for Payer: Cash Price |
$6,423.20
|
| Rate for Payer: Cigna Commercial |
$10,662.50
|
| Rate for Payer: First Health Commercial |
$12,204.07
|
| Rate for Payer: Humana Commercial |
$10,919.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,534.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,480.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,853.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,304.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,634.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,569.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,670.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,982.38
|
| Rate for Payer: PHCS Commercial |
$12,332.53
|
|
|
15 SLV SM CONE 2 SPOU TALL SLT
|
Facility
OP
|
$12,846.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$9,891.72
|
| Rate for Payer: Anthem Medicaid |
$4,417.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,020.18
|
| Rate for Payer: Cash Price |
$6,423.20
|
| Rate for Payer: Cigna Commercial |
$10,662.50
|
| Rate for Payer: First Health Commercial |
$12,204.07
|
| Rate for Payer: Humana Commercial |
$10,919.43
|
| Rate for Payer: Humana KY Medicaid |
$4,417.87
|
| Rate for Payer: Kentucky WC Medicaid |
$4,462.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,534.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,480.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,853.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,506.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,304.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,634.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,569.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,670.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,982.38
|
| Rate for Payer: PHCS Commercial |
$12,332.53
|
| Rate for Payer: United Healthcare All Payer |
$11,304.82
|
|
|
15 STEM PRIMARY HO
|
Facility
IP
|
$18,000.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$13,860.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,040.47
|
| Rate for Payer: Cash Price |
$9,000.30
|
| Rate for Payer: Cigna Commercial |
$14,940.50
|
| Rate for Payer: First Health Commercial |
$17,100.57
|
| Rate for Payer: Humana Commercial |
$15,300.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,760.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,284.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,400.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,840.53
|
| Rate for Payer: Ohio Health Group HMO |
$13,500.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,600.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,340.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,580.19
|
| Rate for Payer: PHCS Commercial |
$17,280.58
|
|
|
15 STEM PRIMARY HO
|
Facility
OP
|
$18,000.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$13,860.46
|
| Rate for Payer: Anthem Medicaid |
$6,190.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,040.47
|
| Rate for Payer: Cash Price |
$9,000.30
|
| Rate for Payer: Cigna Commercial |
$14,940.50
|
| Rate for Payer: First Health Commercial |
$17,100.57
|
| Rate for Payer: Humana Commercial |
$15,300.51
|
| Rate for Payer: Humana KY Medicaid |
$6,190.41
|
| Rate for Payer: Kentucky WC Medicaid |
$6,253.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,760.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,284.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,400.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,314.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,840.53
|
| Rate for Payer: Ohio Health Group HMO |
$13,500.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,600.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,340.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,580.19
|
| Rate for Payer: PHCS Commercial |
$17,280.58
|
| Rate for Payer: United Healthcare All Payer |
$15,840.53
|
|
|
15 STEM PRIMARY SO
|
Facility
IP
|
$17,679.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$13,613.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,789.85
|
| Rate for Payer: Cash Price |
$8,839.65
|
| Rate for Payer: Cigna Commercial |
$14,673.82
|
| Rate for Payer: First Health Commercial |
$16,795.34
|
| Rate for Payer: Humana Commercial |
$15,027.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,497.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,047.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,303.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,557.78
|
| Rate for Payer: Ohio Health Group HMO |
$13,259.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,535.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,298.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,480.58
|
| Rate for Payer: PHCS Commercial |
$16,972.13
|
|
|
15 STEM PRIMARY SO
|
Facility
OP
|
$17,679.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$13,613.06
|
| Rate for Payer: Anthem Medicaid |
$6,079.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,789.85
|
| Rate for Payer: Cash Price |
$8,839.65
|
| Rate for Payer: Cigna Commercial |
$14,673.82
|
| Rate for Payer: First Health Commercial |
$16,795.34
|
| Rate for Payer: Humana Commercial |
$15,027.40
|
| Rate for Payer: Humana KY Medicaid |
$6,079.91
|
| Rate for Payer: Kentucky WC Medicaid |
$6,141.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,497.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,047.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,303.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,201.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,557.78
|
| Rate for Payer: Ohio Health Group HMO |
$13,259.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,535.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,298.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,480.58
|
| Rate for Payer: PHCS Commercial |
$16,972.13
|
| Rate for Payer: United Healthcare All Payer |
$15,557.78
|
|
|
15 STEM SH REV POL +0
|
Facility
OP
|
$21,950.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$16,901.98
|
| Rate for Payer: Anthem Medicaid |
$7,548.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,121.48
|
| Rate for Payer: Cash Price |
$10,975.31
|
| Rate for Payer: Cigna Commercial |
$18,219.01
|
| Rate for Payer: First Health Commercial |
$20,853.09
|
| Rate for Payer: Humana Commercial |
$18,658.03
|
| Rate for Payer: Humana KY Medicaid |
$7,548.82
|
| Rate for Payer: Kentucky WC Medicaid |
$7,625.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,999.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,199.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,585.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,700.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,316.55
|
| Rate for Payer: Ohio Health Group HMO |
$16,462.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,853.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,804.69
|
| Rate for Payer: PHCS Commercial |
$21,072.60
|
| Rate for Payer: United Healthcare All Payer |
$19,316.55
|
|
|
15 STEM SH REV POL +0
|
Facility
IP
|
$21,950.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$16,901.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,121.48
|
| Rate for Payer: Cash Price |
$10,975.31
|
| Rate for Payer: Cigna Commercial |
$18,219.01
|
| Rate for Payer: First Health Commercial |
$20,853.09
|
| Rate for Payer: Humana Commercial |
$18,658.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,999.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,199.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,585.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,316.55
|
| Rate for Payer: Ohio Health Group HMO |
$16,462.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,853.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,804.69
|
| Rate for Payer: PHCS Commercial |
$21,072.60
|
|
|
15 STEM SH REV POL +10
|
Facility
OP
|
$21,950.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$16,901.98
|
| Rate for Payer: Anthem Medicaid |
$7,548.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,121.48
|
| Rate for Payer: Cash Price |
$10,975.31
|
| Rate for Payer: Cigna Commercial |
$18,219.01
|
| Rate for Payer: First Health Commercial |
$20,853.09
|
| Rate for Payer: Humana Commercial |
$18,658.03
|
| Rate for Payer: Humana KY Medicaid |
$7,548.82
|
| Rate for Payer: Kentucky WC Medicaid |
$7,625.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,999.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,199.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,585.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,700.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,316.55
|
| Rate for Payer: Ohio Health Group HMO |
$16,462.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,853.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,804.69
|
| Rate for Payer: PHCS Commercial |
$21,072.60
|
| Rate for Payer: United Healthcare All Payer |
$19,316.55
|
|
|
15 STEM SH REV POL +10
|
Facility
IP
|
$21,950.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$16,901.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,121.48
|
| Rate for Payer: Cash Price |
$10,975.31
|
| Rate for Payer: Cigna Commercial |
$18,219.01
|
| Rate for Payer: First Health Commercial |
$20,853.09
|
| Rate for Payer: Humana Commercial |
$18,658.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,999.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,199.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,585.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,316.55
|
| Rate for Payer: Ohio Health Group HMO |
$16,462.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,853.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,804.69
|
| Rate for Payer: PHCS Commercial |
$21,072.60
|
|
|
17 SLV MD CONE 1 SPOU TALL SLT
|
Facility
OP
|
$12,846.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$9,891.72
|
| Rate for Payer: Anthem Medicaid |
$4,417.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,020.18
|
| Rate for Payer: Cash Price |
$6,423.20
|
| Rate for Payer: Cigna Commercial |
$10,662.50
|
| Rate for Payer: First Health Commercial |
$12,204.07
|
| Rate for Payer: Humana Commercial |
$10,919.43
|
| Rate for Payer: Humana KY Medicaid |
$4,417.87
|
| Rate for Payer: Kentucky WC Medicaid |
$4,462.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,534.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,480.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,853.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,506.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,304.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,634.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,569.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,670.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,982.38
|
| Rate for Payer: PHCS Commercial |
$12,332.53
|
| Rate for Payer: United Healthcare All Payer |
$11,304.82
|
|
|
17 SLV MD CONE 1 SPOU TALL SLT
|
Facility
IP
|
$12,846.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$9,891.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,020.18
|
| Rate for Payer: Cash Price |
$6,423.20
|
| Rate for Payer: Cigna Commercial |
$10,662.50
|
| Rate for Payer: First Health Commercial |
$12,204.07
|
| Rate for Payer: Humana Commercial |
$10,919.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,534.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,480.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,853.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,304.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,634.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,569.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,670.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,982.38
|
| Rate for Payer: PHCS Commercial |
$12,332.53
|
|
|
17 SLV MD CONE 2 SPOU TALL SLT
|
Facility
OP
|
$12,846.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$9,891.72
|
| Rate for Payer: Anthem Medicaid |
$4,417.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,020.18
|
| Rate for Payer: Cash Price |
$6,423.20
|
| Rate for Payer: Cigna Commercial |
$10,662.50
|
| Rate for Payer: First Health Commercial |
$12,204.07
|
| Rate for Payer: Humana Commercial |
$10,919.43
|
| Rate for Payer: Humana KY Medicaid |
$4,417.87
|
| Rate for Payer: Kentucky WC Medicaid |
$4,462.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,534.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,480.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,853.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,506.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,304.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,634.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,569.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,670.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,982.38
|
| Rate for Payer: PHCS Commercial |
$12,332.53
|
| Rate for Payer: United Healthcare All Payer |
$11,304.82
|
|
|
17 SLV MD CONE 2 SPOU TALL SLT
|
Facility
IP
|
$12,846.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$9,891.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,020.18
|
| Rate for Payer: Cash Price |
$6,423.20
|
| Rate for Payer: Cigna Commercial |
$10,662.50
|
| Rate for Payer: First Health Commercial |
$12,204.07
|
| Rate for Payer: Humana Commercial |
$10,919.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,534.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,480.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,853.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,304.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,634.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,569.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,670.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,982.38
|
| Rate for Payer: PHCS Commercial |
$12,332.53
|
|
|
17 SLV SM CONE 1 SPOU TALL SLT
|
Facility
IP
|
$12,846.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$9,891.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,020.18
|
| Rate for Payer: Cash Price |
$6,423.20
|
| Rate for Payer: Cigna Commercial |
$10,662.50
|
| Rate for Payer: First Health Commercial |
$12,204.07
|
| Rate for Payer: Humana Commercial |
$10,919.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,534.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,480.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,853.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,304.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,634.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,569.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,670.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,982.38
|
| Rate for Payer: PHCS Commercial |
$12,332.53
|
|
|
17 SLV SM CONE 1 SPOU TALL SLT
|
Facility
OP
|
$12,846.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$9,891.72
|
| Rate for Payer: Anthem Medicaid |
$4,417.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,020.18
|
| Rate for Payer: Cash Price |
$6,423.20
|
| Rate for Payer: Cigna Commercial |
$10,662.50
|
| Rate for Payer: First Health Commercial |
$12,204.07
|
| Rate for Payer: Humana Commercial |
$10,919.43
|
| Rate for Payer: Humana KY Medicaid |
$4,417.87
|
| Rate for Payer: Kentucky WC Medicaid |
$4,462.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,534.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,480.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,853.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,506.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,304.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,634.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,569.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,670.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,982.38
|
| Rate for Payer: PHCS Commercial |
$12,332.53
|
| Rate for Payer: United Healthcare All Payer |
$11,304.82
|
|
|
17 SLV SM CONE 2 SPOU TALL SLT
|
Facility
OP
|
$12,846.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$9,891.72
|
| Rate for Payer: Anthem Medicaid |
$4,417.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,020.18
|
| Rate for Payer: Cash Price |
$6,423.20
|
| Rate for Payer: Cigna Commercial |
$10,662.50
|
| Rate for Payer: First Health Commercial |
$12,204.07
|
| Rate for Payer: Humana Commercial |
$10,919.43
|
| Rate for Payer: Humana KY Medicaid |
$4,417.87
|
| Rate for Payer: Kentucky WC Medicaid |
$4,462.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,534.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,480.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,853.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,506.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,304.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,634.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,569.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,670.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,982.38
|
| Rate for Payer: PHCS Commercial |
$12,332.53
|
| Rate for Payer: United Healthcare All Payer |
$11,304.82
|
|
|
17 SLV SM CONE 2 SPOU TALL SLT
|
Facility
IP
|
$12,846.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$9,891.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,020.18
|
| Rate for Payer: Cash Price |
$6,423.20
|
| Rate for Payer: Cigna Commercial |
$10,662.50
|
| Rate for Payer: First Health Commercial |
$12,204.07
|
| Rate for Payer: Humana Commercial |
$10,919.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,534.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,480.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,853.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,304.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,634.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,569.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,670.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,982.38
|
| Rate for Payer: PHCS Commercial |
$12,332.53
|
|
|
17 STEM LNG REV POL +0 L
|
Facility
OP
|
$16,140.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$12,428.17
|
| Rate for Payer: Anthem Medicaid |
$5,550.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,589.57
|
| Rate for Payer: Cash Price |
$8,070.24
|
| Rate for Payer: Cigna Commercial |
$13,396.60
|
| Rate for Payer: First Health Commercial |
$15,333.46
|
| Rate for Payer: Humana Commercial |
$13,719.41
|
| Rate for Payer: Humana KY Medicaid |
$5,550.71
|
| Rate for Payer: Kentucky WC Medicaid |
$5,607.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,235.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,911.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,842.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,662.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,203.62
|
| Rate for Payer: Ohio Health Group HMO |
$12,105.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,228.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,098.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,003.55
|
| Rate for Payer: PHCS Commercial |
$15,494.86
|
| Rate for Payer: United Healthcare All Payer |
$14,203.62
|
|
|
17 STEM LNG REV POL +0 L
|
Facility
IP
|
$16,140.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$12,428.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,589.57
|
| Rate for Payer: Cash Price |
$8,070.24
|
| Rate for Payer: Cigna Commercial |
$13,396.60
|
| Rate for Payer: First Health Commercial |
$15,333.46
|
| Rate for Payer: Humana Commercial |
$13,719.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,235.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,911.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,842.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,203.62
|
| Rate for Payer: Ohio Health Group HMO |
$12,105.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,228.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,098.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,003.55
|
| Rate for Payer: PHCS Commercial |
$15,494.86
|
|
|
17 STEM LNG REV POL +0 R
|
Facility
IP
|
$21,950.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$16,901.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,121.48
|
| Rate for Payer: Cash Price |
$10,975.31
|
| Rate for Payer: Cigna Commercial |
$18,219.01
|
| Rate for Payer: First Health Commercial |
$20,853.09
|
| Rate for Payer: Humana Commercial |
$18,658.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,999.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,199.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,585.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,316.55
|
| Rate for Payer: Ohio Health Group HMO |
$16,462.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,853.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,804.69
|
| Rate for Payer: PHCS Commercial |
$21,072.60
|
|
|
17 STEM LNG REV POL +0 R
|
Facility
OP
|
$21,950.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$16,901.98
|
| Rate for Payer: Anthem Medicaid |
$7,548.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,121.48
|
| Rate for Payer: Cash Price |
$10,975.31
|
| Rate for Payer: Cigna Commercial |
$18,219.01
|
| Rate for Payer: First Health Commercial |
$20,853.09
|
| Rate for Payer: Humana Commercial |
$18,658.03
|
| Rate for Payer: Humana KY Medicaid |
$7,548.82
|
| Rate for Payer: Kentucky WC Medicaid |
$7,625.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,999.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,199.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,585.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,700.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,316.55
|
| Rate for Payer: Ohio Health Group HMO |
$16,462.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,853.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,804.69
|
| Rate for Payer: PHCS Commercial |
$21,072.60
|
| Rate for Payer: United Healthcare All Payer |
$19,316.55
|
|
|
17 STEM LNG REV POL +10 L
|
Facility
IP
|
$24,916.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$19,185.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,434.96
|
| Rate for Payer: Cash Price |
$12,458.31
|
| Rate for Payer: Cigna Commercial |
$20,680.79
|
| Rate for Payer: First Health Commercial |
$23,670.78
|
| Rate for Payer: Humana Commercial |
$21,179.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,431.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,388.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,474.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,926.62
|
| Rate for Payer: Ohio Health Group HMO |
$18,687.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,983.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,239.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,724.15
|
| Rate for Payer: PHCS Commercial |
$23,919.95
|
|
