|
19 STEM LNG REV POL +10 R
|
Facility
IP
|
$24,913.51
|
|
|
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 |
$19,183.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,432.54
|
| Rate for Payer: Cash Price |
$12,456.75
|
| Rate for Payer: Cigna Commercial |
$20,678.21
|
| Rate for Payer: First Health Commercial |
$23,667.83
|
| Rate for Payer: Humana Commercial |
$21,176.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,429.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,386.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,474.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,923.89
|
| Rate for Payer: Ohio Health Group HMO |
$18,685.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,982.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,238.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,723.19
|
| Rate for Payer: PHCS Commercial |
$23,916.97
|
|
|
19 STEM LNG REV POL +10 R
|
Facility
OP
|
$24,913.51
|
|
|
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 |
$19,183.40
|
| Rate for Payer: Anthem Medicaid |
$8,567.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,432.54
|
| Rate for Payer: Cash Price |
$12,456.75
|
| Rate for Payer: Cigna Commercial |
$20,678.21
|
| Rate for Payer: First Health Commercial |
$23,667.83
|
| Rate for Payer: Humana Commercial |
$21,176.48
|
| Rate for Payer: Humana KY Medicaid |
$8,567.76
|
| Rate for Payer: Kentucky WC Medicaid |
$8,654.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,429.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,386.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,474.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,739.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,923.89
|
| Rate for Payer: Ohio Health Group HMO |
$18,685.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,982.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,238.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,723.19
|
| Rate for Payer: PHCS Commercial |
$23,916.97
|
| Rate for Payer: United Healthcare All Payer |
$21,923.89
|
|
|
19 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
|
|
|
19 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
|
|
|
19 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
|
|
|
19 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
|
|
|
19 STEM SH REV POL +0
|
Facility
IP
|
$20,126.35
|
|
|
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 |
$15,497.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,698.55
|
| Rate for Payer: Cash Price |
$10,063.17
|
| Rate for Payer: Cigna Commercial |
$16,704.87
|
| Rate for Payer: First Health Commercial |
$19,120.03
|
| Rate for Payer: Humana Commercial |
$17,107.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,503.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,853.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,037.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,711.19
|
| Rate for Payer: Ohio Health Group HMO |
$15,094.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,025.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,616.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,239.17
|
| Rate for Payer: PHCS Commercial |
$19,321.30
|
|
|
19 STEM SH REV POL +0
|
Facility
OP
|
$20,126.35
|
|
|
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 |
$15,497.29
|
| Rate for Payer: Anthem Medicaid |
$6,921.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,698.55
|
| Rate for Payer: Cash Price |
$10,063.17
|
| Rate for Payer: Cigna Commercial |
$16,704.87
|
| Rate for Payer: First Health Commercial |
$19,120.03
|
| Rate for Payer: Humana Commercial |
$17,107.40
|
| Rate for Payer: Humana KY Medicaid |
$6,921.45
|
| Rate for Payer: Kentucky WC Medicaid |
$6,991.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,503.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,853.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,037.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,060.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,711.19
|
| Rate for Payer: Ohio Health Group HMO |
$15,094.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,025.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,616.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,239.17
|
| Rate for Payer: PHCS Commercial |
$19,321.30
|
| Rate for Payer: United Healthcare All Payer |
$17,711.19
|
|
|
19 STEM SH REV POL +10
|
Facility
OP
|
$20,126.35
|
|
|
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 |
$15,497.29
|
| Rate for Payer: Anthem Medicaid |
$6,921.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,698.55
|
| Rate for Payer: Cash Price |
$10,063.17
|
| Rate for Payer: Cigna Commercial |
$16,704.87
|
| Rate for Payer: First Health Commercial |
$19,120.03
|
| Rate for Payer: Humana Commercial |
$17,107.40
|
| Rate for Payer: Humana KY Medicaid |
$6,921.45
|
| Rate for Payer: Kentucky WC Medicaid |
$6,991.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,503.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,853.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,037.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,060.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,711.19
|
| Rate for Payer: Ohio Health Group HMO |
$15,094.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,025.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,616.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,239.17
|
| Rate for Payer: PHCS Commercial |
$19,321.30
|
| Rate for Payer: United Healthcare All Payer |
$17,711.19
|
|
|
19 STEM SH REV POL +10
|
Facility
IP
|
$20,126.35
|
|
|
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 |
$15,497.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,698.55
|
| Rate for Payer: Cash Price |
$10,063.17
|
| Rate for Payer: Cigna Commercial |
$16,704.87
|
| Rate for Payer: First Health Commercial |
$19,120.03
|
| Rate for Payer: Humana Commercial |
$17,107.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,503.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,853.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,037.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,711.19
|
| Rate for Payer: Ohio Health Group HMO |
$15,094.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,025.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,616.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,239.17
|
| Rate for Payer: PHCS Commercial |
$19,321.30
|
|
|
20 H PLATE/2.3MMSCREW TITANIU
|
Facility
OP
|
$10,621.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$39,122.40 |
| Rate for Payer: Aetna Commercial |
$8,178.86
|
| Rate for Payer: Anthem Medicaid |
$3,652.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,285.08
|
| Rate for Payer: Cash Price |
$5,310.95
|
| Rate for Payer: Cigna Commercial |
$8,816.18
|
| Rate for Payer: First Health Commercial |
$10,090.80
|
| Rate for Payer: Humana Commercial |
$9,028.62
|
| Rate for Payer: Humana KY Medicaid |
$3,652.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,690.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,709.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,838.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,186.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,726.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,347.27
|
| Rate for Payer: Ohio Health Group HMO |
$7,966.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,124.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,380.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,292.79
|
| Rate for Payer: PHCS Commercial |
$10,197.02
|
| Rate for Payer: United Healthcare All Payer |
$9,347.27
|
|
|
20 H PLATE/2.3MMSCREW TITANIU
|
Facility
IP
|
$10,621.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$39,122.40 |
| Rate for Payer: Aetna Commercial |
$8,178.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,285.08
|
| Rate for Payer: Cash Price |
$5,310.95
|
| Rate for Payer: Cigna Commercial |
$8,816.18
|
| Rate for Payer: First Health Commercial |
$10,090.80
|
| Rate for Payer: Humana Commercial |
$9,028.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,709.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,838.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,186.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,347.27
|
| Rate for Payer: Ohio Health Group HMO |
$7,966.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,124.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,380.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,292.79
|
| Rate for Payer: PHCS Commercial |
$10,197.02
|
|
|
21 HYDROXYLASE AB S
|
Facility
IP
|
$163.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
30001033
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.19 |
| Max. Negotiated Rate |
$156.48 |
| Rate for Payer: Aetna Commercial |
$125.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.89
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$135.29
|
| Rate for Payer: First Health Commercial |
$154.85
|
| Rate for Payer: Humana Commercial |
$138.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$133.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.44
|
| Rate for Payer: Ohio Health Group HMO |
$122.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.53
|
| Rate for Payer: PHCS Commercial |
$156.48
|
|
|
21 HYDROXYLASE AB S
|
Facility
OP
|
$163.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
30001033
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$156.48 |
| Rate for Payer: Aetna Commercial |
$125.51
|
| Rate for Payer: Anthem Medicaid |
$12.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$135.29
|
| Rate for Payer: First Health Commercial |
$154.85
|
| Rate for Payer: Humana Commercial |
$138.55
|
| Rate for Payer: Humana KY Medicaid |
$12.05
|
| Rate for Payer: Humana Medicare Advantage |
$12.05
|
| Rate for Payer: Kentucky WC Medicaid |
$12.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$133.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.44
|
| Rate for Payer: Ohio Health Group HMO |
$122.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.53
|
| Rate for Payer: PHCS Commercial |
$156.48
|
| Rate for Payer: United Healthcare All Payer |
$143.44
|
|
|
21 SLV MD CONE 1 SPOU TALL SLT
|
Facility
IP
|
$13,317.97
|
|
|
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 |
$10,254.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,388.02
|
| Rate for Payer: Cash Price |
$6,658.99
|
| Rate for Payer: Cigna Commercial |
$11,053.92
|
| Rate for Payer: First Health Commercial |
$12,652.07
|
| Rate for Payer: Humana Commercial |
$11,320.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,920.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,828.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,995.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,719.81
|
| Rate for Payer: Ohio Health Group HMO |
$9,988.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,663.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,731.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,128.57
|
| Rate for Payer: PHCS Commercial |
$12,785.25
|
|
|
21 SLV MD CONE 1 SPOU TALL SLT
|
Facility
OP
|
$13,317.97
|
|
|
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 |
$10,254.84
|
| Rate for Payer: Anthem Medicaid |
$4,580.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,388.02
|
| Rate for Payer: Cash Price |
$6,658.99
|
| Rate for Payer: Cigna Commercial |
$11,053.92
|
| Rate for Payer: First Health Commercial |
$12,652.07
|
| Rate for Payer: Humana Commercial |
$11,320.27
|
| Rate for Payer: Humana KY Medicaid |
$4,580.05
|
| Rate for Payer: Kentucky WC Medicaid |
$4,626.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,920.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,828.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,995.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,671.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,719.81
|
| Rate for Payer: Ohio Health Group HMO |
$9,988.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,663.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,731.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,128.57
|
| Rate for Payer: PHCS Commercial |
$12,785.25
|
| Rate for Payer: United Healthcare All Payer |
$11,719.81
|
|
|
21 SLV MD CONE 2 SPOU TALL SLT
|
Facility
OP
|
$13,317.97
|
|
|
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 |
$10,254.84
|
| Rate for Payer: Anthem Medicaid |
$4,580.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,388.02
|
| Rate for Payer: Cash Price |
$6,658.99
|
| Rate for Payer: Cigna Commercial |
$11,053.92
|
| Rate for Payer: First Health Commercial |
$12,652.07
|
| Rate for Payer: Humana Commercial |
$11,320.27
|
| Rate for Payer: Humana KY Medicaid |
$4,580.05
|
| Rate for Payer: Kentucky WC Medicaid |
$4,626.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,920.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,828.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,995.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,671.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,719.81
|
| Rate for Payer: Ohio Health Group HMO |
$9,988.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,663.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,731.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,128.57
|
| Rate for Payer: PHCS Commercial |
$12,785.25
|
| Rate for Payer: United Healthcare All Payer |
$11,719.81
|
|
|
21 SLV MD CONE 2 SPOU TALL SLT
|
Facility
IP
|
$13,317.97
|
|
|
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 |
$10,254.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,388.02
|
| Rate for Payer: Cash Price |
$6,658.99
|
| Rate for Payer: Cigna Commercial |
$11,053.92
|
| Rate for Payer: First Health Commercial |
$12,652.07
|
| Rate for Payer: Humana Commercial |
$11,320.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,920.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,828.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,995.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,719.81
|
| Rate for Payer: Ohio Health Group HMO |
$9,988.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,663.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,731.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,128.57
|
| Rate for Payer: PHCS Commercial |
$12,785.25
|
|
|
21 SLV SM CONE 1 SPOU TALL SLT
|
Facility
IP
|
$13,317.97
|
|
|
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 |
$10,254.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,388.02
|
| Rate for Payer: Cash Price |
$6,658.99
|
| Rate for Payer: Cigna Commercial |
$11,053.92
|
| Rate for Payer: First Health Commercial |
$12,652.07
|
| Rate for Payer: Humana Commercial |
$11,320.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,920.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,828.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,995.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,719.81
|
| Rate for Payer: Ohio Health Group HMO |
$9,988.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,663.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,731.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,128.57
|
| Rate for Payer: PHCS Commercial |
$12,785.25
|
|
|
21 SLV SM CONE 1 SPOU TALL SLT
|
Facility
OP
|
$13,317.97
|
|
|
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 |
$10,254.84
|
| Rate for Payer: Anthem Medicaid |
$4,580.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,388.02
|
| Rate for Payer: Cash Price |
$6,658.99
|
| Rate for Payer: Cigna Commercial |
$11,053.92
|
| Rate for Payer: First Health Commercial |
$12,652.07
|
| Rate for Payer: Humana Commercial |
$11,320.27
|
| Rate for Payer: Humana KY Medicaid |
$4,580.05
|
| Rate for Payer: Kentucky WC Medicaid |
$4,626.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,920.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,828.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,995.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,671.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,719.81
|
| Rate for Payer: Ohio Health Group HMO |
$9,988.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,663.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,731.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,128.57
|
| Rate for Payer: PHCS Commercial |
$12,785.25
|
| Rate for Payer: United Healthcare All Payer |
$11,719.81
|
|
|
21 SLV SM CONE 2 SPOU TALL SLT
|
Facility
OP
|
$13,317.97
|
|
|
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 |
$10,254.84
|
| Rate for Payer: Anthem Medicaid |
$4,580.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,388.02
|
| Rate for Payer: Cash Price |
$6,658.99
|
| Rate for Payer: Cigna Commercial |
$11,053.92
|
| Rate for Payer: First Health Commercial |
$12,652.07
|
| Rate for Payer: Humana Commercial |
$11,320.27
|
| Rate for Payer: Humana KY Medicaid |
$4,580.05
|
| Rate for Payer: Kentucky WC Medicaid |
$4,626.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,920.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,828.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,995.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,671.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,719.81
|
| Rate for Payer: Ohio Health Group HMO |
$9,988.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,663.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,731.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,128.57
|
| Rate for Payer: PHCS Commercial |
$12,785.25
|
| Rate for Payer: United Healthcare All Payer |
$11,719.81
|
|
|
21 SLV SM CONE 2 SPOU TALL SLT
|
Facility
IP
|
$13,317.97
|
|
|
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 |
$10,254.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,388.02
|
| Rate for Payer: Cash Price |
$6,658.99
|
| Rate for Payer: Cigna Commercial |
$11,053.92
|
| Rate for Payer: First Health Commercial |
$12,652.07
|
| Rate for Payer: Humana Commercial |
$11,320.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,920.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,828.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,995.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,719.81
|
| Rate for Payer: Ohio Health Group HMO |
$9,988.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,663.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,731.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,128.57
|
| Rate for Payer: PHCS Commercial |
$12,785.25
|
|
|
23 SLV MD CONE 1 SPOU TALL SLT
|
Facility
IP
|
$13,317.97
|
|
|
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 |
$10,254.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,388.02
|
| Rate for Payer: Cash Price |
$6,658.99
|
| Rate for Payer: Cigna Commercial |
$11,053.92
|
| Rate for Payer: First Health Commercial |
$12,652.07
|
| Rate for Payer: Humana Commercial |
$11,320.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,920.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,828.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,995.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,719.81
|
| Rate for Payer: Ohio Health Group HMO |
$9,988.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,663.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,731.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,128.57
|
| Rate for Payer: PHCS Commercial |
$12,785.25
|
|
|
23 SLV MD CONE 1 SPOU TALL SLT
|
Facility
OP
|
$13,317.97
|
|
|
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 |
$10,254.84
|
| Rate for Payer: Anthem Medicaid |
$4,580.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,388.02
|
| Rate for Payer: Cash Price |
$6,658.99
|
| Rate for Payer: Cigna Commercial |
$11,053.92
|
| Rate for Payer: First Health Commercial |
$12,652.07
|
| Rate for Payer: Humana Commercial |
$11,320.27
|
| Rate for Payer: Humana KY Medicaid |
$4,580.05
|
| Rate for Payer: Kentucky WC Medicaid |
$4,626.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,920.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,828.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,995.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,671.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,719.81
|
| Rate for Payer: Ohio Health Group HMO |
$9,988.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,663.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,731.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,128.57
|
| Rate for Payer: PHCS Commercial |
$12,785.25
|
| Rate for Payer: United Healthcare All Payer |
$11,719.81
|
|
|
23 SLV MD CONE 2 SPOU TALL SLT
|
Facility
IP
|
$13,317.97
|
|
|
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 |
$10,254.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,388.02
|
| Rate for Payer: Cash Price |
$6,658.99
|
| Rate for Payer: Cigna Commercial |
$11,053.92
|
| Rate for Payer: First Health Commercial |
$12,652.07
|
| Rate for Payer: Humana Commercial |
$11,320.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,920.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,828.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,995.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,719.81
|
| Rate for Payer: Ohio Health Group HMO |
$9,988.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,663.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,731.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,128.57
|
| Rate for Payer: PHCS Commercial |
$12,785.25
|
|
