|
19 STEM LNG REV POL +10 R
|
Facility
|
IP
|
$25,664.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,699.37 |
| Max. Negotiated Rate |
$24,637.98 |
| Rate for Payer: Aetna Commercial |
$19,761.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,018.36
|
| Rate for Payer: Cash Price |
$12,832.28
|
| Rate for Payer: Cigna Commercial |
$21,301.58
|
| Rate for Payer: First Health Commercial |
$24,381.33
|
| Rate for Payer: Humana Commercial |
$21,814.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,044.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,940.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,699.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,584.81
|
| Rate for Payer: Ohio Health Group HMO |
$19,248.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,531.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,328.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,708.55
|
| Rate for Payer: PHCS Commercial |
$24,637.98
|
| Rate for Payer: United Healthcare All Payer |
$22,584.81
|
|
|
19 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
|
|
|
19 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
|
|
|
19 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
|
|
|
19 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
|
|
|
19 STEM SH REV POL +0
|
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
|
|
|
19 STEM SH REV POL +0
|
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
|
|
|
19 STEM SH REV POL +10
|
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
|
|
|
19 STEM SH REV POL +10
|
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
|
|
|
20 H PLATE/2.3MMSCREW TITANIU
|
Facility
|
OP
|
$10,862.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,258.61 |
| Max. Negotiated Rate |
$10,427.54 |
| Rate for Payer: Aetna Commercial |
$8,363.76
|
| Rate for Payer: Anthem Medicaid |
$3,735.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,472.38
|
| Rate for Payer: Cash Price |
$5,431.01
|
| Rate for Payer: Cigna Commercial |
$9,015.48
|
| Rate for Payer: First Health Commercial |
$10,318.92
|
| Rate for Payer: Humana Commercial |
$9,232.72
|
| Rate for Payer: Humana KY Medicaid |
$3,735.45
|
| Rate for Payer: Kentucky WC Medicaid |
$3,773.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,906.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,016.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,258.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,810.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,558.58
|
| Rate for Payer: Ohio Health Group HMO |
$8,146.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,689.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,449.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,494.79
|
| Rate for Payer: PHCS Commercial |
$10,427.54
|
| Rate for Payer: United Healthcare All Payer |
$9,558.58
|
|
|
20 H PLATE/2.3MMSCREW TITANIU
|
Facility
|
IP
|
$10,862.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,258.61 |
| Max. Negotiated Rate |
$10,427.54 |
| Rate for Payer: Aetna Commercial |
$8,363.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,472.38
|
| Rate for Payer: Cash Price |
$5,431.01
|
| Rate for Payer: Cigna Commercial |
$9,015.48
|
| Rate for Payer: First Health Commercial |
$10,318.92
|
| Rate for Payer: Humana Commercial |
$9,232.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,906.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,016.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,258.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,558.58
|
| Rate for Payer: Ohio Health Group HMO |
$8,146.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,689.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,449.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,494.79
|
| Rate for Payer: PHCS Commercial |
$10,427.54
|
| Rate for Payer: United Healthcare All Payer |
$9,558.58
|
|
|
21 HYDROXYLASE AB S
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
30001033
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$160.32 |
| Rate for Payer: Aetna Commercial |
$128.59
|
| Rate for Payer: Anthem Medicaid |
$12.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$134.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.05
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Cigna Commercial |
$138.61
|
| Rate for Payer: First Health Commercial |
$158.65
|
| Rate for Payer: Humana Commercial |
$141.95
|
| 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 |
$136.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$123.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$146.96
|
| Rate for Payer: Ohio Health Group HMO |
$125.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$133.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.23
|
| Rate for Payer: PHCS Commercial |
$160.32
|
| Rate for Payer: United Healthcare All Payer |
$146.96
|
|
|
21 HYDROXYLASE AB S
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
30001033
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.10 |
| Max. Negotiated Rate |
$160.32 |
| Rate for Payer: Aetna Commercial |
$128.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$134.10
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Cigna Commercial |
$138.61
|
| Rate for Payer: First Health Commercial |
$158.65
|
| Rate for Payer: Humana Commercial |
$141.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$123.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$146.96
|
| Rate for Payer: Ohio Health Group HMO |
$125.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$133.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.23
|
| Rate for Payer: PHCS Commercial |
$160.32
|
| Rate for Payer: United Healthcare All Payer |
$146.96
|
|
|
21 SLV MD CONE 1 SPOU TALL SLT
|
Facility
|
OP
|
$13,572.87
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,071.86 |
| Max. Negotiated Rate |
$13,029.96 |
| Rate for Payer: Aetna Commercial |
$10,451.11
|
| Rate for Payer: Anthem Medicaid |
$4,667.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,586.84
|
| Rate for Payer: Cash Price |
$6,786.43
|
| Rate for Payer: Cigna Commercial |
$11,265.48
|
| Rate for Payer: First Health Commercial |
$12,894.23
|
| Rate for Payer: Humana Commercial |
$11,536.94
|
| Rate for Payer: Humana KY Medicaid |
$4,667.71
|
| Rate for Payer: Kentucky WC Medicaid |
$4,715.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,129.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,016.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,071.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,761.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,944.13
|
| Rate for Payer: Ohio Health Group HMO |
$10,179.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,858.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,808.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,365.28
|
| Rate for Payer: PHCS Commercial |
$13,029.96
|
| Rate for Payer: United Healthcare All Payer |
$11,944.13
|
|
|
21 SLV MD CONE 1 SPOU TALL SLT
|
Facility
|
IP
|
$13,572.87
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,071.86 |
| Max. Negotiated Rate |
$13,029.96 |
| Rate for Payer: Aetna Commercial |
$10,451.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,586.84
|
| Rate for Payer: Cash Price |
$6,786.43
|
| Rate for Payer: Cigna Commercial |
$11,265.48
|
| Rate for Payer: First Health Commercial |
$12,894.23
|
| Rate for Payer: Humana Commercial |
$11,536.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,129.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,016.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,071.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,944.13
|
| Rate for Payer: Ohio Health Group HMO |
$10,179.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,858.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,808.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,365.28
|
| Rate for Payer: PHCS Commercial |
$13,029.96
|
| Rate for Payer: United Healthcare All Payer |
$11,944.13
|
|
|
21 SLV MD CONE 2 SPOU TALL SLT
|
Facility
|
OP
|
$13,572.87
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,071.86 |
| Max. Negotiated Rate |
$13,029.96 |
| Rate for Payer: Aetna Commercial |
$10,451.11
|
| Rate for Payer: Anthem Medicaid |
$4,667.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,586.84
|
| Rate for Payer: Cash Price |
$6,786.43
|
| Rate for Payer: Cigna Commercial |
$11,265.48
|
| Rate for Payer: First Health Commercial |
$12,894.23
|
| Rate for Payer: Humana Commercial |
$11,536.94
|
| Rate for Payer: Humana KY Medicaid |
$4,667.71
|
| Rate for Payer: Kentucky WC Medicaid |
$4,715.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,129.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,016.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,071.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,761.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,944.13
|
| Rate for Payer: Ohio Health Group HMO |
$10,179.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,858.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,808.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,365.28
|
| Rate for Payer: PHCS Commercial |
$13,029.96
|
| Rate for Payer: United Healthcare All Payer |
$11,944.13
|
|
|
21 SLV MD CONE 2 SPOU TALL SLT
|
Facility
|
IP
|
$13,572.87
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,071.86 |
| Max. Negotiated Rate |
$13,029.96 |
| Rate for Payer: Aetna Commercial |
$10,451.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,586.84
|
| Rate for Payer: Cash Price |
$6,786.43
|
| Rate for Payer: Cigna Commercial |
$11,265.48
|
| Rate for Payer: First Health Commercial |
$12,894.23
|
| Rate for Payer: Humana Commercial |
$11,536.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,129.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,016.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,071.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,944.13
|
| Rate for Payer: Ohio Health Group HMO |
$10,179.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,858.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,808.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,365.28
|
| Rate for Payer: PHCS Commercial |
$13,029.96
|
| Rate for Payer: United Healthcare All Payer |
$11,944.13
|
|
|
21 SLV SM CONE 1 SPOU TALL SLT
|
Facility
|
OP
|
$13,572.87
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,071.86 |
| Max. Negotiated Rate |
$13,029.96 |
| Rate for Payer: Aetna Commercial |
$10,451.11
|
| Rate for Payer: Anthem Medicaid |
$4,667.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,586.84
|
| Rate for Payer: Cash Price |
$6,786.43
|
| Rate for Payer: Cigna Commercial |
$11,265.48
|
| Rate for Payer: First Health Commercial |
$12,894.23
|
| Rate for Payer: Humana Commercial |
$11,536.94
|
| Rate for Payer: Humana KY Medicaid |
$4,667.71
|
| Rate for Payer: Kentucky WC Medicaid |
$4,715.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,129.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,016.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,071.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,761.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,944.13
|
| Rate for Payer: Ohio Health Group HMO |
$10,179.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,858.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,808.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,365.28
|
| Rate for Payer: PHCS Commercial |
$13,029.96
|
| Rate for Payer: United Healthcare All Payer |
$11,944.13
|
|
|
21 SLV SM CONE 1 SPOU TALL SLT
|
Facility
|
IP
|
$13,572.87
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,071.86 |
| Max. Negotiated Rate |
$13,029.96 |
| Rate for Payer: Aetna Commercial |
$10,451.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,586.84
|
| Rate for Payer: Cash Price |
$6,786.43
|
| Rate for Payer: Cigna Commercial |
$11,265.48
|
| Rate for Payer: First Health Commercial |
$12,894.23
|
| Rate for Payer: Humana Commercial |
$11,536.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,129.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,016.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,071.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,944.13
|
| Rate for Payer: Ohio Health Group HMO |
$10,179.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,858.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,808.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,365.28
|
| Rate for Payer: PHCS Commercial |
$13,029.96
|
| Rate for Payer: United Healthcare All Payer |
$11,944.13
|
|
|
21 SLV SM CONE 2 SPOU TALL SLT
|
Facility
|
OP
|
$13,572.87
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,071.86 |
| Max. Negotiated Rate |
$13,029.96 |
| Rate for Payer: Aetna Commercial |
$10,451.11
|
| Rate for Payer: Anthem Medicaid |
$4,667.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,586.84
|
| Rate for Payer: Cash Price |
$6,786.43
|
| Rate for Payer: Cigna Commercial |
$11,265.48
|
| Rate for Payer: First Health Commercial |
$12,894.23
|
| Rate for Payer: Humana Commercial |
$11,536.94
|
| Rate for Payer: Humana KY Medicaid |
$4,667.71
|
| Rate for Payer: Kentucky WC Medicaid |
$4,715.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,129.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,016.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,071.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,761.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,944.13
|
| Rate for Payer: Ohio Health Group HMO |
$10,179.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,858.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,808.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,365.28
|
| Rate for Payer: PHCS Commercial |
$13,029.96
|
| Rate for Payer: United Healthcare All Payer |
$11,944.13
|
|
|
21 SLV SM CONE 2 SPOU TALL SLT
|
Facility
|
IP
|
$13,572.87
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,071.86 |
| Max. Negotiated Rate |
$13,029.96 |
| Rate for Payer: Aetna Commercial |
$10,451.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,586.84
|
| Rate for Payer: Cash Price |
$6,786.43
|
| Rate for Payer: Cigna Commercial |
$11,265.48
|
| Rate for Payer: First Health Commercial |
$12,894.23
|
| Rate for Payer: Humana Commercial |
$11,536.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,129.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,016.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,071.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,944.13
|
| Rate for Payer: Ohio Health Group HMO |
$10,179.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,858.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,808.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,365.28
|
| Rate for Payer: PHCS Commercial |
$13,029.96
|
| Rate for Payer: United Healthcare All Payer |
$11,944.13
|
|
|
23 SLV MD CONE 1 SPOU TALL SLT
|
Facility
|
OP
|
$13,572.87
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,071.86 |
| Max. Negotiated Rate |
$13,029.96 |
| Rate for Payer: Aetna Commercial |
$10,451.11
|
| Rate for Payer: Anthem Medicaid |
$4,667.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,586.84
|
| Rate for Payer: Cash Price |
$6,786.43
|
| Rate for Payer: Cigna Commercial |
$11,265.48
|
| Rate for Payer: First Health Commercial |
$12,894.23
|
| Rate for Payer: Humana Commercial |
$11,536.94
|
| Rate for Payer: Humana KY Medicaid |
$4,667.71
|
| Rate for Payer: Kentucky WC Medicaid |
$4,715.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,129.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,016.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,071.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,761.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,944.13
|
| Rate for Payer: Ohio Health Group HMO |
$10,179.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,858.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,808.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,365.28
|
| Rate for Payer: PHCS Commercial |
$13,029.96
|
| Rate for Payer: United Healthcare All Payer |
$11,944.13
|
|
|
23 SLV MD CONE 1 SPOU TALL SLT
|
Facility
|
IP
|
$13,572.87
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,071.86 |
| Max. Negotiated Rate |
$13,029.96 |
| Rate for Payer: Aetna Commercial |
$10,451.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,586.84
|
| Rate for Payer: Cash Price |
$6,786.43
|
| Rate for Payer: Cigna Commercial |
$11,265.48
|
| Rate for Payer: First Health Commercial |
$12,894.23
|
| Rate for Payer: Humana Commercial |
$11,536.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,129.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,016.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,071.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,944.13
|
| Rate for Payer: Ohio Health Group HMO |
$10,179.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,858.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,808.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,365.28
|
| Rate for Payer: PHCS Commercial |
$13,029.96
|
| Rate for Payer: United Healthcare All Payer |
$11,944.13
|
|
|
23 SLV MD CONE 2 SPOU TALL SLT
|
Facility
|
OP
|
$13,572.87
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,071.86 |
| Max. Negotiated Rate |
$13,029.96 |
| Rate for Payer: Aetna Commercial |
$10,451.11
|
| Rate for Payer: Anthem Medicaid |
$4,667.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,586.84
|
| Rate for Payer: Cash Price |
$6,786.43
|
| Rate for Payer: Cigna Commercial |
$11,265.48
|
| Rate for Payer: First Health Commercial |
$12,894.23
|
| Rate for Payer: Humana Commercial |
$11,536.94
|
| Rate for Payer: Humana KY Medicaid |
$4,667.71
|
| Rate for Payer: Kentucky WC Medicaid |
$4,715.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,129.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,016.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,071.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,761.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,944.13
|
| Rate for Payer: Ohio Health Group HMO |
$10,179.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,858.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,808.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,365.28
|
| Rate for Payer: PHCS Commercial |
$13,029.96
|
| Rate for Payer: United Healthcare All Payer |
$11,944.13
|
|
|
23 SLV MD CONE 2 SPOU TALL SLT
|
Facility
|
IP
|
$13,572.87
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,071.86 |
| Max. Negotiated Rate |
$13,029.96 |
| Rate for Payer: Aetna Commercial |
$10,451.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,586.84
|
| Rate for Payer: Cash Price |
$6,786.43
|
| Rate for Payer: Cigna Commercial |
$11,265.48
|
| Rate for Payer: First Health Commercial |
$12,894.23
|
| Rate for Payer: Humana Commercial |
$11,536.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,129.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,016.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,071.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,944.13
|
| Rate for Payer: Ohio Health Group HMO |
$10,179.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,858.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,808.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,365.28
|
| Rate for Payer: PHCS Commercial |
$13,029.96
|
| Rate for Payer: United Healthcare All Payer |
$11,944.13
|
|
