|
EMG THORACIC (EXCL T1/T12)
|
Professional
|
Both
|
$298.00
|
|
|
Service Code
|
HCPCS 95869
|
| Hospital Charge Code |
92200006
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$22.73 |
| Max. Negotiated Rate |
$298.00 |
| Rate for Payer: Aetna Commercial |
$68.63
|
| Rate for Payer: Anthem Medicaid |
$26.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$298.00
|
| Rate for Payer: Cash Price |
$149.00
|
| Rate for Payer: Cash Price |
$149.00
|
| Rate for Payer: Cigna Commercial |
$52.31
|
| Rate for Payer: Healthspan PPO |
$60.45
|
| Rate for Payer: Humana Medicaid |
$26.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$22.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.82
|
| Rate for Payer: Molina Healthcare Passport |
$26.29
|
| Rate for Payer: Multiplan PHCS |
$178.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$208.60
|
| Rate for Payer: UHCCP Medicaid |
$104.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.55
|
|
|
EMG THORACIC (EXCL T1/T12)
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
HCPCS 95869
|
| Hospital Charge Code |
92200006
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$38.74 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Aetna Commercial |
$229.46
|
| Rate for Payer: Anthem Medicaid |
$102.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$232.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$149.00
|
| Rate for Payer: Cash Price |
$149.00
|
| Rate for Payer: Cigna Commercial |
$247.34
|
| Rate for Payer: First Health Commercial |
$283.10
|
| Rate for Payer: Humana Commercial |
$253.30
|
| Rate for Payer: Humana KY Medicaid |
$102.48
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$103.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$244.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$219.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$104.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$262.24
|
| Rate for Payer: Ohio Health Group HMO |
$223.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$92.38
|
| Rate for Payer: PHCS Commercial |
$286.08
|
| Rate for Payer: United Healthcare All Payer |
$262.24
|
|
|
EMG THORACIC (EXCL T1/T12)
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
HCPCS 95869
|
| Hospital Charge Code |
92200006
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$38.74 |
| Max. Negotiated Rate |
$286.08 |
| Rate for Payer: Aetna Commercial |
$229.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$232.44
|
| Rate for Payer: Cash Price |
$149.00
|
| Rate for Payer: Cigna Commercial |
$247.34
|
| Rate for Payer: First Health Commercial |
$283.10
|
| Rate for Payer: Humana Commercial |
$253.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$244.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$219.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$262.24
|
| Rate for Payer: Ohio Health Group HMO |
$223.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$92.38
|
| Rate for Payer: PHCS Commercial |
$286.08
|
| Rate for Payer: United Healthcare All Payer |
$262.24
|
|
|
EMG THORACIC (EXCL T1/T12)(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 95869
|
| Hospital Charge Code |
922P0006
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$22.73 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$68.63
|
| Rate for Payer: Anthem Medicaid |
$26.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$52.31
|
| Rate for Payer: Healthspan PPO |
$60.45
|
| Rate for Payer: Humana Medicaid |
$26.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$22.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.82
|
| Rate for Payer: Molina Healthcare Passport |
$26.29
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.55
|
|
|
EMG THORACIC (EXCL T1/T12)(T
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
HCPCS 95869
|
| Hospital Charge Code |
922T0006
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$25.74 |
| Max. Negotiated Rate |
$190.08 |
| Rate for Payer: Aetna Commercial |
$152.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$154.44
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$164.34
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: Humana Commercial |
$168.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$162.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$174.24
|
| Rate for Payer: Ohio Health Group HMO |
$148.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$61.38
|
| Rate for Payer: PHCS Commercial |
$190.08
|
| Rate for Payer: United Healthcare All Payer |
$174.24
|
|
|
EMG THORACIC (EXCL T1/T12)(T
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
HCPCS 95869
|
| Hospital Charge Code |
922T0006
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$25.74 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Aetna Commercial |
$152.46
|
| Rate for Payer: Anthem Medicaid |
$68.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$154.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$164.34
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: Humana Commercial |
$168.30
|
| Rate for Payer: Humana KY Medicaid |
$68.09
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$68.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$162.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$69.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$174.24
|
| Rate for Payer: Ohio Health Group HMO |
$148.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$61.38
|
| Rate for Payer: PHCS Commercial |
$190.08
|
| Rate for Payer: United Healthcare All Payer |
$174.24
|
|
|
EMP 13 SLV LG CONE 1 SPOUT SLT
|
Facility
|
OP
|
$10,938.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,421.99 |
| Max. Negotiated Rate |
$10,500.82 |
| Rate for Payer: Aetna Commercial |
$8,422.53
|
| Rate for Payer: Anthem Medicaid |
$3,761.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,531.91
|
| Rate for Payer: Cash Price |
$5,469.18
|
| Rate for Payer: Cigna Commercial |
$9,078.83
|
| Rate for Payer: First Health Commercial |
$10,391.43
|
| Rate for Payer: Humana Commercial |
$9,297.60
|
| Rate for Payer: Humana KY Medicaid |
$3,761.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,799.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,969.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,072.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,281.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,837.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,625.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,203.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,187.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,421.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,390.89
|
| Rate for Payer: PHCS Commercial |
$10,500.82
|
| Rate for Payer: United Healthcare All Payer |
$9,625.75
|
|
|
EMP 13 SLV LG CONE 1 SPOUT SLT
|
Facility
|
IP
|
$10,938.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,421.99 |
| Max. Negotiated Rate |
$10,500.82 |
| Rate for Payer: Aetna Commercial |
$8,422.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,531.91
|
| Rate for Payer: Cash Price |
$5,469.18
|
| Rate for Payer: Cigna Commercial |
$9,078.83
|
| Rate for Payer: First Health Commercial |
$10,391.43
|
| Rate for Payer: Humana Commercial |
$9,297.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,969.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,072.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,281.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,625.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,203.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,187.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,421.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,390.89
|
| Rate for Payer: PHCS Commercial |
$10,500.82
|
| Rate for Payer: United Healthcare All Payer |
$9,625.75
|
|
|
EMP 13 SLV LG CONE 2 SPOUT SLT
|
Facility
|
OP
|
$10,938.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,421.99 |
| Max. Negotiated Rate |
$10,500.82 |
| Rate for Payer: Aetna Commercial |
$8,422.53
|
| Rate for Payer: Anthem Medicaid |
$3,761.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,531.91
|
| Rate for Payer: Cash Price |
$5,469.18
|
| Rate for Payer: Cigna Commercial |
$9,078.83
|
| Rate for Payer: First Health Commercial |
$10,391.43
|
| Rate for Payer: Humana Commercial |
$9,297.60
|
| Rate for Payer: Humana KY Medicaid |
$3,761.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,799.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,969.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,072.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,281.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,837.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,625.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,203.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,187.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,421.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,390.89
|
| Rate for Payer: PHCS Commercial |
$10,500.82
|
| Rate for Payer: United Healthcare All Payer |
$9,625.75
|
|
|
EMP 13 SLV LG CONE 2 SPOUT SLT
|
Facility
|
IP
|
$10,938.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,421.99 |
| Max. Negotiated Rate |
$10,500.82 |
| Rate for Payer: Aetna Commercial |
$8,422.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,531.91
|
| Rate for Payer: Cash Price |
$5,469.18
|
| Rate for Payer: Cigna Commercial |
$9,078.83
|
| Rate for Payer: First Health Commercial |
$10,391.43
|
| Rate for Payer: Humana Commercial |
$9,297.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,969.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,072.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,281.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,625.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,203.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,187.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,421.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,390.89
|
| Rate for Payer: PHCS Commercial |
$10,500.82
|
| Rate for Payer: United Healthcare All Payer |
$9,625.75
|
|
|
EMP 13 SLV LG CONE 3 SPOUT SLT
|
Facility
|
OP
|
$10,938.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,421.99 |
| Max. Negotiated Rate |
$10,500.82 |
| Rate for Payer: Aetna Commercial |
$8,422.53
|
| Rate for Payer: Anthem Medicaid |
$3,761.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,531.91
|
| Rate for Payer: Cash Price |
$5,469.18
|
| Rate for Payer: Cigna Commercial |
$9,078.83
|
| Rate for Payer: First Health Commercial |
$10,391.43
|
| Rate for Payer: Humana Commercial |
$9,297.60
|
| Rate for Payer: Humana KY Medicaid |
$3,761.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,799.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,969.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,072.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,281.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,837.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,625.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,203.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,187.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,421.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,390.89
|
| Rate for Payer: PHCS Commercial |
$10,500.82
|
| Rate for Payer: United Healthcare All Payer |
$9,625.75
|
|
|
EMP 13 SLV LG CONE 3 SPOUT SLT
|
Facility
|
IP
|
$10,938.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,421.99 |
| Max. Negotiated Rate |
$10,500.82 |
| Rate for Payer: Aetna Commercial |
$8,422.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,531.91
|
| Rate for Payer: Cash Price |
$5,469.18
|
| Rate for Payer: Cigna Commercial |
$9,078.83
|
| Rate for Payer: First Health Commercial |
$10,391.43
|
| Rate for Payer: Humana Commercial |
$9,297.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,969.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,072.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,281.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,625.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,203.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,187.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,421.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,390.89
|
| Rate for Payer: PHCS Commercial |
$10,500.82
|
| Rate for Payer: United Healthcare All Payer |
$9,625.75
|
|
|
EMP 13 SLV MD CONE 1 SPOUT SLT
|
Facility
|
OP
|
$10,938.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,421.99 |
| Max. Negotiated Rate |
$10,500.82 |
| Rate for Payer: Aetna Commercial |
$8,422.53
|
| Rate for Payer: Anthem Medicaid |
$3,761.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,531.91
|
| Rate for Payer: Cash Price |
$5,469.18
|
| Rate for Payer: Cigna Commercial |
$9,078.83
|
| Rate for Payer: First Health Commercial |
$10,391.43
|
| Rate for Payer: Humana Commercial |
$9,297.60
|
| Rate for Payer: Humana KY Medicaid |
$3,761.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,799.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,969.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,072.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,281.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,837.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,625.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,203.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,187.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,421.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,390.89
|
| Rate for Payer: PHCS Commercial |
$10,500.82
|
| Rate for Payer: United Healthcare All Payer |
$9,625.75
|
|
|
EMP 13 SLV MD CONE 1 SPOUT SLT
|
Facility
|
IP
|
$10,938.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,421.99 |
| Max. Negotiated Rate |
$10,500.82 |
| Rate for Payer: Aetna Commercial |
$8,422.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,531.91
|
| Rate for Payer: Cash Price |
$5,469.18
|
| Rate for Payer: Cigna Commercial |
$9,078.83
|
| Rate for Payer: First Health Commercial |
$10,391.43
|
| Rate for Payer: Humana Commercial |
$9,297.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,969.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,072.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,281.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,625.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,203.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,187.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,421.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,390.89
|
| Rate for Payer: PHCS Commercial |
$10,500.82
|
| Rate for Payer: United Healthcare All Payer |
$9,625.75
|
|
|
EMP 13 SLV MD CONE 2 SPOUT SLT
|
Facility
|
OP
|
$10,938.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,421.99 |
| Max. Negotiated Rate |
$10,500.82 |
| Rate for Payer: Aetna Commercial |
$8,422.53
|
| Rate for Payer: Anthem Medicaid |
$3,761.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,531.91
|
| Rate for Payer: Cash Price |
$5,469.18
|
| Rate for Payer: Cigna Commercial |
$9,078.83
|
| Rate for Payer: First Health Commercial |
$10,391.43
|
| Rate for Payer: Humana Commercial |
$9,297.60
|
| Rate for Payer: Humana KY Medicaid |
$3,761.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,799.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,969.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,072.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,281.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,837.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,625.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,203.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,187.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,421.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,390.89
|
| Rate for Payer: PHCS Commercial |
$10,500.82
|
| Rate for Payer: United Healthcare All Payer |
$9,625.75
|
|
|
EMP 13 SLV MD CONE 2 SPOUT SLT
|
Facility
|
IP
|
$10,938.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,421.99 |
| Max. Negotiated Rate |
$10,500.82 |
| Rate for Payer: Aetna Commercial |
$8,422.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,531.91
|
| Rate for Payer: Cash Price |
$5,469.18
|
| Rate for Payer: Cigna Commercial |
$9,078.83
|
| Rate for Payer: First Health Commercial |
$10,391.43
|
| Rate for Payer: Humana Commercial |
$9,297.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,969.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,072.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,281.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,625.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,203.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,187.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,421.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,390.89
|
| Rate for Payer: PHCS Commercial |
$10,500.82
|
| Rate for Payer: United Healthcare All Payer |
$9,625.75
|
|
|
EMP 13 SLV MD CONE 3 SPOUT SLT
|
Facility
|
OP
|
$10,938.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,421.99 |
| Max. Negotiated Rate |
$10,500.82 |
| Rate for Payer: Aetna Commercial |
$8,422.53
|
| Rate for Payer: Anthem Medicaid |
$3,761.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,531.91
|
| Rate for Payer: Cash Price |
$5,469.18
|
| Rate for Payer: Cigna Commercial |
$9,078.83
|
| Rate for Payer: First Health Commercial |
$10,391.43
|
| Rate for Payer: Humana Commercial |
$9,297.60
|
| Rate for Payer: Humana KY Medicaid |
$3,761.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,799.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,969.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,072.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,281.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,837.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,625.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,203.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,187.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,421.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,390.89
|
| Rate for Payer: PHCS Commercial |
$10,500.82
|
| Rate for Payer: United Healthcare All Payer |
$9,625.75
|
|
|
EMP 13 SLV MD CONE 3 SPOUT SLT
|
Facility
|
IP
|
$10,938.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,421.99 |
| Max. Negotiated Rate |
$10,500.82 |
| Rate for Payer: Aetna Commercial |
$8,422.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,531.91
|
| Rate for Payer: Cash Price |
$5,469.18
|
| Rate for Payer: Cigna Commercial |
$9,078.83
|
| Rate for Payer: First Health Commercial |
$10,391.43
|
| Rate for Payer: Humana Commercial |
$9,297.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,969.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,072.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,281.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,625.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,203.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,187.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,421.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,390.89
|
| Rate for Payer: PHCS Commercial |
$10,500.82
|
| Rate for Payer: United Healthcare All Payer |
$9,625.75
|
|
|
EMP 13 SLV SM CONE 1 SPOUT SLT
|
Facility
|
OP
|
$10,938.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,421.99 |
| Max. Negotiated Rate |
$10,500.82 |
| Rate for Payer: Aetna Commercial |
$8,422.53
|
| Rate for Payer: Anthem Medicaid |
$3,761.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,531.91
|
| Rate for Payer: Cash Price |
$5,469.18
|
| Rate for Payer: Cigna Commercial |
$9,078.83
|
| Rate for Payer: First Health Commercial |
$10,391.43
|
| Rate for Payer: Humana Commercial |
$9,297.60
|
| Rate for Payer: Humana KY Medicaid |
$3,761.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,799.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,969.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,072.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,281.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,837.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,625.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,203.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,187.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,421.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,390.89
|
| Rate for Payer: PHCS Commercial |
$10,500.82
|
| Rate for Payer: United Healthcare All Payer |
$9,625.75
|
|
|
EMP 13 SLV SM CONE 1 SPOUT SLT
|
Facility
|
IP
|
$10,938.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,421.99 |
| Max. Negotiated Rate |
$10,500.82 |
| Rate for Payer: Aetna Commercial |
$8,422.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,531.91
|
| Rate for Payer: Cash Price |
$5,469.18
|
| Rate for Payer: Cigna Commercial |
$9,078.83
|
| Rate for Payer: First Health Commercial |
$10,391.43
|
| Rate for Payer: Humana Commercial |
$9,297.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,969.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,072.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,281.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,625.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,203.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,187.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,421.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,390.89
|
| Rate for Payer: PHCS Commercial |
$10,500.82
|
| Rate for Payer: United Healthcare All Payer |
$9,625.75
|
|
|
EMP 13 SLV SM CONE 2 SPOUT SLT
|
Facility
|
OP
|
$10,938.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,421.99 |
| Max. Negotiated Rate |
$10,500.82 |
| Rate for Payer: Aetna Commercial |
$8,422.53
|
| Rate for Payer: Anthem Medicaid |
$3,761.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,531.91
|
| Rate for Payer: Cash Price |
$5,469.18
|
| Rate for Payer: Cigna Commercial |
$9,078.83
|
| Rate for Payer: First Health Commercial |
$10,391.43
|
| Rate for Payer: Humana Commercial |
$9,297.60
|
| Rate for Payer: Humana KY Medicaid |
$3,761.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,799.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,969.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,072.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,281.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,837.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,625.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,203.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,187.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,421.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,390.89
|
| Rate for Payer: PHCS Commercial |
$10,500.82
|
| Rate for Payer: United Healthcare All Payer |
$9,625.75
|
|
|
EMP 13 SLV SM CONE 2 SPOUT SLT
|
Facility
|
IP
|
$10,938.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,421.99 |
| Max. Negotiated Rate |
$10,500.82 |
| Rate for Payer: Aetna Commercial |
$8,422.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,531.91
|
| Rate for Payer: Cash Price |
$5,469.18
|
| Rate for Payer: Cigna Commercial |
$9,078.83
|
| Rate for Payer: First Health Commercial |
$10,391.43
|
| Rate for Payer: Humana Commercial |
$9,297.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,969.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,072.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,281.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,625.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,203.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,187.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,421.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,390.89
|
| Rate for Payer: PHCS Commercial |
$10,500.82
|
| Rate for Payer: United Healthcare All Payer |
$9,625.75
|
|
|
EMP 15 SLV LG CONE 1 SPOUT SLT
|
Facility
|
IP
|
$10,938.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,421.99 |
| Max. Negotiated Rate |
$10,500.82 |
| Rate for Payer: Aetna Commercial |
$8,422.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,531.91
|
| Rate for Payer: Cash Price |
$5,469.18
|
| Rate for Payer: Cigna Commercial |
$9,078.83
|
| Rate for Payer: First Health Commercial |
$10,391.43
|
| Rate for Payer: Humana Commercial |
$9,297.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,969.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,072.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,281.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,625.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,203.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,187.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,421.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,390.89
|
| Rate for Payer: PHCS Commercial |
$10,500.82
|
| Rate for Payer: United Healthcare All Payer |
$9,625.75
|
|
|
EMP 15 SLV LG CONE 1 SPOUT SLT
|
Facility
|
OP
|
$10,938.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,421.99 |
| Max. Negotiated Rate |
$10,500.82 |
| Rate for Payer: Aetna Commercial |
$8,422.53
|
| Rate for Payer: Anthem Medicaid |
$3,761.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,531.91
|
| Rate for Payer: Cash Price |
$5,469.18
|
| Rate for Payer: Cigna Commercial |
$9,078.83
|
| Rate for Payer: First Health Commercial |
$10,391.43
|
| Rate for Payer: Humana Commercial |
$9,297.60
|
| Rate for Payer: Humana KY Medicaid |
$3,761.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,799.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,969.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,072.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,281.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,837.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,625.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,203.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,187.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,421.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,390.89
|
| Rate for Payer: PHCS Commercial |
$10,500.82
|
| Rate for Payer: United Healthcare All Payer |
$9,625.75
|
|
|
EMP 15 SLV LG CONE 2 SPOUT SLT
|
Facility
|
IP
|
$10,938.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,421.99 |
| Max. Negotiated Rate |
$10,500.82 |
| Rate for Payer: Aetna Commercial |
$8,422.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,531.91
|
| Rate for Payer: Cash Price |
$5,469.18
|
| Rate for Payer: Cigna Commercial |
$9,078.83
|
| Rate for Payer: First Health Commercial |
$10,391.43
|
| Rate for Payer: Humana Commercial |
$9,297.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,969.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,072.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,281.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,625.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,203.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,187.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,421.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,390.89
|
| Rate for Payer: PHCS Commercial |
$10,500.82
|
| Rate for Payer: United Healthcare All Payer |
$9,625.75
|
|
