|
EMP 17 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 17 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 17 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 17 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 17 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 17 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 17 SLV SM 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 17 SLV SM 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 19 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 19 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 19 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 19 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 19 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 19 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 19 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 19 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 19 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 19 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 19 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 19 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 19 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 19 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 19 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 19 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 19 SLV SM 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
|
|
