|
EMP 19 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
|
|
|
EMPERION STEM 11 SH REV POL+10
|
Facility
|
OP
|
$17,672.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,297.37 |
| Max. Negotiated Rate |
$16,965.22 |
| Rate for Payer: Aetna Commercial |
$13,607.52
|
| Rate for Payer: Anthem Medicaid |
$6,077.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,784.24
|
| Rate for Payer: Cash Price |
$8,836.05
|
| Rate for Payer: Cigna Commercial |
$14,667.84
|
| Rate for Payer: First Health Commercial |
$16,788.50
|
| Rate for Payer: Humana Commercial |
$15,021.28
|
| Rate for Payer: Humana KY Medicaid |
$6,077.44
|
| Rate for Payer: Kentucky WC Medicaid |
$6,139.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,491.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,042.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,301.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,199.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,551.45
|
| Rate for Payer: Ohio Health Group HMO |
$13,254.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,534.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,297.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,478.35
|
| Rate for Payer: PHCS Commercial |
$16,965.22
|
| Rate for Payer: United Healthcare All Payer |
$15,551.45
|
|
|
EMPERION STEM 11 SH REV POL+10
|
Facility
|
IP
|
$17,672.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,297.37 |
| Max. Negotiated Rate |
$16,965.22 |
| Rate for Payer: Aetna Commercial |
$13,607.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,784.24
|
| Rate for Payer: Cash Price |
$8,836.05
|
| Rate for Payer: Cigna Commercial |
$14,667.84
|
| Rate for Payer: First Health Commercial |
$16,788.50
|
| Rate for Payer: Humana Commercial |
$15,021.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,491.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,042.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,301.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,551.45
|
| Rate for Payer: Ohio Health Group HMO |
$13,254.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,534.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,297.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,478.35
|
| Rate for Payer: PHCS Commercial |
$16,965.22
|
| Rate for Payer: United Healthcare All Payer |
$15,551.45
|
|
|
EMPERN STEM 11 SH REV GRIT+10
|
Facility
|
IP
|
$17,563.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,283.30 |
| Max. Negotiated Rate |
$16,861.30 |
| Rate for Payer: Aetna Commercial |
$13,524.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,699.80
|
| Rate for Payer: Cash Price |
$8,781.92
|
| Rate for Payer: Cigna Commercial |
$14,578.00
|
| Rate for Payer: First Health Commercial |
$16,685.66
|
| Rate for Payer: Humana Commercial |
$14,929.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,402.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,962.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,269.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,456.19
|
| Rate for Payer: Ohio Health Group HMO |
$13,172.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,512.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,283.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,444.79
|
| Rate for Payer: PHCS Commercial |
$16,861.30
|
| Rate for Payer: United Healthcare All Payer |
$15,456.19
|
|
|
EMPERN STEM 11 SH REV GRIT+10
|
Facility
|
OP
|
$17,563.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,283.30 |
| Max. Negotiated Rate |
$16,861.30 |
| Rate for Payer: Aetna Commercial |
$13,524.16
|
| Rate for Payer: Anthem Medicaid |
$6,040.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,699.80
|
| Rate for Payer: Cash Price |
$8,781.92
|
| Rate for Payer: Cigna Commercial |
$14,578.00
|
| Rate for Payer: First Health Commercial |
$16,685.66
|
| Rate for Payer: Humana Commercial |
$14,929.27
|
| Rate for Payer: Humana KY Medicaid |
$6,040.21
|
| Rate for Payer: Kentucky WC Medicaid |
$6,101.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,402.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,962.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,269.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,161.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,456.19
|
| Rate for Payer: Ohio Health Group HMO |
$13,172.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,512.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,283.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,444.79
|
| Rate for Payer: PHCS Commercial |
$16,861.30
|
| Rate for Payer: United Healthcare All Payer |
$15,456.19
|
|
|
EMPERN STEM 11 SH REV GRIT+20
|
Facility
|
IP
|
$18,015.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,342.07 |
| Max. Negotiated Rate |
$17,295.26 |
| Rate for Payer: Aetna Commercial |
$13,872.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,052.40
|
| Rate for Payer: Cash Price |
$9,007.95
|
| Rate for Payer: Cigna Commercial |
$14,953.20
|
| Rate for Payer: First Health Commercial |
$17,115.10
|
| Rate for Payer: Humana Commercial |
$15,313.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,773.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,295.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,404.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,853.99
|
| Rate for Payer: Ohio Health Group HMO |
$13,511.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,603.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,342.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,584.93
|
| Rate for Payer: PHCS Commercial |
$17,295.26
|
| Rate for Payer: United Healthcare All Payer |
$15,853.99
|
|
|
EMPERN STEM 11 SH REV GRIT+20
|
Facility
|
OP
|
$18,015.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,342.07 |
| Max. Negotiated Rate |
$17,295.26 |
| Rate for Payer: Aetna Commercial |
$13,872.24
|
| Rate for Payer: Anthem Medicaid |
$6,195.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,052.40
|
| Rate for Payer: Cash Price |
$9,007.95
|
| Rate for Payer: Cigna Commercial |
$14,953.20
|
| Rate for Payer: First Health Commercial |
$17,115.10
|
| Rate for Payer: Humana Commercial |
$15,313.52
|
| Rate for Payer: Humana KY Medicaid |
$6,195.67
|
| Rate for Payer: Kentucky WC Medicaid |
$6,258.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,773.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,295.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,404.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,319.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,853.99
|
| Rate for Payer: Ohio Health Group HMO |
$13,511.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,603.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,342.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,584.93
|
| Rate for Payer: PHCS Commercial |
$17,295.26
|
| Rate for Payer: United Healthcare All Payer |
$15,853.99
|
|
|
EMP II 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 II 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 II 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 II 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 II 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 II 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 II 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 II 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 II 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 II 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 II 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 II 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 II 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 II 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 II 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 II 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 II 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 II 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
|
|
