|
EMP SLV 11M CON 2 SPT TALLSLT
|
Facility
|
OP
|
$11,118.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,445.38 |
| Max. Negotiated Rate |
$10,673.57 |
| Rate for Payer: Aetna Commercial |
$8,561.09
|
| Rate for Payer: Anthem Medicaid |
$3,823.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,672.27
|
| Rate for Payer: Cash Price |
$5,559.15
|
| Rate for Payer: Cigna Commercial |
$9,228.19
|
| Rate for Payer: First Health Commercial |
$10,562.38
|
| Rate for Payer: Humana Commercial |
$9,450.56
|
| Rate for Payer: Humana KY Medicaid |
$3,823.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,862.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,117.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,205.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,335.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,900.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,784.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,338.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,223.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,445.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,446.67
|
| Rate for Payer: PHCS Commercial |
$10,673.57
|
| Rate for Payer: United Healthcare All Payer |
$9,784.10
|
|
|
EMP SLV 11M CON 2 SPT TALLSLT
|
Facility
|
IP
|
$11,118.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,445.38 |
| Max. Negotiated Rate |
$10,673.57 |
| Rate for Payer: Aetna Commercial |
$8,561.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,672.27
|
| Rate for Payer: Cash Price |
$5,559.15
|
| Rate for Payer: Cigna Commercial |
$9,228.19
|
| Rate for Payer: First Health Commercial |
$10,562.38
|
| Rate for Payer: Humana Commercial |
$9,450.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,117.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,205.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,335.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,784.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,338.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,223.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,445.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,446.67
|
| Rate for Payer: PHCS Commercial |
$10,673.57
|
| Rate for Payer: United Healthcare All Payer |
$9,784.10
|
|
|
EMP SLV 11 MD CONE 1 SP SLT TL
|
Facility
|
IP
|
$12,846.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,670.03 |
| Max. Negotiated Rate |
$12,332.53 |
| Rate for Payer: Aetna Commercial |
$9,891.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,020.18
|
| Rate for Payer: Cash Price |
$6,423.20
|
| Rate for Payer: Cigna Commercial |
$10,662.50
|
| Rate for Payer: First Health Commercial |
$12,204.07
|
| Rate for Payer: Humana Commercial |
$10,919.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,534.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,480.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,853.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,304.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,634.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,569.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,670.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,982.38
|
| Rate for Payer: PHCS Commercial |
$12,332.53
|
| Rate for Payer: United Healthcare All Payer |
$11,304.82
|
|
|
EMP SLV 11 MD CONE 1 SP SLT TL
|
Facility
|
OP
|
$12,846.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,670.03 |
| Max. Negotiated Rate |
$12,332.53 |
| Rate for Payer: Aetna Commercial |
$9,891.72
|
| Rate for Payer: Anthem Medicaid |
$4,417.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,020.18
|
| Rate for Payer: Cash Price |
$6,423.20
|
| Rate for Payer: Cigna Commercial |
$10,662.50
|
| Rate for Payer: First Health Commercial |
$12,204.07
|
| Rate for Payer: Humana Commercial |
$10,919.43
|
| Rate for Payer: Humana KY Medicaid |
$4,417.87
|
| Rate for Payer: Kentucky WC Medicaid |
$4,462.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,534.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,480.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,853.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,506.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,304.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,634.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,569.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,670.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,982.38
|
| Rate for Payer: PHCS Commercial |
$12,332.53
|
| Rate for Payer: United Healthcare All Payer |
$11,304.82
|
|
|
EMP SLV 11 SM CONE 1 SP SLT TL
|
Facility
|
IP
|
$12,846.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,670.03 |
| Max. Negotiated Rate |
$12,332.53 |
| Rate for Payer: Aetna Commercial |
$9,891.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,020.18
|
| Rate for Payer: Cash Price |
$6,423.20
|
| Rate for Payer: Cigna Commercial |
$10,662.50
|
| Rate for Payer: First Health Commercial |
$12,204.07
|
| Rate for Payer: Humana Commercial |
$10,919.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,534.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,480.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,853.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,304.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,634.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,569.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,670.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,982.38
|
| Rate for Payer: PHCS Commercial |
$12,332.53
|
| Rate for Payer: United Healthcare All Payer |
$11,304.82
|
|
|
EMP SLV 11 SM CONE 1 SP SLT TL
|
Facility
|
OP
|
$12,846.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,670.03 |
| Max. Negotiated Rate |
$12,332.53 |
| Rate for Payer: Aetna Commercial |
$9,891.72
|
| Rate for Payer: Anthem Medicaid |
$4,417.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,020.18
|
| Rate for Payer: Cash Price |
$6,423.20
|
| Rate for Payer: Cigna Commercial |
$10,662.50
|
| Rate for Payer: First Health Commercial |
$12,204.07
|
| Rate for Payer: Humana Commercial |
$10,919.43
|
| Rate for Payer: Humana KY Medicaid |
$4,417.87
|
| Rate for Payer: Kentucky WC Medicaid |
$4,462.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,534.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,480.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,853.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,506.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,304.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,634.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,569.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,670.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,982.38
|
| Rate for Payer: PHCS Commercial |
$12,332.53
|
| Rate for Payer: United Healthcare All Payer |
$11,304.82
|
|
|
EMP SLV 11 SM CONE 2 SP SLT TL
|
Facility
|
OP
|
$12,846.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,670.03 |
| Max. Negotiated Rate |
$12,332.53 |
| Rate for Payer: Aetna Commercial |
$9,891.72
|
| Rate for Payer: Anthem Medicaid |
$4,417.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,020.18
|
| Rate for Payer: Cash Price |
$6,423.20
|
| Rate for Payer: Cigna Commercial |
$10,662.50
|
| Rate for Payer: First Health Commercial |
$12,204.07
|
| Rate for Payer: Humana Commercial |
$10,919.43
|
| Rate for Payer: Humana KY Medicaid |
$4,417.87
|
| Rate for Payer: Kentucky WC Medicaid |
$4,462.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,534.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,480.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,853.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,506.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,304.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,634.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,569.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,670.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,982.38
|
| Rate for Payer: PHCS Commercial |
$12,332.53
|
| Rate for Payer: United Healthcare All Payer |
$11,304.82
|
|
|
EMP SLV 11 SM CONE 2 SP SLT TL
|
Facility
|
IP
|
$12,846.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,670.03 |
| Max. Negotiated Rate |
$12,332.53 |
| Rate for Payer: Aetna Commercial |
$9,891.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,020.18
|
| Rate for Payer: Cash Price |
$6,423.20
|
| Rate for Payer: Cigna Commercial |
$10,662.50
|
| Rate for Payer: First Health Commercial |
$12,204.07
|
| Rate for Payer: Humana Commercial |
$10,919.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,534.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,480.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,853.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,304.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,634.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,569.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,670.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,982.38
|
| Rate for Payer: PHCS Commercial |
$12,332.53
|
| Rate for Payer: United Healthcare All Payer |
$11,304.82
|
|
|
EMP SLV 13 M CONE 3 SPOUT TALL
|
Facility
|
IP
|
$10,066.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,308.59 |
| Max. Negotiated Rate |
$9,663.42 |
| Rate for Payer: Aetna Commercial |
$7,750.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,851.53
|
| Rate for Payer: Cash Price |
$5,033.03
|
| Rate for Payer: Cigna Commercial |
$8,354.83
|
| Rate for Payer: First Health Commercial |
$9,562.76
|
| Rate for Payer: Humana Commercial |
$8,556.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,254.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,428.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,019.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,858.13
|
| Rate for Payer: Ohio Health Group HMO |
$7,549.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,013.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,308.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,120.48
|
| Rate for Payer: PHCS Commercial |
$9,663.42
|
| Rate for Payer: United Healthcare All Payer |
$8,858.13
|
|
|
EMP SLV 13 M CONE 3 SPOUT TALL
|
Facility
|
OP
|
$10,066.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,308.59 |
| Max. Negotiated Rate |
$9,663.42 |
| Rate for Payer: Aetna Commercial |
$7,750.87
|
| Rate for Payer: Anthem Medicaid |
$3,461.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,851.53
|
| Rate for Payer: Cash Price |
$5,033.03
|
| Rate for Payer: Cigna Commercial |
$8,354.83
|
| Rate for Payer: First Health Commercial |
$9,562.76
|
| Rate for Payer: Humana Commercial |
$8,556.15
|
| Rate for Payer: Humana KY Medicaid |
$3,461.72
|
| Rate for Payer: Kentucky WC Medicaid |
$3,496.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,254.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,428.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,019.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,531.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,858.13
|
| Rate for Payer: Ohio Health Group HMO |
$7,549.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,013.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,308.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,120.48
|
| Rate for Payer: PHCS Commercial |
$9,663.42
|
| Rate for Payer: United Healthcare All Payer |
$8,858.13
|
|
|
EMP SLV 17 XL CONE 1 SPOUT SLT
|
Facility
|
IP
|
$12,846.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,670.03 |
| Max. Negotiated Rate |
$12,332.53 |
| Rate for Payer: Aetna Commercial |
$9,891.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,020.18
|
| Rate for Payer: Cash Price |
$6,423.20
|
| Rate for Payer: Cigna Commercial |
$10,662.50
|
| Rate for Payer: First Health Commercial |
$12,204.07
|
| Rate for Payer: Humana Commercial |
$10,919.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,534.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,480.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,853.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,304.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,634.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,569.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,670.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,982.38
|
| Rate for Payer: PHCS Commercial |
$12,332.53
|
| Rate for Payer: United Healthcare All Payer |
$11,304.82
|
|
|
EMP SLV 17 XL CONE 1 SPOUT SLT
|
Facility
|
OP
|
$12,846.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,670.03 |
| Max. Negotiated Rate |
$12,332.53 |
| Rate for Payer: Aetna Commercial |
$9,891.72
|
| Rate for Payer: Anthem Medicaid |
$4,417.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,020.18
|
| Rate for Payer: Cash Price |
$6,423.20
|
| Rate for Payer: Cigna Commercial |
$10,662.50
|
| Rate for Payer: First Health Commercial |
$12,204.07
|
| Rate for Payer: Humana Commercial |
$10,919.43
|
| Rate for Payer: Humana KY Medicaid |
$4,417.87
|
| Rate for Payer: Kentucky WC Medicaid |
$4,462.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,534.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,480.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,853.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,506.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,304.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,634.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,569.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,670.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,982.38
|
| Rate for Payer: PHCS Commercial |
$12,332.53
|
| Rate for Payer: United Healthcare All Payer |
$11,304.82
|
|
|
EMP SLV 17 XL CONE 2 SPOUT SLT
|
Facility
|
IP
|
$12,846.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,670.03 |
| Max. Negotiated Rate |
$12,332.53 |
| Rate for Payer: Aetna Commercial |
$9,891.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,020.18
|
| Rate for Payer: Cash Price |
$6,423.20
|
| Rate for Payer: Cigna Commercial |
$10,662.50
|
| Rate for Payer: First Health Commercial |
$12,204.07
|
| Rate for Payer: Humana Commercial |
$10,919.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,534.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,480.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,853.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,304.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,634.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,569.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,670.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,982.38
|
| Rate for Payer: PHCS Commercial |
$12,332.53
|
| Rate for Payer: United Healthcare All Payer |
$11,304.82
|
|
|
EMP SLV 17 XL CONE 2 SPOUT SLT
|
Facility
|
OP
|
$12,846.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,670.03 |
| Max. Negotiated Rate |
$12,332.53 |
| Rate for Payer: Aetna Commercial |
$9,891.72
|
| Rate for Payer: Anthem Medicaid |
$4,417.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,020.18
|
| Rate for Payer: Cash Price |
$6,423.20
|
| Rate for Payer: Cigna Commercial |
$10,662.50
|
| Rate for Payer: First Health Commercial |
$12,204.07
|
| Rate for Payer: Humana Commercial |
$10,919.43
|
| Rate for Payer: Humana KY Medicaid |
$4,417.87
|
| Rate for Payer: Kentucky WC Medicaid |
$4,462.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,534.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,480.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,853.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,506.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,304.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,634.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,569.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,670.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,982.38
|
| Rate for Payer: PHCS Commercial |
$12,332.53
|
| Rate for Payer: United Healthcare All Payer |
$11,304.82
|
|
|
EMP SLV 17 XL CONE 3 SPOUT SLT
|
Facility
|
OP
|
$12,846.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,670.03 |
| Max. Negotiated Rate |
$12,332.53 |
| Rate for Payer: Aetna Commercial |
$9,891.72
|
| Rate for Payer: Anthem Medicaid |
$4,417.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,020.18
|
| Rate for Payer: Cash Price |
$6,423.20
|
| Rate for Payer: Cigna Commercial |
$10,662.50
|
| Rate for Payer: First Health Commercial |
$12,204.07
|
| Rate for Payer: Humana Commercial |
$10,919.43
|
| Rate for Payer: Humana KY Medicaid |
$4,417.87
|
| Rate for Payer: Kentucky WC Medicaid |
$4,462.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,534.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,480.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,853.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,506.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,304.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,634.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,569.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,670.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,982.38
|
| Rate for Payer: PHCS Commercial |
$12,332.53
|
| Rate for Payer: United Healthcare All Payer |
$11,304.82
|
|
|
EMP SLV 17 XL CONE 3 SPOUT SLT
|
Facility
|
IP
|
$12,846.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,670.03 |
| Max. Negotiated Rate |
$12,332.53 |
| Rate for Payer: Aetna Commercial |
$9,891.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,020.18
|
| Rate for Payer: Cash Price |
$6,423.20
|
| Rate for Payer: Cigna Commercial |
$10,662.50
|
| Rate for Payer: First Health Commercial |
$12,204.07
|
| Rate for Payer: Humana Commercial |
$10,919.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,534.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,480.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,853.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,304.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,634.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,569.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,670.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,982.38
|
| Rate for Payer: PHCS Commercial |
$12,332.53
|
| Rate for Payer: United Healthcare All Payer |
$11,304.82
|
|
|
EMP SLV 19 XL CONE 1 SPOU SLOT
|
Facility
|
IP
|
$12,840.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,669.22 |
| Max. Negotiated Rate |
$12,326.58 |
| Rate for Payer: Aetna Commercial |
$9,886.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,015.35
|
| Rate for Payer: Cash Price |
$6,420.09
|
| Rate for Payer: Cigna Commercial |
$10,657.36
|
| Rate for Payer: First Health Commercial |
$12,198.18
|
| Rate for Payer: Humana Commercial |
$10,914.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,528.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,476.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,852.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,299.37
|
| Rate for Payer: Ohio Health Group HMO |
$9,630.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,568.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,669.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,980.46
|
| Rate for Payer: PHCS Commercial |
$12,326.58
|
| Rate for Payer: United Healthcare All Payer |
$11,299.37
|
|
|
EMP SLV 19 XL CONE 1 SPOU SLOT
|
Facility
|
OP
|
$12,840.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,669.22 |
| Max. Negotiated Rate |
$12,326.58 |
| Rate for Payer: Aetna Commercial |
$9,886.95
|
| Rate for Payer: Anthem Medicaid |
$4,415.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,015.35
|
| Rate for Payer: Cash Price |
$6,420.09
|
| Rate for Payer: Cigna Commercial |
$10,657.36
|
| Rate for Payer: First Health Commercial |
$12,198.18
|
| Rate for Payer: Humana Commercial |
$10,914.16
|
| Rate for Payer: Humana KY Medicaid |
$4,415.74
|
| Rate for Payer: Kentucky WC Medicaid |
$4,460.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,528.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,476.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,852.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,504.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,299.37
|
| Rate for Payer: Ohio Health Group HMO |
$9,630.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,568.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,669.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,980.46
|
| Rate for Payer: PHCS Commercial |
$12,326.58
|
| Rate for Payer: United Healthcare All Payer |
$11,299.37
|
|
|
EMP SLV 19 XL CONE 2 SPOU SLOT
|
Facility
|
OP
|
$12,840.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,669.22 |
| Max. Negotiated Rate |
$12,326.58 |
| Rate for Payer: Aetna Commercial |
$9,886.95
|
| Rate for Payer: Anthem Medicaid |
$4,415.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,015.35
|
| Rate for Payer: Cash Price |
$6,420.09
|
| Rate for Payer: Cigna Commercial |
$10,657.36
|
| Rate for Payer: First Health Commercial |
$12,198.18
|
| Rate for Payer: Humana Commercial |
$10,914.16
|
| Rate for Payer: Humana KY Medicaid |
$4,415.74
|
| Rate for Payer: Kentucky WC Medicaid |
$4,460.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,528.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,476.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,852.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,504.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,299.37
|
| Rate for Payer: Ohio Health Group HMO |
$9,630.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,568.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,669.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,980.46
|
| Rate for Payer: PHCS Commercial |
$12,326.58
|
| Rate for Payer: United Healthcare All Payer |
$11,299.37
|
|
|
EMP SLV 19 XL CONE 2 SPOU SLOT
|
Facility
|
IP
|
$12,840.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,669.22 |
| Max. Negotiated Rate |
$12,326.58 |
| Rate for Payer: Aetna Commercial |
$9,886.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,015.35
|
| Rate for Payer: Cash Price |
$6,420.09
|
| Rate for Payer: Cigna Commercial |
$10,657.36
|
| Rate for Payer: First Health Commercial |
$12,198.18
|
| Rate for Payer: Humana Commercial |
$10,914.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,528.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,476.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,852.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,299.37
|
| Rate for Payer: Ohio Health Group HMO |
$9,630.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,568.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,669.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,980.46
|
| Rate for Payer: PHCS Commercial |
$12,326.58
|
| Rate for Payer: United Healthcare All Payer |
$11,299.37
|
|
|
EMP SLV 19 XL CONE 3 SPOU SLOT
|
Facility
|
OP
|
$12,840.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,669.22 |
| Max. Negotiated Rate |
$12,326.58 |
| Rate for Payer: Aetna Commercial |
$9,886.95
|
| Rate for Payer: Anthem Medicaid |
$4,415.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,015.35
|
| Rate for Payer: Cash Price |
$6,420.09
|
| Rate for Payer: Cigna Commercial |
$10,657.36
|
| Rate for Payer: First Health Commercial |
$12,198.18
|
| Rate for Payer: Humana Commercial |
$10,914.16
|
| Rate for Payer: Humana KY Medicaid |
$4,415.74
|
| Rate for Payer: Kentucky WC Medicaid |
$4,460.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,528.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,476.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,852.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,504.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,299.37
|
| Rate for Payer: Ohio Health Group HMO |
$9,630.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,568.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,669.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,980.46
|
| Rate for Payer: PHCS Commercial |
$12,326.58
|
| Rate for Payer: United Healthcare All Payer |
$11,299.37
|
|
|
EMP SLV 19 XL CONE 3 SPOU SLOT
|
Facility
|
IP
|
$12,840.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,669.22 |
| Max. Negotiated Rate |
$12,326.58 |
| Rate for Payer: Aetna Commercial |
$9,886.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,015.35
|
| Rate for Payer: Cash Price |
$6,420.09
|
| Rate for Payer: Cigna Commercial |
$10,657.36
|
| Rate for Payer: First Health Commercial |
$12,198.18
|
| Rate for Payer: Humana Commercial |
$10,914.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,528.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,476.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,852.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,299.37
|
| Rate for Payer: Ohio Health Group HMO |
$9,630.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,568.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,669.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,980.46
|
| Rate for Payer: PHCS Commercial |
$12,326.58
|
| Rate for Payer: United Healthcare All Payer |
$11,299.37
|
|
|
EMP SLV 21 LG CONE 1 SP SLT TL
|
Facility
|
IP
|
$11,313.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,470.79 |
| Max. Negotiated Rate |
$10,861.21 |
| Rate for Payer: Aetna Commercial |
$8,711.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,824.73
|
| Rate for Payer: Cash Price |
$5,656.88
|
| Rate for Payer: Cigna Commercial |
$9,390.42
|
| Rate for Payer: First Health Commercial |
$10,748.07
|
| Rate for Payer: Humana Commercial |
$9,616.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,277.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,349.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,394.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,956.11
|
| Rate for Payer: Ohio Health Group HMO |
$8,485.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,262.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,470.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,507.27
|
| Rate for Payer: PHCS Commercial |
$10,861.21
|
| Rate for Payer: United Healthcare All Payer |
$9,956.11
|
|
|
EMP SLV 21 LG CONE 1 SP SLT TL
|
Facility
|
OP
|
$11,313.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,470.79 |
| Max. Negotiated Rate |
$10,861.21 |
| Rate for Payer: Aetna Commercial |
$8,711.60
|
| Rate for Payer: Anthem Medicaid |
$3,890.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,824.73
|
| Rate for Payer: Cash Price |
$5,656.88
|
| Rate for Payer: Cigna Commercial |
$9,390.42
|
| Rate for Payer: First Health Commercial |
$10,748.07
|
| Rate for Payer: Humana Commercial |
$9,616.70
|
| Rate for Payer: Humana KY Medicaid |
$3,890.80
|
| Rate for Payer: Kentucky WC Medicaid |
$3,930.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,277.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,349.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,394.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,968.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,956.11
|
| Rate for Payer: Ohio Health Group HMO |
$8,485.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,262.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,470.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,507.27
|
| Rate for Payer: PHCS Commercial |
$10,861.21
|
| Rate for Payer: United Healthcare All Payer |
$9,956.11
|
|
|
EMP SLV 21 LG CONE 2 SP SLT TL
|
Facility
|
IP
|
$11,313.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,470.79 |
| Max. Negotiated Rate |
$10,861.21 |
| Rate for Payer: Aetna Commercial |
$8,711.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,824.73
|
| Rate for Payer: Cash Price |
$5,656.88
|
| Rate for Payer: Cigna Commercial |
$9,390.42
|
| Rate for Payer: First Health Commercial |
$10,748.07
|
| Rate for Payer: Humana Commercial |
$9,616.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,277.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,349.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,394.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,956.11
|
| Rate for Payer: Ohio Health Group HMO |
$8,485.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,262.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,470.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,507.27
|
| Rate for Payer: PHCS Commercial |
$10,861.21
|
| Rate for Payer: United Healthcare All Payer |
$9,956.11
|
|
