|
EMP SLV 21 LG CONE 2 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 3 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 3 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 MD 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 MD 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 MD CONE 2 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 MD 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
|
|
|
EMP SLV 21 MD CONE 3 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 MD CONE 3 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 SM CONE 1 SPOU SLOT
|
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 SM CONE 1 SPOU SLOT
|
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 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 21 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 21 SM CONE 3 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 SM CONE 3 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 XL CONE 1 SPOUT
|
Facility
|
IP
|
$11,720.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,523.62 |
| Max. Negotiated Rate |
$11,251.37 |
| Rate for Payer: Aetna Commercial |
$9,024.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,141.74
|
| Rate for Payer: Cash Price |
$5,860.09
|
| Rate for Payer: Cigna Commercial |
$9,727.75
|
| Rate for Payer: First Health Commercial |
$11,134.17
|
| Rate for Payer: Humana Commercial |
$9,962.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,610.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,649.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,516.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,313.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,790.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,344.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,523.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,633.26
|
| Rate for Payer: PHCS Commercial |
$11,251.37
|
| Rate for Payer: United Healthcare All Payer |
$10,313.76
|
|
|
EMP SLV 21 XL CONE 1 SPOUT
|
Facility
|
OP
|
$11,720.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,523.62 |
| Max. Negotiated Rate |
$11,251.37 |
| Rate for Payer: Aetna Commercial |
$9,024.54
|
| Rate for Payer: Anthem Medicaid |
$4,030.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,141.74
|
| Rate for Payer: Cash Price |
$5,860.09
|
| Rate for Payer: Cigna Commercial |
$9,727.75
|
| Rate for Payer: First Health Commercial |
$11,134.17
|
| Rate for Payer: Humana Commercial |
$9,962.15
|
| Rate for Payer: Humana KY Medicaid |
$4,030.57
|
| Rate for Payer: Kentucky WC Medicaid |
$4,071.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,610.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,649.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,516.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,111.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,313.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,790.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,344.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,523.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,633.26
|
| Rate for Payer: PHCS Commercial |
$11,251.37
|
| Rate for Payer: United Healthcare All Payer |
$10,313.76
|
|
|
EMP SLV 21 XL CONE 2 SPOUT
|
Facility
|
IP
|
$11,720.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,523.62 |
| Max. Negotiated Rate |
$11,251.37 |
| Rate for Payer: Aetna Commercial |
$9,024.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,141.74
|
| Rate for Payer: Cash Price |
$5,860.09
|
| Rate for Payer: Cigna Commercial |
$9,727.75
|
| Rate for Payer: First Health Commercial |
$11,134.17
|
| Rate for Payer: Humana Commercial |
$9,962.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,610.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,649.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,516.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,313.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,790.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,344.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,523.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,633.26
|
| Rate for Payer: PHCS Commercial |
$11,251.37
|
| Rate for Payer: United Healthcare All Payer |
$10,313.76
|
|
|
EMP SLV 21 XL CONE 2 SPOUT
|
Facility
|
OP
|
$11,720.18
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,523.62 |
| Max. Negotiated Rate |
$11,251.37 |
| Rate for Payer: Aetna Commercial |
$9,024.54
|
| Rate for Payer: Anthem Medicaid |
$4,030.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,141.74
|
| Rate for Payer: Cash Price |
$5,860.09
|
| Rate for Payer: Cigna Commercial |
$9,727.75
|
| Rate for Payer: First Health Commercial |
$11,134.17
|
| Rate for Payer: Humana Commercial |
$9,962.15
|
| Rate for Payer: Humana KY Medicaid |
$4,030.57
|
| Rate for Payer: Kentucky WC Medicaid |
$4,071.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,610.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,649.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,516.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,111.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,313.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,790.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,344.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,523.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,633.26
|
| Rate for Payer: PHCS Commercial |
$11,251.37
|
| Rate for Payer: United Healthcare All Payer |
$10,313.76
|
|
|
EMP SLV 21 XL CONE 3 SPOUT
|
Facility
|
IP
|
$20,892.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,716.05 |
| Max. Negotiated Rate |
$20,056.96 |
| Rate for Payer: Aetna Commercial |
$16,087.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,296.28
|
| Rate for Payer: Cash Price |
$10,446.33
|
| Rate for Payer: Cigna Commercial |
$17,340.92
|
| Rate for Payer: First Health Commercial |
$19,848.04
|
| Rate for Payer: Humana Commercial |
$17,758.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,131.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,418.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,267.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,385.55
|
| Rate for Payer: Ohio Health Group HMO |
$15,669.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,178.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,716.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,476.73
|
| Rate for Payer: PHCS Commercial |
$20,056.96
|
| Rate for Payer: United Healthcare All Payer |
$18,385.55
|
|
|
EMP SLV 21 XL CONE 3 SPOUT
|
Facility
|
OP
|
$20,892.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,716.05 |
| Max. Negotiated Rate |
$20,056.96 |
| Rate for Payer: Aetna Commercial |
$16,087.36
|
| Rate for Payer: Anthem Medicaid |
$7,184.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,296.28
|
| Rate for Payer: Cash Price |
$10,446.33
|
| Rate for Payer: Cigna Commercial |
$17,340.92
|
| Rate for Payer: First Health Commercial |
$19,848.04
|
| Rate for Payer: Humana Commercial |
$17,758.77
|
| Rate for Payer: Humana KY Medicaid |
$7,184.99
|
| Rate for Payer: Kentucky WC Medicaid |
$7,258.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,131.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,418.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,267.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,329.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,385.55
|
| Rate for Payer: Ohio Health Group HMO |
$15,669.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,178.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,716.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,476.73
|
| Rate for Payer: PHCS Commercial |
$20,056.96
|
| Rate for Payer: United Healthcare All Payer |
$18,385.55
|
|
|
EMP SLV 23 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 23 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 23 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
|
|
|
EMP SLV 23 LG CONE 2 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
|
|
