|
EMP SLV 9 LG CONE 3 SPOUT SLOT
|
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 SLV 9 MD CONE 1 SPOUT SLOT
|
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 SLV 9 MD CONE 1 SPOUT SLOT
|
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 SLV 9 MD CONE 2 SPOUT SLOT
|
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 SLV 9 MD CONE 2 SPOUT SLOT
|
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 SLV 9 MD CONE 3 SPOUT SLOT
|
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 SLV 9 MD CONE 3 SPOUT SLOT
|
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 SLV 9 SM CONE 1 SPOUT SLOT
|
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 SLV 9 SM CONE 1 SPOUT SLOT
|
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 SLV 9 SM CONE 2 SPOUT SLOT
|
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 SLV 9 SM CONE 2 SPOUT SLOT
|
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 SLV 9 SM CONE 3 SPOUT SLOT
|
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 SLV 9 SM CONE 3 SPOUT SLOT
|
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 STEM 11 LNG REV POL +0 L
|
Facility
|
IP
|
$21,950.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,853.58 |
| Max. Negotiated Rate |
$21,072.60 |
| Rate for Payer: Aetna Commercial |
$16,901.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,121.48
|
| Rate for Payer: Cash Price |
$10,975.31
|
| Rate for Payer: Cigna Commercial |
$18,219.01
|
| Rate for Payer: First Health Commercial |
$20,853.09
|
| Rate for Payer: Humana Commercial |
$18,658.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,999.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,199.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,585.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,316.55
|
| Rate for Payer: Ohio Health Group HMO |
$16,462.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,853.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,804.69
|
| Rate for Payer: PHCS Commercial |
$21,072.60
|
| Rate for Payer: United Healthcare All Payer |
$19,316.55
|
|
|
EMP STEM 11 LNG REV POL +0 L
|
Facility
|
OP
|
$21,950.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,853.58 |
| Max. Negotiated Rate |
$21,072.60 |
| Rate for Payer: Aetna Commercial |
$16,901.98
|
| Rate for Payer: Anthem Medicaid |
$7,548.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,121.48
|
| Rate for Payer: Cash Price |
$10,975.31
|
| Rate for Payer: Cigna Commercial |
$18,219.01
|
| Rate for Payer: First Health Commercial |
$20,853.09
|
| Rate for Payer: Humana Commercial |
$18,658.03
|
| Rate for Payer: Humana KY Medicaid |
$7,548.82
|
| Rate for Payer: Kentucky WC Medicaid |
$7,625.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,999.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,199.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,585.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,700.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,316.55
|
| Rate for Payer: Ohio Health Group HMO |
$16,462.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,853.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,804.69
|
| Rate for Payer: PHCS Commercial |
$21,072.60
|
| Rate for Payer: United Healthcare All Payer |
$19,316.55
|
|
|
EMP STEM 11 LNG REV POL +0 R
|
Facility
|
IP
|
$21,950.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,853.58 |
| Max. Negotiated Rate |
$21,072.60 |
| Rate for Payer: Aetna Commercial |
$16,901.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,121.48
|
| Rate for Payer: Cash Price |
$10,975.31
|
| Rate for Payer: Cigna Commercial |
$18,219.01
|
| Rate for Payer: First Health Commercial |
$20,853.09
|
| Rate for Payer: Humana Commercial |
$18,658.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,999.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,199.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,585.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,316.55
|
| Rate for Payer: Ohio Health Group HMO |
$16,462.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,853.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,804.69
|
| Rate for Payer: PHCS Commercial |
$21,072.60
|
| Rate for Payer: United Healthcare All Payer |
$19,316.55
|
|
|
EMP STEM 11 LNG REV POL +0 R
|
Facility
|
OP
|
$21,950.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,853.58 |
| Max. Negotiated Rate |
$21,072.60 |
| Rate for Payer: Aetna Commercial |
$16,901.98
|
| Rate for Payer: Anthem Medicaid |
$7,548.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,121.48
|
| Rate for Payer: Cash Price |
$10,975.31
|
| Rate for Payer: Cigna Commercial |
$18,219.01
|
| Rate for Payer: First Health Commercial |
$20,853.09
|
| Rate for Payer: Humana Commercial |
$18,658.03
|
| Rate for Payer: Humana KY Medicaid |
$7,548.82
|
| Rate for Payer: Kentucky WC Medicaid |
$7,625.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,999.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,199.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,585.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,700.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,316.55
|
| Rate for Payer: Ohio Health Group HMO |
$16,462.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,853.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,804.69
|
| Rate for Payer: PHCS Commercial |
$21,072.60
|
| Rate for Payer: United Healthcare All Payer |
$19,316.55
|
|
|
EMP STEM 11 LNG REV POL +10 L
|
Facility
|
IP
|
$24,916.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,239.16 |
| Max. Negotiated Rate |
$23,919.95 |
| Rate for Payer: Aetna Commercial |
$19,185.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,434.96
|
| Rate for Payer: Cash Price |
$12,458.31
|
| Rate for Payer: Cigna Commercial |
$20,680.79
|
| Rate for Payer: First Health Commercial |
$23,670.78
|
| Rate for Payer: Humana Commercial |
$21,179.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,431.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,388.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,474.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,926.62
|
| Rate for Payer: Ohio Health Group HMO |
$18,687.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,983.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,239.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,724.15
|
| Rate for Payer: PHCS Commercial |
$23,919.95
|
| Rate for Payer: United Healthcare All Payer |
$21,926.62
|
|
|
EMP STEM 11 LNG REV POL +10 L
|
Facility
|
OP
|
$24,916.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,239.16 |
| Max. Negotiated Rate |
$23,919.95 |
| Rate for Payer: Aetna Commercial |
$19,185.79
|
| Rate for Payer: Anthem Medicaid |
$8,568.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,434.96
|
| Rate for Payer: Cash Price |
$12,458.31
|
| Rate for Payer: Cigna Commercial |
$20,680.79
|
| Rate for Payer: First Health Commercial |
$23,670.78
|
| Rate for Payer: Humana Commercial |
$21,179.12
|
| Rate for Payer: Humana KY Medicaid |
$8,568.82
|
| Rate for Payer: Kentucky WC Medicaid |
$8,656.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,431.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,388.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,474.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,740.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,926.62
|
| Rate for Payer: Ohio Health Group HMO |
$18,687.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,983.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,239.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,724.15
|
| Rate for Payer: PHCS Commercial |
$23,919.95
|
| Rate for Payer: United Healthcare All Payer |
$21,926.62
|
|
|
EMP STEM 11 LNG REV POL +10 R
|
Facility
|
IP
|
$24,916.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,239.16 |
| Max. Negotiated Rate |
$23,919.95 |
| Rate for Payer: Aetna Commercial |
$19,185.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,434.96
|
| Rate for Payer: Cash Price |
$12,458.31
|
| Rate for Payer: Cigna Commercial |
$20,680.79
|
| Rate for Payer: First Health Commercial |
$23,670.78
|
| Rate for Payer: Humana Commercial |
$21,179.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,431.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,388.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,474.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,926.62
|
| Rate for Payer: Ohio Health Group HMO |
$18,687.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,983.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,239.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,724.15
|
| Rate for Payer: PHCS Commercial |
$23,919.95
|
| Rate for Payer: United Healthcare All Payer |
$21,926.62
|
|
|
EMP STEM 11 LNG REV POL +10 R
|
Facility
|
OP
|
$24,916.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,239.16 |
| Max. Negotiated Rate |
$23,919.95 |
| Rate for Payer: Aetna Commercial |
$19,185.79
|
| Rate for Payer: Anthem Medicaid |
$8,568.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,434.96
|
| Rate for Payer: Cash Price |
$12,458.31
|
| Rate for Payer: Cigna Commercial |
$20,680.79
|
| Rate for Payer: First Health Commercial |
$23,670.78
|
| Rate for Payer: Humana Commercial |
$21,179.12
|
| Rate for Payer: Humana KY Medicaid |
$8,568.82
|
| Rate for Payer: Kentucky WC Medicaid |
$8,656.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,431.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,388.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,474.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,740.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,926.62
|
| Rate for Payer: Ohio Health Group HMO |
$18,687.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,983.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,239.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,724.15
|
| Rate for Payer: PHCS Commercial |
$23,919.95
|
| Rate for Payer: United Healthcare All Payer |
$21,926.62
|
|
|
EMP STEM 11 SH REV POL +0
|
Facility
|
OP
|
$20,126.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,616.43 |
| Max. Negotiated Rate |
$19,321.30 |
| Rate for Payer: Aetna Commercial |
$15,497.29
|
| Rate for Payer: Anthem Medicaid |
$6,921.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,698.55
|
| Rate for Payer: Cash Price |
$10,063.17
|
| Rate for Payer: Cigna Commercial |
$16,704.87
|
| Rate for Payer: First Health Commercial |
$19,120.03
|
| Rate for Payer: Humana Commercial |
$17,107.40
|
| Rate for Payer: Humana KY Medicaid |
$6,921.45
|
| Rate for Payer: Kentucky WC Medicaid |
$6,991.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,503.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,853.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,037.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,060.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,711.19
|
| Rate for Payer: Ohio Health Group HMO |
$15,094.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,025.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,616.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,239.17
|
| Rate for Payer: PHCS Commercial |
$19,321.30
|
| Rate for Payer: United Healthcare All Payer |
$17,711.19
|
|
|
EMP STEM 11 SH REV POL +0
|
Facility
|
IP
|
$20,126.35
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,616.43 |
| Max. Negotiated Rate |
$19,321.30 |
| Rate for Payer: Aetna Commercial |
$15,497.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,698.55
|
| Rate for Payer: Cash Price |
$10,063.17
|
| Rate for Payer: Cigna Commercial |
$16,704.87
|
| Rate for Payer: First Health Commercial |
$19,120.03
|
| Rate for Payer: Humana Commercial |
$17,107.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,503.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,853.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,037.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,711.19
|
| Rate for Payer: Ohio Health Group HMO |
$15,094.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,025.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,616.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,239.17
|
| Rate for Payer: PHCS Commercial |
$19,321.30
|
| Rate for Payer: United Healthcare All Payer |
$17,711.19
|
|
|
EMP STEM 11 SH REV POL +10
|
Facility
|
OP
|
$22,505.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,925.78 |
| Max. Negotiated Rate |
$21,605.73 |
| Rate for Payer: Aetna Commercial |
$17,329.60
|
| Rate for Payer: Anthem Medicaid |
$7,739.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,554.66
|
| Rate for Payer: Cash Price |
$11,252.98
|
| Rate for Payer: Cigna Commercial |
$18,679.96
|
| Rate for Payer: First Health Commercial |
$21,380.67
|
| Rate for Payer: Humana Commercial |
$19,130.07
|
| Rate for Payer: Humana KY Medicaid |
$7,739.80
|
| Rate for Payer: Kentucky WC Medicaid |
$7,818.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,454.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,609.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,751.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,895.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,805.25
|
| Rate for Payer: Ohio Health Group HMO |
$16,879.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,501.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,925.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,976.85
|
| Rate for Payer: PHCS Commercial |
$21,605.73
|
| Rate for Payer: United Healthcare All Payer |
$19,805.25
|
|
|
EMP STEM 11 SH REV POL +10
|
Facility
|
IP
|
$22,505.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,925.78 |
| Max. Negotiated Rate |
$21,605.73 |
| Rate for Payer: Aetna Commercial |
$17,329.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,554.66
|
| Rate for Payer: Cash Price |
$11,252.98
|
| Rate for Payer: Cigna Commercial |
$18,679.96
|
| Rate for Payer: First Health Commercial |
$21,380.67
|
| Rate for Payer: Humana Commercial |
$19,130.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,454.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,609.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,751.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,805.25
|
| Rate for Payer: Ohio Health Group HMO |
$16,879.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,501.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,925.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,976.85
|
| Rate for Payer: PHCS Commercial |
$21,605.73
|
| Rate for Payer: United Healthcare All Payer |
$19,805.25
|
|
