|
EMG LIMITED STUDY
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
HCPCS 95870
|
| Hospital Charge Code |
92200007
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$22.33 |
| Max. Negotiated Rate |
$155.40 |
| Rate for Payer: Aetna Commercial |
$67.03
|
| Rate for Payer: Ambetter Exchange |
$71.91
|
| Rate for Payer: Anthem Medicaid |
$25.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$71.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$71.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$86.29
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$70.97
|
| Rate for Payer: Healthspan PPO |
$59.04
|
| Rate for Payer: Humana Medicaid |
$25.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$22.33
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$71.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$71.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.07
|
| Rate for Payer: Molina Healthcare Passport |
$25.56
|
| Rate for Payer: Multiplan PHCS |
$155.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$93.48
|
| Rate for Payer: UHCCP Medicaid |
$90.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$25.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$71.91
|
|
|
EMG LIMITED STUDY
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
HCPCS 95870
|
| Hospital Charge Code |
92200007
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$89.07 |
| Max. Negotiated Rate |
$248.64 |
| Rate for Payer: Aetna Commercial |
$199.43
|
| Rate for Payer: Anthem Medicaid |
$89.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$202.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$214.97
|
| Rate for Payer: First Health Commercial |
$246.05
|
| Rate for Payer: Humana Commercial |
$220.15
|
| Rate for Payer: Humana KY Medicaid |
$89.07
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$89.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$212.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$191.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$90.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$227.92
|
| Rate for Payer: Ohio Health Group HMO |
$194.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$207.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$225.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$178.71
|
| Rate for Payer: PHCS Commercial |
$248.64
|
| Rate for Payer: United Healthcare All Payer |
$227.92
|
|
|
EMG LIMITED STUDY(P
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 95870
|
| Hospital Charge Code |
922P0007
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$22.33 |
| Max. Negotiated Rate |
$93.48 |
| Rate for Payer: Aetna Commercial |
$67.03
|
| Rate for Payer: Ambetter Exchange |
$71.91
|
| Rate for Payer: Anthem Medicaid |
$25.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$71.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$71.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$86.29
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$70.97
|
| Rate for Payer: Healthspan PPO |
$59.04
|
| Rate for Payer: Humana Medicaid |
$25.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$22.33
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$71.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$71.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.07
|
| Rate for Payer: Molina Healthcare Passport |
$25.56
|
| Rate for Payer: Multiplan PHCS |
$72.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$93.48
|
| Rate for Payer: UHCCP Medicaid |
$42.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$25.82
|
| Rate for Payer: Wellcare Medicare Advantage |
$71.91
|
|
|
EMG LIMITED STUDY(T
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
HCPCS 95870
|
| Hospital Charge Code |
922T0007
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$41.70 |
| Max. Negotiated Rate |
$133.44 |
| Rate for Payer: Aetna Commercial |
$107.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$108.42
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cigna Commercial |
$115.37
|
| Rate for Payer: First Health Commercial |
$132.05
|
| Rate for Payer: Humana Commercial |
$118.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$113.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$102.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$122.32
|
| Rate for Payer: Ohio Health Group HMO |
$104.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$111.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$95.91
|
| Rate for Payer: PHCS Commercial |
$133.44
|
| Rate for Payer: United Healthcare All Payer |
$122.32
|
|
|
EMG LIMITED STUDY(T
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
HCPCS 95870
|
| Hospital Charge Code |
922T0007
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$47.80 |
| Max. Negotiated Rate |
$166.74 |
| Rate for Payer: Aetna Commercial |
$107.03
|
| Rate for Payer: Anthem Medicaid |
$47.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$108.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cigna Commercial |
$115.37
|
| Rate for Payer: First Health Commercial |
$132.05
|
| Rate for Payer: Humana Commercial |
$118.15
|
| Rate for Payer: Humana KY Medicaid |
$47.80
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$48.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$113.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$102.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$48.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$122.32
|
| Rate for Payer: Ohio Health Group HMO |
$104.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$111.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$95.91
|
| Rate for Payer: PHCS Commercial |
$133.44
|
| Rate for Payer: United Healthcare All Payer |
$122.32
|
|
|
EMG THORACIC (EXCL T1/T12)
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
HCPCS 95869
|
| Hospital Charge Code |
92200006
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$104.89 |
| Max. Negotiated Rate |
$402.82 |
| Rate for Payer: Aetna Commercial |
$234.85
|
| Rate for Payer: Anthem Medicaid |
$104.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$152.50
|
| Rate for Payer: Cash Price |
$152.50
|
| Rate for Payer: Cigna Commercial |
$253.15
|
| Rate for Payer: First Health Commercial |
$289.75
|
| Rate for Payer: Humana Commercial |
$259.25
|
| Rate for Payer: Humana KY Medicaid |
$104.89
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$105.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$250.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$225.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$106.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$268.40
|
| Rate for Payer: Ohio Health Group HMO |
$228.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$244.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$265.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$210.45
|
| Rate for Payer: PHCS Commercial |
$292.80
|
| Rate for Payer: United Healthcare All Payer |
$268.40
|
|
|
EMG THORACIC (EXCL T1/T12)
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
HCPCS 95869
|
| Hospital Charge Code |
92200006
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$91.50 |
| Max. Negotiated Rate |
$292.80 |
| Rate for Payer: Aetna Commercial |
$234.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.90
|
| Rate for Payer: Cash Price |
$152.50
|
| Rate for Payer: Cigna Commercial |
$253.15
|
| Rate for Payer: First Health Commercial |
$289.75
|
| Rate for Payer: Humana Commercial |
$259.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$250.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$225.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$268.40
|
| Rate for Payer: Ohio Health Group HMO |
$228.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$244.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$265.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$210.45
|
| Rate for Payer: PHCS Commercial |
$292.80
|
| Rate for Payer: United Healthcare All Payer |
$268.40
|
|
|
EMG THORACIC (EXCL T1/T12)
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
HCPCS 95869
|
| Hospital Charge Code |
92200006
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$22.73 |
| Max. Negotiated Rate |
$183.00 |
| Rate for Payer: Aetna Commercial |
$68.63
|
| Rate for Payer: Ambetter Exchange |
$81.34
|
| Rate for Payer: Anthem Medicaid |
$26.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$81.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$81.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$97.61
|
| Rate for Payer: Cash Price |
$152.50
|
| Rate for Payer: Cash Price |
$152.50
|
| Rate for Payer: Cigna Commercial |
$52.31
|
| Rate for Payer: Healthspan PPO |
$60.45
|
| Rate for Payer: Humana Medicaid |
$26.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$22.73
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$81.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$81.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.82
|
| Rate for Payer: Molina Healthcare Passport |
$26.29
|
| Rate for Payer: Multiplan PHCS |
$183.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.74
|
| Rate for Payer: UHCCP Medicaid |
$106.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$81.34
|
|
|
EMG THORACIC (EXCL T1/T12)(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 95869
|
| Hospital Charge Code |
922P0006
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$22.73 |
| Max. Negotiated Rate |
$105.74 |
| Rate for Payer: Aetna Commercial |
$68.63
|
| Rate for Payer: Ambetter Exchange |
$81.34
|
| Rate for Payer: Anthem Medicaid |
$26.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$81.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$81.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$97.61
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$52.31
|
| Rate for Payer: Healthspan PPO |
$60.45
|
| Rate for Payer: Humana Medicaid |
$26.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$22.73
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$81.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$81.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.82
|
| Rate for Payer: Molina Healthcare Passport |
$26.29
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.74
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$81.34
|
|
|
EMG THORACIC (EXCL T1/T12)(T
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
HCPCS 95869
|
| Hospital Charge Code |
922T0006
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$61.50 |
| Max. Negotiated Rate |
$196.80 |
| Rate for Payer: Aetna Commercial |
$157.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$159.90
|
| Rate for Payer: Cash Price |
$102.50
|
| Rate for Payer: Cigna Commercial |
$170.15
|
| Rate for Payer: First Health Commercial |
$194.75
|
| Rate for Payer: Humana Commercial |
$174.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$151.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$180.40
|
| Rate for Payer: Ohio Health Group HMO |
$153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$164.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$141.45
|
| Rate for Payer: PHCS Commercial |
$196.80
|
| Rate for Payer: United Healthcare All Payer |
$180.40
|
|
|
EMG THORACIC (EXCL T1/T12)(T
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
HCPCS 95869
|
| Hospital Charge Code |
922T0006
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$70.50 |
| Max. Negotiated Rate |
$402.82 |
| Rate for Payer: Aetna Commercial |
$157.85
|
| Rate for Payer: Anthem Medicaid |
$70.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$159.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$102.50
|
| Rate for Payer: Cash Price |
$102.50
|
| Rate for Payer: Cigna Commercial |
$170.15
|
| Rate for Payer: First Health Commercial |
$194.75
|
| Rate for Payer: Humana Commercial |
$174.25
|
| Rate for Payer: Humana KY Medicaid |
$70.50
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$71.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$151.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$71.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$180.40
|
| Rate for Payer: Ohio Health Group HMO |
$153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$164.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$141.45
|
| Rate for Payer: PHCS Commercial |
$196.80
|
| Rate for Payer: United Healthcare All Payer |
$180.40
|
|
|
EMP 13 SLV LG CONE 1 SPOUT SLT
|
Facility
|
IP
|
$11,180.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,354.06 |
| Max. Negotiated Rate |
$10,733.00 |
| Rate for Payer: Aetna Commercial |
$8,608.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,720.56
|
| Rate for Payer: Cash Price |
$5,590.10
|
| Rate for Payer: Cigna Commercial |
$9,279.57
|
| Rate for Payer: First Health Commercial |
$10,621.20
|
| Rate for Payer: Humana Commercial |
$9,503.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,167.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,250.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,354.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,838.58
|
| Rate for Payer: Ohio Health Group HMO |
$8,385.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,944.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,726.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,714.34
|
| Rate for Payer: PHCS Commercial |
$10,733.00
|
| Rate for Payer: United Healthcare All Payer |
$9,838.58
|
|
|
EMP 13 SLV LG CONE 1 SPOUT SLT
|
Facility
|
OP
|
$11,180.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,354.06 |
| Max. Negotiated Rate |
$10,733.00 |
| Rate for Payer: Aetna Commercial |
$8,608.76
|
| Rate for Payer: Anthem Medicaid |
$3,844.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,720.56
|
| Rate for Payer: Cash Price |
$5,590.10
|
| Rate for Payer: Cigna Commercial |
$9,279.57
|
| Rate for Payer: First Health Commercial |
$10,621.20
|
| Rate for Payer: Humana Commercial |
$9,503.18
|
| Rate for Payer: Humana KY Medicaid |
$3,844.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,884.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,167.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,250.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,354.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,922.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,838.58
|
| Rate for Payer: Ohio Health Group HMO |
$8,385.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,944.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,726.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,714.34
|
| Rate for Payer: PHCS Commercial |
$10,733.00
|
| Rate for Payer: United Healthcare All Payer |
$9,838.58
|
|
|
EMP 13 SLV LG CONE 2 SPOUT SLT
|
Facility
|
OP
|
$11,180.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,354.06 |
| Max. Negotiated Rate |
$10,733.00 |
| Rate for Payer: Aetna Commercial |
$8,608.76
|
| Rate for Payer: Anthem Medicaid |
$3,844.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,720.56
|
| Rate for Payer: Cash Price |
$5,590.10
|
| Rate for Payer: Cigna Commercial |
$9,279.57
|
| Rate for Payer: First Health Commercial |
$10,621.20
|
| Rate for Payer: Humana Commercial |
$9,503.18
|
| Rate for Payer: Humana KY Medicaid |
$3,844.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,884.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,167.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,250.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,354.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,922.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,838.58
|
| Rate for Payer: Ohio Health Group HMO |
$8,385.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,944.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,726.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,714.34
|
| Rate for Payer: PHCS Commercial |
$10,733.00
|
| Rate for Payer: United Healthcare All Payer |
$9,838.58
|
|
|
EMP 13 SLV LG CONE 2 SPOUT SLT
|
Facility
|
IP
|
$11,180.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,354.06 |
| Max. Negotiated Rate |
$10,733.00 |
| Rate for Payer: Aetna Commercial |
$8,608.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,720.56
|
| Rate for Payer: Cash Price |
$5,590.10
|
| Rate for Payer: Cigna Commercial |
$9,279.57
|
| Rate for Payer: First Health Commercial |
$10,621.20
|
| Rate for Payer: Humana Commercial |
$9,503.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,167.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,250.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,354.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,838.58
|
| Rate for Payer: Ohio Health Group HMO |
$8,385.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,944.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,726.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,714.34
|
| Rate for Payer: PHCS Commercial |
$10,733.00
|
| Rate for Payer: United Healthcare All Payer |
$9,838.58
|
|
|
EMP 13 SLV LG CONE 3 SPOUT SLT
|
Facility
|
OP
|
$11,180.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,354.06 |
| Max. Negotiated Rate |
$10,733.00 |
| Rate for Payer: Aetna Commercial |
$8,608.76
|
| Rate for Payer: Anthem Medicaid |
$3,844.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,720.56
|
| Rate for Payer: Cash Price |
$5,590.10
|
| Rate for Payer: Cigna Commercial |
$9,279.57
|
| Rate for Payer: First Health Commercial |
$10,621.20
|
| Rate for Payer: Humana Commercial |
$9,503.18
|
| Rate for Payer: Humana KY Medicaid |
$3,844.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,884.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,167.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,250.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,354.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,922.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,838.58
|
| Rate for Payer: Ohio Health Group HMO |
$8,385.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,944.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,726.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,714.34
|
| Rate for Payer: PHCS Commercial |
$10,733.00
|
| Rate for Payer: United Healthcare All Payer |
$9,838.58
|
|
|
EMP 13 SLV LG CONE 3 SPOUT SLT
|
Facility
|
IP
|
$11,180.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,354.06 |
| Max. Negotiated Rate |
$10,733.00 |
| Rate for Payer: Aetna Commercial |
$8,608.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,720.56
|
| Rate for Payer: Cash Price |
$5,590.10
|
| Rate for Payer: Cigna Commercial |
$9,279.57
|
| Rate for Payer: First Health Commercial |
$10,621.20
|
| Rate for Payer: Humana Commercial |
$9,503.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,167.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,250.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,354.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,838.58
|
| Rate for Payer: Ohio Health Group HMO |
$8,385.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,944.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,726.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,714.34
|
| Rate for Payer: PHCS Commercial |
$10,733.00
|
| Rate for Payer: United Healthcare All Payer |
$9,838.58
|
|
|
EMP 13 SLV MD CONE 1 SPOUT SLT
|
Facility
|
IP
|
$11,180.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,354.06 |
| Max. Negotiated Rate |
$10,733.00 |
| Rate for Payer: Aetna Commercial |
$8,608.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,720.56
|
| Rate for Payer: Cash Price |
$5,590.10
|
| Rate for Payer: Cigna Commercial |
$9,279.57
|
| Rate for Payer: First Health Commercial |
$10,621.20
|
| Rate for Payer: Humana Commercial |
$9,503.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,167.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,250.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,354.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,838.58
|
| Rate for Payer: Ohio Health Group HMO |
$8,385.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,944.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,726.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,714.34
|
| Rate for Payer: PHCS Commercial |
$10,733.00
|
| Rate for Payer: United Healthcare All Payer |
$9,838.58
|
|
|
EMP 13 SLV MD CONE 1 SPOUT SLT
|
Facility
|
OP
|
$11,180.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,354.06 |
| Max. Negotiated Rate |
$10,733.00 |
| Rate for Payer: Aetna Commercial |
$8,608.76
|
| Rate for Payer: Anthem Medicaid |
$3,844.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,720.56
|
| Rate for Payer: Cash Price |
$5,590.10
|
| Rate for Payer: Cigna Commercial |
$9,279.57
|
| Rate for Payer: First Health Commercial |
$10,621.20
|
| Rate for Payer: Humana Commercial |
$9,503.18
|
| Rate for Payer: Humana KY Medicaid |
$3,844.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,884.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,167.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,250.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,354.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,922.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,838.58
|
| Rate for Payer: Ohio Health Group HMO |
$8,385.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,944.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,726.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,714.34
|
| Rate for Payer: PHCS Commercial |
$10,733.00
|
| Rate for Payer: United Healthcare All Payer |
$9,838.58
|
|
|
EMP 13 SLV MD CONE 2 SPOUT SLT
|
Facility
|
IP
|
$11,180.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,354.06 |
| Max. Negotiated Rate |
$10,733.00 |
| Rate for Payer: Aetna Commercial |
$8,608.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,720.56
|
| Rate for Payer: Cash Price |
$5,590.10
|
| Rate for Payer: Cigna Commercial |
$9,279.57
|
| Rate for Payer: First Health Commercial |
$10,621.20
|
| Rate for Payer: Humana Commercial |
$9,503.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,167.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,250.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,354.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,838.58
|
| Rate for Payer: Ohio Health Group HMO |
$8,385.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,944.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,726.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,714.34
|
| Rate for Payer: PHCS Commercial |
$10,733.00
|
| Rate for Payer: United Healthcare All Payer |
$9,838.58
|
|
|
EMP 13 SLV MD CONE 2 SPOUT SLT
|
Facility
|
OP
|
$11,180.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,354.06 |
| Max. Negotiated Rate |
$10,733.00 |
| Rate for Payer: Aetna Commercial |
$8,608.76
|
| Rate for Payer: Anthem Medicaid |
$3,844.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,720.56
|
| Rate for Payer: Cash Price |
$5,590.10
|
| Rate for Payer: Cigna Commercial |
$9,279.57
|
| Rate for Payer: First Health Commercial |
$10,621.20
|
| Rate for Payer: Humana Commercial |
$9,503.18
|
| Rate for Payer: Humana KY Medicaid |
$3,844.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,884.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,167.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,250.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,354.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,922.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,838.58
|
| Rate for Payer: Ohio Health Group HMO |
$8,385.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,944.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,726.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,714.34
|
| Rate for Payer: PHCS Commercial |
$10,733.00
|
| Rate for Payer: United Healthcare All Payer |
$9,838.58
|
|
|
EMP 13 SLV MD CONE 3 SPOUT SLT
|
Facility
|
IP
|
$11,180.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,354.06 |
| Max. Negotiated Rate |
$10,733.00 |
| Rate for Payer: Aetna Commercial |
$8,608.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,720.56
|
| Rate for Payer: Cash Price |
$5,590.10
|
| Rate for Payer: Cigna Commercial |
$9,279.57
|
| Rate for Payer: First Health Commercial |
$10,621.20
|
| Rate for Payer: Humana Commercial |
$9,503.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,167.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,250.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,354.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,838.58
|
| Rate for Payer: Ohio Health Group HMO |
$8,385.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,944.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,726.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,714.34
|
| Rate for Payer: PHCS Commercial |
$10,733.00
|
| Rate for Payer: United Healthcare All Payer |
$9,838.58
|
|
|
EMP 13 SLV MD CONE 3 SPOUT SLT
|
Facility
|
OP
|
$11,180.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,354.06 |
| Max. Negotiated Rate |
$10,733.00 |
| Rate for Payer: Aetna Commercial |
$8,608.76
|
| Rate for Payer: Anthem Medicaid |
$3,844.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,720.56
|
| Rate for Payer: Cash Price |
$5,590.10
|
| Rate for Payer: Cigna Commercial |
$9,279.57
|
| Rate for Payer: First Health Commercial |
$10,621.20
|
| Rate for Payer: Humana Commercial |
$9,503.18
|
| Rate for Payer: Humana KY Medicaid |
$3,844.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,884.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,167.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,250.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,354.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,922.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,838.58
|
| Rate for Payer: Ohio Health Group HMO |
$8,385.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,944.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,726.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,714.34
|
| Rate for Payer: PHCS Commercial |
$10,733.00
|
| Rate for Payer: United Healthcare All Payer |
$9,838.58
|
|
|
EMP 13 SLV SM CONE 1 SPOUT SLT
|
Facility
|
IP
|
$11,180.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,354.06 |
| Max. Negotiated Rate |
$10,733.00 |
| Rate for Payer: Aetna Commercial |
$8,608.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,720.56
|
| Rate for Payer: Cash Price |
$5,590.10
|
| Rate for Payer: Cigna Commercial |
$9,279.57
|
| Rate for Payer: First Health Commercial |
$10,621.20
|
| Rate for Payer: Humana Commercial |
$9,503.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,167.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,250.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,354.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,838.58
|
| Rate for Payer: Ohio Health Group HMO |
$8,385.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,944.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,726.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,714.34
|
| Rate for Payer: PHCS Commercial |
$10,733.00
|
| Rate for Payer: United Healthcare All Payer |
$9,838.58
|
|
|
EMP 13 SLV SM CONE 1 SPOUT SLT
|
Facility
|
OP
|
$11,180.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,354.06 |
| Max. Negotiated Rate |
$10,733.00 |
| Rate for Payer: Aetna Commercial |
$8,608.76
|
| Rate for Payer: Anthem Medicaid |
$3,844.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,720.56
|
| Rate for Payer: Cash Price |
$5,590.10
|
| Rate for Payer: Cigna Commercial |
$9,279.57
|
| Rate for Payer: First Health Commercial |
$10,621.20
|
| Rate for Payer: Humana Commercial |
$9,503.18
|
| Rate for Payer: Humana KY Medicaid |
$3,844.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,884.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,167.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,250.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,354.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,922.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,838.58
|
| Rate for Payer: Ohio Health Group HMO |
$8,385.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,944.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,726.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,714.34
|
| Rate for Payer: PHCS Commercial |
$10,733.00
|
| Rate for Payer: United Healthcare All Payer |
$9,838.58
|
|
