|
EMP 17 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 17 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 17 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 17 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 17 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 17 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 17 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 17 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
|
|
|
EMP 17 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 17 SLV SM 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 17 SLV SM 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 17 SLV SM 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 17 SLV SM 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 19 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 19 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 19 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 19 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 19 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 19 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 19 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 19 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 19 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 19 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 19 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 19 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
|
|
