|
EMP 19 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 19 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 19 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 19 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 19 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 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
|
|
|
EMPERION STEM 11 SH REV POL+10
|
Facility
|
OP
|
$18,246.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,473.90 |
| Max. Negotiated Rate |
$17,516.47 |
| Rate for Payer: Aetna Commercial |
$14,049.67
|
| Rate for Payer: Anthem Medicaid |
$6,274.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,232.13
|
| Rate for Payer: Cash Price |
$9,123.16
|
| Rate for Payer: Cigna Commercial |
$15,144.45
|
| Rate for Payer: First Health Commercial |
$17,334.00
|
| Rate for Payer: Humana Commercial |
$15,509.37
|
| Rate for Payer: Humana KY Medicaid |
$6,274.91
|
| Rate for Payer: Kentucky WC Medicaid |
$6,338.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,961.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,465.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,473.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,400.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,056.76
|
| Rate for Payer: Ohio Health Group HMO |
$13,684.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,597.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,874.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,589.96
|
| Rate for Payer: PHCS Commercial |
$17,516.47
|
| Rate for Payer: United Healthcare All Payer |
$16,056.76
|
|
|
EMPERION STEM 11 SH REV POL+10
|
Facility
|
IP
|
$18,246.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,473.90 |
| Max. Negotiated Rate |
$17,516.47 |
| Rate for Payer: Aetna Commercial |
$14,049.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,232.13
|
| Rate for Payer: Cash Price |
$9,123.16
|
| Rate for Payer: Cigna Commercial |
$15,144.45
|
| Rate for Payer: First Health Commercial |
$17,334.00
|
| Rate for Payer: Humana Commercial |
$15,509.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,961.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,465.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,473.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,056.76
|
| Rate for Payer: Ohio Health Group HMO |
$13,684.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,597.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,874.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,589.96
|
| Rate for Payer: PHCS Commercial |
$17,516.47
|
| Rate for Payer: United Healthcare All Payer |
$16,056.76
|
|
|
EMPERN STEM 11 SH REV GRIT+10
|
Facility
|
IP
|
$18,135.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,440.52 |
| Max. Negotiated Rate |
$17,409.67 |
| Rate for Payer: Aetna Commercial |
$13,964.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,145.35
|
| Rate for Payer: Cash Price |
$9,067.53
|
| Rate for Payer: Cigna Commercial |
$15,052.11
|
| Rate for Payer: First Health Commercial |
$17,228.32
|
| Rate for Payer: Humana Commercial |
$15,414.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,870.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,383.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,440.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,958.86
|
| Rate for Payer: Ohio Health Group HMO |
$13,601.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,508.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,777.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,513.20
|
| Rate for Payer: PHCS Commercial |
$17,409.67
|
| Rate for Payer: United Healthcare All Payer |
$15,958.86
|
|
|
EMPERN STEM 11 SH REV GRIT+10
|
Facility
|
OP
|
$18,135.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,440.52 |
| Max. Negotiated Rate |
$17,409.67 |
| Rate for Payer: Aetna Commercial |
$13,964.00
|
| Rate for Payer: Anthem Medicaid |
$6,236.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,145.35
|
| Rate for Payer: Cash Price |
$9,067.53
|
| Rate for Payer: Cigna Commercial |
$15,052.11
|
| Rate for Payer: First Health Commercial |
$17,228.32
|
| Rate for Payer: Humana Commercial |
$15,414.81
|
| Rate for Payer: Humana KY Medicaid |
$6,236.65
|
| Rate for Payer: Kentucky WC Medicaid |
$6,300.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,870.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,383.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,440.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,361.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,958.86
|
| Rate for Payer: Ohio Health Group HMO |
$13,601.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,508.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,777.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,513.20
|
| Rate for Payer: PHCS Commercial |
$17,409.67
|
| Rate for Payer: United Healthcare All Payer |
$15,958.86
|
|
|
EMPERN STEM 11 SH REV GRIT+20
|
Facility
|
IP
|
$18,599.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,579.90 |
| Max. Negotiated Rate |
$17,855.69 |
| Rate for Payer: Aetna Commercial |
$14,321.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,507.75
|
| Rate for Payer: Cash Price |
$9,299.84
|
| Rate for Payer: Cigna Commercial |
$15,437.73
|
| Rate for Payer: First Health Commercial |
$17,669.70
|
| Rate for Payer: Humana Commercial |
$15,809.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,251.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,726.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,579.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,367.72
|
| Rate for Payer: Ohio Health Group HMO |
$13,949.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,879.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,181.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,833.78
|
| Rate for Payer: PHCS Commercial |
$17,855.69
|
| Rate for Payer: United Healthcare All Payer |
$16,367.72
|
|
|
EMPERN STEM 11 SH REV GRIT+20
|
Facility
|
OP
|
$18,599.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,579.90 |
| Max. Negotiated Rate |
$17,855.69 |
| Rate for Payer: Aetna Commercial |
$14,321.75
|
| Rate for Payer: Anthem Medicaid |
$6,396.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,507.75
|
| Rate for Payer: Cash Price |
$9,299.84
|
| Rate for Payer: Cigna Commercial |
$15,437.73
|
| Rate for Payer: First Health Commercial |
$17,669.70
|
| Rate for Payer: Humana Commercial |
$15,809.73
|
| Rate for Payer: Humana KY Medicaid |
$6,396.43
|
| Rate for Payer: Kentucky WC Medicaid |
$6,461.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,251.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,726.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,579.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,524.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,367.72
|
| Rate for Payer: Ohio Health Group HMO |
$13,949.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,879.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,181.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,833.78
|
| Rate for Payer: PHCS Commercial |
$17,855.69
|
| Rate for Payer: United Healthcare All Payer |
$16,367.72
|
|
|
EMP II 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 II 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 II 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 II 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 II 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 II 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 II 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 II 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 II 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 II 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 II 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 II 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 II 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
|
|
