|
EMP II 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 II 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 II 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 II 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 II 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 SLV 11M CON 2 SPT TALLSLT
|
Facility
|
IP
|
$11,361.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,408.34 |
| Max. Negotiated Rate |
$10,906.69 |
| Rate for Payer: Aetna Commercial |
$8,748.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,861.69
|
| Rate for Payer: Cash Price |
$5,680.57
|
| Rate for Payer: Cigna Commercial |
$9,429.75
|
| Rate for Payer: First Health Commercial |
$10,793.08
|
| Rate for Payer: Humana Commercial |
$9,656.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,316.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,384.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,408.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,997.80
|
| Rate for Payer: Ohio Health Group HMO |
$8,520.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,088.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,884.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,839.19
|
| Rate for Payer: PHCS Commercial |
$10,906.69
|
| Rate for Payer: United Healthcare All Payer |
$9,997.80
|
|
|
EMP SLV 11M CON 2 SPT TALLSLT
|
Facility
|
OP
|
$11,361.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,408.34 |
| Max. Negotiated Rate |
$10,906.69 |
| Rate for Payer: Aetna Commercial |
$8,748.08
|
| Rate for Payer: Anthem Medicaid |
$3,907.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,861.69
|
| Rate for Payer: Cash Price |
$5,680.57
|
| Rate for Payer: Cigna Commercial |
$9,429.75
|
| Rate for Payer: First Health Commercial |
$10,793.08
|
| Rate for Payer: Humana Commercial |
$9,656.97
|
| Rate for Payer: Humana KY Medicaid |
$3,907.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,946.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,316.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,384.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,408.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,985.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,997.80
|
| Rate for Payer: Ohio Health Group HMO |
$8,520.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,088.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,884.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,839.19
|
| Rate for Payer: PHCS Commercial |
$10,906.69
|
| Rate for Payer: United Healthcare All Payer |
$9,997.80
|
|
|
EMP SLV 11 MD CONE 1 SP SLT TL
|
Facility
|
IP
|
$13,098.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,929.61 |
| Max. Negotiated Rate |
$12,574.75 |
| Rate for Payer: Aetna Commercial |
$10,086.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,216.99
|
| Rate for Payer: Cash Price |
$6,549.35
|
| Rate for Payer: Cigna Commercial |
$10,871.92
|
| Rate for Payer: First Health Commercial |
$12,443.76
|
| Rate for Payer: Humana Commercial |
$11,133.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,740.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,666.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,929.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,526.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,824.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,478.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,395.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,038.10
|
| Rate for Payer: PHCS Commercial |
$12,574.75
|
| Rate for Payer: United Healthcare All Payer |
$11,526.86
|
|
|
EMP SLV 11 MD CONE 1 SP SLT TL
|
Facility
|
OP
|
$13,098.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,929.61 |
| Max. Negotiated Rate |
$12,574.75 |
| Rate for Payer: Aetna Commercial |
$10,086.00
|
| Rate for Payer: Anthem Medicaid |
$4,504.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,216.99
|
| Rate for Payer: Cash Price |
$6,549.35
|
| Rate for Payer: Cigna Commercial |
$10,871.92
|
| Rate for Payer: First Health Commercial |
$12,443.76
|
| Rate for Payer: Humana Commercial |
$11,133.90
|
| Rate for Payer: Humana KY Medicaid |
$4,504.64
|
| Rate for Payer: Kentucky WC Medicaid |
$4,550.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,740.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,666.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,929.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,595.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,526.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,824.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,478.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,395.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,038.10
|
| Rate for Payer: PHCS Commercial |
$12,574.75
|
| Rate for Payer: United Healthcare All Payer |
$11,526.86
|
|
|
EMP SLV 11 SM CONE 1 SP SLT TL
|
Facility
|
OP
|
$13,098.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,929.61 |
| Max. Negotiated Rate |
$12,574.75 |
| Rate for Payer: Aetna Commercial |
$10,086.00
|
| Rate for Payer: Anthem Medicaid |
$4,504.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,216.99
|
| Rate for Payer: Cash Price |
$6,549.35
|
| Rate for Payer: Cigna Commercial |
$10,871.92
|
| Rate for Payer: First Health Commercial |
$12,443.76
|
| Rate for Payer: Humana Commercial |
$11,133.90
|
| Rate for Payer: Humana KY Medicaid |
$4,504.64
|
| Rate for Payer: Kentucky WC Medicaid |
$4,550.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,740.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,666.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,929.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,595.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,526.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,824.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,478.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,395.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,038.10
|
| Rate for Payer: PHCS Commercial |
$12,574.75
|
| Rate for Payer: United Healthcare All Payer |
$11,526.86
|
|
|
EMP SLV 11 SM CONE 1 SP SLT TL
|
Facility
|
IP
|
$13,098.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,929.61 |
| Max. Negotiated Rate |
$12,574.75 |
| Rate for Payer: Aetna Commercial |
$10,086.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,216.99
|
| Rate for Payer: Cash Price |
$6,549.35
|
| Rate for Payer: Cigna Commercial |
$10,871.92
|
| Rate for Payer: First Health Commercial |
$12,443.76
|
| Rate for Payer: Humana Commercial |
$11,133.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,740.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,666.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,929.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,526.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,824.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,478.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,395.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,038.10
|
| Rate for Payer: PHCS Commercial |
$12,574.75
|
| Rate for Payer: United Healthcare All Payer |
$11,526.86
|
|
|
EMP SLV 11 SM CONE 2 SP SLT TL
|
Facility
|
OP
|
$13,098.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,929.61 |
| Max. Negotiated Rate |
$12,574.75 |
| Rate for Payer: Aetna Commercial |
$10,086.00
|
| Rate for Payer: Anthem Medicaid |
$4,504.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,216.99
|
| Rate for Payer: Cash Price |
$6,549.35
|
| Rate for Payer: Cigna Commercial |
$10,871.92
|
| Rate for Payer: First Health Commercial |
$12,443.76
|
| Rate for Payer: Humana Commercial |
$11,133.90
|
| Rate for Payer: Humana KY Medicaid |
$4,504.64
|
| Rate for Payer: Kentucky WC Medicaid |
$4,550.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,740.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,666.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,929.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,595.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,526.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,824.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,478.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,395.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,038.10
|
| Rate for Payer: PHCS Commercial |
$12,574.75
|
| Rate for Payer: United Healthcare All Payer |
$11,526.86
|
|
|
EMP SLV 11 SM CONE 2 SP SLT TL
|
Facility
|
IP
|
$13,098.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,929.61 |
| Max. Negotiated Rate |
$12,574.75 |
| Rate for Payer: Aetna Commercial |
$10,086.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,216.99
|
| Rate for Payer: Cash Price |
$6,549.35
|
| Rate for Payer: Cigna Commercial |
$10,871.92
|
| Rate for Payer: First Health Commercial |
$12,443.76
|
| Rate for Payer: Humana Commercial |
$11,133.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,740.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,666.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,929.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,526.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,824.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,478.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,395.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,038.10
|
| Rate for Payer: PHCS Commercial |
$12,574.75
|
| Rate for Payer: United Healthcare All Payer |
$11,526.86
|
|
|
EMP SLV 13 M CONE 3 SPOUT TALL
|
Facility
|
IP
|
$10,266.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,079.82 |
| Max. Negotiated Rate |
$9,855.42 |
| Rate for Payer: Aetna Commercial |
$7,904.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,007.53
|
| Rate for Payer: Cash Price |
$5,133.03
|
| Rate for Payer: Cigna Commercial |
$8,520.83
|
| Rate for Payer: First Health Commercial |
$9,752.76
|
| Rate for Payer: Humana Commercial |
$8,726.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,418.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,576.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,079.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,034.13
|
| Rate for Payer: Ohio Health Group HMO |
$7,699.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,212.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,931.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,083.58
|
| Rate for Payer: PHCS Commercial |
$9,855.42
|
| Rate for Payer: United Healthcare All Payer |
$9,034.13
|
|
|
EMP SLV 13 M CONE 3 SPOUT TALL
|
Facility
|
OP
|
$10,266.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,079.82 |
| Max. Negotiated Rate |
$9,855.42 |
| Rate for Payer: Aetna Commercial |
$7,904.87
|
| Rate for Payer: Anthem Medicaid |
$3,530.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,007.53
|
| Rate for Payer: Cash Price |
$5,133.03
|
| Rate for Payer: Cigna Commercial |
$8,520.83
|
| Rate for Payer: First Health Commercial |
$9,752.76
|
| Rate for Payer: Humana Commercial |
$8,726.15
|
| Rate for Payer: Humana KY Medicaid |
$3,530.50
|
| Rate for Payer: Kentucky WC Medicaid |
$3,566.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,418.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,576.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,079.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,601.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,034.13
|
| Rate for Payer: Ohio Health Group HMO |
$7,699.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,212.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,931.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,083.58
|
| Rate for Payer: PHCS Commercial |
$9,855.42
|
| Rate for Payer: United Healthcare All Payer |
$9,034.13
|
|
|
EMP SLV 17 XL CONE 1 SPOUT SLT
|
Facility
|
OP
|
$13,098.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,929.61 |
| Max. Negotiated Rate |
$12,574.75 |
| Rate for Payer: Aetna Commercial |
$10,086.00
|
| Rate for Payer: Anthem Medicaid |
$4,504.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,216.99
|
| Rate for Payer: Cash Price |
$6,549.35
|
| Rate for Payer: Cigna Commercial |
$10,871.92
|
| Rate for Payer: First Health Commercial |
$12,443.76
|
| Rate for Payer: Humana Commercial |
$11,133.90
|
| Rate for Payer: Humana KY Medicaid |
$4,504.64
|
| Rate for Payer: Kentucky WC Medicaid |
$4,550.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,740.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,666.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,929.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,595.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,526.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,824.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,478.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,395.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,038.10
|
| Rate for Payer: PHCS Commercial |
$12,574.75
|
| Rate for Payer: United Healthcare All Payer |
$11,526.86
|
|
|
EMP SLV 17 XL CONE 1 SPOUT SLT
|
Facility
|
IP
|
$13,098.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,929.61 |
| Max. Negotiated Rate |
$12,574.75 |
| Rate for Payer: Aetna Commercial |
$10,086.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,216.99
|
| Rate for Payer: Cash Price |
$6,549.35
|
| Rate for Payer: Cigna Commercial |
$10,871.92
|
| Rate for Payer: First Health Commercial |
$12,443.76
|
| Rate for Payer: Humana Commercial |
$11,133.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,740.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,666.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,929.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,526.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,824.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,478.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,395.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,038.10
|
| Rate for Payer: PHCS Commercial |
$12,574.75
|
| Rate for Payer: United Healthcare All Payer |
$11,526.86
|
|
|
EMP SLV 17 XL CONE 2 SPOUT SLT
|
Facility
|
OP
|
$13,098.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,929.61 |
| Max. Negotiated Rate |
$12,574.75 |
| Rate for Payer: Aetna Commercial |
$10,086.00
|
| Rate for Payer: Anthem Medicaid |
$4,504.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,216.99
|
| Rate for Payer: Cash Price |
$6,549.35
|
| Rate for Payer: Cigna Commercial |
$10,871.92
|
| Rate for Payer: First Health Commercial |
$12,443.76
|
| Rate for Payer: Humana Commercial |
$11,133.90
|
| Rate for Payer: Humana KY Medicaid |
$4,504.64
|
| Rate for Payer: Kentucky WC Medicaid |
$4,550.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,740.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,666.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,929.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,595.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,526.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,824.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,478.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,395.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,038.10
|
| Rate for Payer: PHCS Commercial |
$12,574.75
|
| Rate for Payer: United Healthcare All Payer |
$11,526.86
|
|
|
EMP SLV 17 XL CONE 2 SPOUT SLT
|
Facility
|
IP
|
$13,098.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,929.61 |
| Max. Negotiated Rate |
$12,574.75 |
| Rate for Payer: Aetna Commercial |
$10,086.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,216.99
|
| Rate for Payer: Cash Price |
$6,549.35
|
| Rate for Payer: Cigna Commercial |
$10,871.92
|
| Rate for Payer: First Health Commercial |
$12,443.76
|
| Rate for Payer: Humana Commercial |
$11,133.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,740.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,666.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,929.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,526.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,824.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,478.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,395.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,038.10
|
| Rate for Payer: PHCS Commercial |
$12,574.75
|
| Rate for Payer: United Healthcare All Payer |
$11,526.86
|
|
|
EMP SLV 17 XL CONE 3 SPOUT SLT
|
Facility
|
OP
|
$13,098.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,929.61 |
| Max. Negotiated Rate |
$12,574.75 |
| Rate for Payer: Aetna Commercial |
$10,086.00
|
| Rate for Payer: Anthem Medicaid |
$4,504.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,216.99
|
| Rate for Payer: Cash Price |
$6,549.35
|
| Rate for Payer: Cigna Commercial |
$10,871.92
|
| Rate for Payer: First Health Commercial |
$12,443.76
|
| Rate for Payer: Humana Commercial |
$11,133.90
|
| Rate for Payer: Humana KY Medicaid |
$4,504.64
|
| Rate for Payer: Kentucky WC Medicaid |
$4,550.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,740.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,666.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,929.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,595.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,526.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,824.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,478.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,395.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,038.10
|
| Rate for Payer: PHCS Commercial |
$12,574.75
|
| Rate for Payer: United Healthcare All Payer |
$11,526.86
|
|
|
EMP SLV 17 XL CONE 3 SPOUT SLT
|
Facility
|
IP
|
$13,098.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,929.61 |
| Max. Negotiated Rate |
$12,574.75 |
| Rate for Payer: Aetna Commercial |
$10,086.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,216.99
|
| Rate for Payer: Cash Price |
$6,549.35
|
| Rate for Payer: Cigna Commercial |
$10,871.92
|
| Rate for Payer: First Health Commercial |
$12,443.76
|
| Rate for Payer: Humana Commercial |
$11,133.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,740.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,666.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,929.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,526.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,824.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,478.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,395.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,038.10
|
| Rate for Payer: PHCS Commercial |
$12,574.75
|
| Rate for Payer: United Healthcare All Payer |
$11,526.86
|
|
|
EMP SLV 19 XL CONE 1 SPOU SLOT
|
Facility
|
OP
|
$13,092.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,927.74 |
| Max. Negotiated Rate |
$12,568.76 |
| Rate for Payer: Aetna Commercial |
$10,081.19
|
| Rate for Payer: Anthem Medicaid |
$4,502.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,212.12
|
| Rate for Payer: Cash Price |
$6,546.23
|
| Rate for Payer: Cigna Commercial |
$10,866.74
|
| Rate for Payer: First Health Commercial |
$12,437.84
|
| Rate for Payer: Humana Commercial |
$11,128.59
|
| Rate for Payer: Humana KY Medicaid |
$4,502.50
|
| Rate for Payer: Kentucky WC Medicaid |
$4,548.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,735.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,662.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,927.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,592.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,521.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,819.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,473.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,390.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,033.80
|
| Rate for Payer: PHCS Commercial |
$12,568.76
|
| Rate for Payer: United Healthcare All Payer |
$11,521.36
|
|
|
EMP SLV 19 XL CONE 1 SPOU SLOT
|
Facility
|
IP
|
$13,092.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,927.74 |
| Max. Negotiated Rate |
$12,568.76 |
| Rate for Payer: Aetna Commercial |
$10,081.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,212.12
|
| Rate for Payer: Cash Price |
$6,546.23
|
| Rate for Payer: Cigna Commercial |
$10,866.74
|
| Rate for Payer: First Health Commercial |
$12,437.84
|
| Rate for Payer: Humana Commercial |
$11,128.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,735.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,662.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,927.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,521.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,819.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,473.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,390.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,033.80
|
| Rate for Payer: PHCS Commercial |
$12,568.76
|
| Rate for Payer: United Healthcare All Payer |
$11,521.36
|
|
|
EMP SLV 19 XL CONE 2 SPOU SLOT
|
Facility
|
IP
|
$13,092.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,927.74 |
| Max. Negotiated Rate |
$12,568.76 |
| Rate for Payer: Aetna Commercial |
$10,081.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,212.12
|
| Rate for Payer: Cash Price |
$6,546.23
|
| Rate for Payer: Cigna Commercial |
$10,866.74
|
| Rate for Payer: First Health Commercial |
$12,437.84
|
| Rate for Payer: Humana Commercial |
$11,128.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,735.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,662.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,927.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,521.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,819.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,473.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,390.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,033.80
|
| Rate for Payer: PHCS Commercial |
$12,568.76
|
| Rate for Payer: United Healthcare All Payer |
$11,521.36
|
|
|
EMP SLV 19 XL CONE 2 SPOU SLOT
|
Facility
|
OP
|
$13,092.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,927.74 |
| Max. Negotiated Rate |
$12,568.76 |
| Rate for Payer: Aetna Commercial |
$10,081.19
|
| Rate for Payer: Anthem Medicaid |
$4,502.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,212.12
|
| Rate for Payer: Cash Price |
$6,546.23
|
| Rate for Payer: Cigna Commercial |
$10,866.74
|
| Rate for Payer: First Health Commercial |
$12,437.84
|
| Rate for Payer: Humana Commercial |
$11,128.59
|
| Rate for Payer: Humana KY Medicaid |
$4,502.50
|
| Rate for Payer: Kentucky WC Medicaid |
$4,548.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,735.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,662.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,927.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,592.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,521.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,819.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,473.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,390.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,033.80
|
| Rate for Payer: PHCS Commercial |
$12,568.76
|
| Rate for Payer: United Healthcare All Payer |
$11,521.36
|
|
