|
EMP SLV 21 XL CONE 3 SPOUT
|
Facility
|
OP
|
$21,533.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,460.07 |
| Max. Negotiated Rate |
$20,672.22 |
| Rate for Payer: Aetna Commercial |
$16,580.84
|
| Rate for Payer: Anthem Medicaid |
$7,405.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,796.18
|
| Rate for Payer: Cash Price |
$10,766.78
|
| Rate for Payer: Cigna Commercial |
$17,872.85
|
| Rate for Payer: First Health Commercial |
$20,456.88
|
| Rate for Payer: Humana Commercial |
$18,303.53
|
| Rate for Payer: Humana KY Medicaid |
$7,405.39
|
| Rate for Payer: Kentucky WC Medicaid |
$7,480.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,657.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,891.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,460.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,553.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,949.53
|
| Rate for Payer: Ohio Health Group HMO |
$16,150.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,226.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,734.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,858.16
|
| Rate for Payer: PHCS Commercial |
$20,672.22
|
| Rate for Payer: United Healthcare All Payer |
$18,949.53
|
|
|
EMP SLV 23 LG CONE 1 SP SLT TL
|
Facility
|
IP
|
$11,557.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,467.30 |
| Max. Negotiated Rate |
$11,095.36 |
| Rate for Payer: Aetna Commercial |
$8,899.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,014.98
|
| Rate for Payer: Cash Price |
$5,778.83
|
| Rate for Payer: Cigna Commercial |
$9,592.87
|
| Rate for Payer: First Health Commercial |
$10,979.79
|
| Rate for Payer: Humana Commercial |
$9,824.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,477.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,529.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,467.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,170.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,668.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,246.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,055.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,974.79
|
| Rate for Payer: PHCS Commercial |
$11,095.36
|
| Rate for Payer: United Healthcare All Payer |
$10,170.75
|
|
|
EMP SLV 23 LG CONE 1 SP SLT TL
|
Facility
|
OP
|
$11,557.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,467.30 |
| Max. Negotiated Rate |
$11,095.36 |
| Rate for Payer: Aetna Commercial |
$8,899.41
|
| Rate for Payer: Anthem Medicaid |
$3,974.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,014.98
|
| Rate for Payer: Cash Price |
$5,778.83
|
| Rate for Payer: Cigna Commercial |
$9,592.87
|
| Rate for Payer: First Health Commercial |
$10,979.79
|
| Rate for Payer: Humana Commercial |
$9,824.02
|
| Rate for Payer: Humana KY Medicaid |
$3,974.68
|
| Rate for Payer: Kentucky WC Medicaid |
$4,015.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,477.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,529.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,467.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,054.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,170.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,668.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,246.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,055.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,974.79
|
| Rate for Payer: PHCS Commercial |
$11,095.36
|
| Rate for Payer: United Healthcare All Payer |
$10,170.75
|
|
|
EMP SLV 23 LG CONE 2 SP SLT TL
|
Facility
|
OP
|
$11,557.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,467.30 |
| Max. Negotiated Rate |
$11,095.36 |
| Rate for Payer: Aetna Commercial |
$8,899.41
|
| Rate for Payer: Anthem Medicaid |
$3,974.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,014.98
|
| Rate for Payer: Cash Price |
$5,778.83
|
| Rate for Payer: Cigna Commercial |
$9,592.87
|
| Rate for Payer: First Health Commercial |
$10,979.79
|
| Rate for Payer: Humana Commercial |
$9,824.02
|
| Rate for Payer: Humana KY Medicaid |
$3,974.68
|
| Rate for Payer: Kentucky WC Medicaid |
$4,015.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,477.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,529.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,467.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,054.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,170.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,668.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,246.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,055.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,974.79
|
| Rate for Payer: PHCS Commercial |
$11,095.36
|
| Rate for Payer: United Healthcare All Payer |
$10,170.75
|
|
|
EMP SLV 23 LG CONE 2 SP SLT TL
|
Facility
|
IP
|
$11,557.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,467.30 |
| Max. Negotiated Rate |
$11,095.36 |
| Rate for Payer: Aetna Commercial |
$8,899.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,014.98
|
| Rate for Payer: Cash Price |
$5,778.83
|
| Rate for Payer: Cigna Commercial |
$9,592.87
|
| Rate for Payer: First Health Commercial |
$10,979.79
|
| Rate for Payer: Humana Commercial |
$9,824.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,477.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,529.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,467.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,170.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,668.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,246.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,055.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,974.79
|
| Rate for Payer: PHCS Commercial |
$11,095.36
|
| Rate for Payer: United Healthcare All Payer |
$10,170.75
|
|
|
EMP SLV 23 LG CONE 3 SP SLT TL
|
Facility
|
IP
|
$11,557.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,467.30 |
| Max. Negotiated Rate |
$11,095.36 |
| Rate for Payer: Aetna Commercial |
$8,899.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,014.98
|
| Rate for Payer: Cash Price |
$5,778.83
|
| Rate for Payer: Cigna Commercial |
$9,592.87
|
| Rate for Payer: First Health Commercial |
$10,979.79
|
| Rate for Payer: Humana Commercial |
$9,824.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,477.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,529.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,467.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,170.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,668.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,246.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,055.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,974.79
|
| Rate for Payer: PHCS Commercial |
$11,095.36
|
| Rate for Payer: United Healthcare All Payer |
$10,170.75
|
|
|
EMP SLV 23 LG CONE 3 SP SLT TL
|
Facility
|
OP
|
$11,557.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,467.30 |
| Max. Negotiated Rate |
$11,095.36 |
| Rate for Payer: Aetna Commercial |
$8,899.41
|
| Rate for Payer: Anthem Medicaid |
$3,974.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,014.98
|
| Rate for Payer: Cash Price |
$5,778.83
|
| Rate for Payer: Cigna Commercial |
$9,592.87
|
| Rate for Payer: First Health Commercial |
$10,979.79
|
| Rate for Payer: Humana Commercial |
$9,824.02
|
| Rate for Payer: Humana KY Medicaid |
$3,974.68
|
| Rate for Payer: Kentucky WC Medicaid |
$4,015.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,477.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,529.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,467.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,054.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,170.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,668.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,246.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,055.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,974.79
|
| Rate for Payer: PHCS Commercial |
$11,095.36
|
| Rate for Payer: United Healthcare All Payer |
$10,170.75
|
|
|
EMP SLV 23 MD CONE 1 SP SLT TL
|
Facility
|
OP
|
$11,557.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,467.30 |
| Max. Negotiated Rate |
$11,095.36 |
| Rate for Payer: Aetna Commercial |
$8,899.41
|
| Rate for Payer: Anthem Medicaid |
$3,974.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,014.98
|
| Rate for Payer: Cash Price |
$5,778.83
|
| Rate for Payer: Cigna Commercial |
$9,592.87
|
| Rate for Payer: First Health Commercial |
$10,979.79
|
| Rate for Payer: Humana Commercial |
$9,824.02
|
| Rate for Payer: Humana KY Medicaid |
$3,974.68
|
| Rate for Payer: Kentucky WC Medicaid |
$4,015.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,477.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,529.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,467.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,054.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,170.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,668.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,246.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,055.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,974.79
|
| Rate for Payer: PHCS Commercial |
$11,095.36
|
| Rate for Payer: United Healthcare All Payer |
$10,170.75
|
|
|
EMP SLV 23 MD CONE 1 SP SLT TL
|
Facility
|
IP
|
$11,557.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,467.30 |
| Max. Negotiated Rate |
$11,095.36 |
| Rate for Payer: Aetna Commercial |
$8,899.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,014.98
|
| Rate for Payer: Cash Price |
$5,778.83
|
| Rate for Payer: Cigna Commercial |
$9,592.87
|
| Rate for Payer: First Health Commercial |
$10,979.79
|
| Rate for Payer: Humana Commercial |
$9,824.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,477.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,529.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,467.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,170.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,668.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,246.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,055.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,974.79
|
| Rate for Payer: PHCS Commercial |
$11,095.36
|
| Rate for Payer: United Healthcare All Payer |
$10,170.75
|
|
|
EMP SLV 23 MD CONE 2 SP SLT TL
|
Facility
|
OP
|
$11,557.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,467.30 |
| Max. Negotiated Rate |
$11,095.36 |
| Rate for Payer: Aetna Commercial |
$8,899.41
|
| Rate for Payer: Anthem Medicaid |
$3,974.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,014.98
|
| Rate for Payer: Cash Price |
$5,778.83
|
| Rate for Payer: Cigna Commercial |
$9,592.87
|
| Rate for Payer: First Health Commercial |
$10,979.79
|
| Rate for Payer: Humana Commercial |
$9,824.02
|
| Rate for Payer: Humana KY Medicaid |
$3,974.68
|
| Rate for Payer: Kentucky WC Medicaid |
$4,015.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,477.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,529.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,467.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,054.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,170.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,668.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,246.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,055.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,974.79
|
| Rate for Payer: PHCS Commercial |
$11,095.36
|
| Rate for Payer: United Healthcare All Payer |
$10,170.75
|
|
|
EMP SLV 23 MD CONE 2 SP SLT TL
|
Facility
|
IP
|
$11,557.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,467.30 |
| Max. Negotiated Rate |
$11,095.36 |
| Rate for Payer: Aetna Commercial |
$8,899.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,014.98
|
| Rate for Payer: Cash Price |
$5,778.83
|
| Rate for Payer: Cigna Commercial |
$9,592.87
|
| Rate for Payer: First Health Commercial |
$10,979.79
|
| Rate for Payer: Humana Commercial |
$9,824.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,477.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,529.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,467.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,170.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,668.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,246.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,055.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,974.79
|
| Rate for Payer: PHCS Commercial |
$11,095.36
|
| Rate for Payer: United Healthcare All Payer |
$10,170.75
|
|
|
EMP SLV 23 MD CONE 3 SP SLT TL
|
Facility
|
IP
|
$11,557.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,467.30 |
| Max. Negotiated Rate |
$11,095.36 |
| Rate for Payer: Aetna Commercial |
$8,899.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,014.98
|
| Rate for Payer: Cash Price |
$5,778.83
|
| Rate for Payer: Cigna Commercial |
$9,592.87
|
| Rate for Payer: First Health Commercial |
$10,979.79
|
| Rate for Payer: Humana Commercial |
$9,824.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,477.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,529.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,467.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,170.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,668.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,246.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,055.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,974.79
|
| Rate for Payer: PHCS Commercial |
$11,095.36
|
| Rate for Payer: United Healthcare All Payer |
$10,170.75
|
|
|
EMP SLV 23 MD CONE 3 SP SLT TL
|
Facility
|
OP
|
$11,557.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,467.30 |
| Max. Negotiated Rate |
$11,095.36 |
| Rate for Payer: Aetna Commercial |
$8,899.41
|
| Rate for Payer: Anthem Medicaid |
$3,974.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,014.98
|
| Rate for Payer: Cash Price |
$5,778.83
|
| Rate for Payer: Cigna Commercial |
$9,592.87
|
| Rate for Payer: First Health Commercial |
$10,979.79
|
| Rate for Payer: Humana Commercial |
$9,824.02
|
| Rate for Payer: Humana KY Medicaid |
$3,974.68
|
| Rate for Payer: Kentucky WC Medicaid |
$4,015.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,477.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,529.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,467.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,054.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,170.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,668.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,246.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,055.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,974.79
|
| Rate for Payer: PHCS Commercial |
$11,095.36
|
| Rate for Payer: United Healthcare All Payer |
$10,170.75
|
|
|
EMP SLV 23 SM CONE 1 SP SLT TL
|
Facility
|
OP
|
$11,557.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,467.30 |
| Max. Negotiated Rate |
$11,095.36 |
| Rate for Payer: Aetna Commercial |
$8,899.41
|
| Rate for Payer: Anthem Medicaid |
$3,974.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,014.98
|
| Rate for Payer: Cash Price |
$5,778.83
|
| Rate for Payer: Cigna Commercial |
$9,592.87
|
| Rate for Payer: First Health Commercial |
$10,979.79
|
| Rate for Payer: Humana Commercial |
$9,824.02
|
| Rate for Payer: Humana KY Medicaid |
$3,974.68
|
| Rate for Payer: Kentucky WC Medicaid |
$4,015.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,477.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,529.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,467.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,054.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,170.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,668.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,246.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,055.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,974.79
|
| Rate for Payer: PHCS Commercial |
$11,095.36
|
| Rate for Payer: United Healthcare All Payer |
$10,170.75
|
|
|
EMP SLV 23 SM CONE 1 SP SLT TL
|
Facility
|
IP
|
$11,557.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,467.30 |
| Max. Negotiated Rate |
$11,095.36 |
| Rate for Payer: Aetna Commercial |
$8,899.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,014.98
|
| Rate for Payer: Cash Price |
$5,778.83
|
| Rate for Payer: Cigna Commercial |
$9,592.87
|
| Rate for Payer: First Health Commercial |
$10,979.79
|
| Rate for Payer: Humana Commercial |
$9,824.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,477.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,529.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,467.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,170.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,668.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,246.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,055.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,974.79
|
| Rate for Payer: PHCS Commercial |
$11,095.36
|
| Rate for Payer: United Healthcare All Payer |
$10,170.75
|
|
|
EMP SLV 23 SM CONE 2 SP SLT TL
|
Facility
|
OP
|
$11,557.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,467.30 |
| Max. Negotiated Rate |
$11,095.36 |
| Rate for Payer: Aetna Commercial |
$8,899.41
|
| Rate for Payer: Anthem Medicaid |
$3,974.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,014.98
|
| Rate for Payer: Cash Price |
$5,778.83
|
| Rate for Payer: Cigna Commercial |
$9,592.87
|
| Rate for Payer: First Health Commercial |
$10,979.79
|
| Rate for Payer: Humana Commercial |
$9,824.02
|
| Rate for Payer: Humana KY Medicaid |
$3,974.68
|
| Rate for Payer: Kentucky WC Medicaid |
$4,015.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,477.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,529.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,467.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,054.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,170.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,668.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,246.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,055.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,974.79
|
| Rate for Payer: PHCS Commercial |
$11,095.36
|
| Rate for Payer: United Healthcare All Payer |
$10,170.75
|
|
|
EMP SLV 23 SM CONE 2 SP SLT TL
|
Facility
|
IP
|
$11,557.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,467.30 |
| Max. Negotiated Rate |
$11,095.36 |
| Rate for Payer: Aetna Commercial |
$8,899.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,014.98
|
| Rate for Payer: Cash Price |
$5,778.83
|
| Rate for Payer: Cigna Commercial |
$9,592.87
|
| Rate for Payer: First Health Commercial |
$10,979.79
|
| Rate for Payer: Humana Commercial |
$9,824.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,477.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,529.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,467.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,170.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,668.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,246.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,055.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,974.79
|
| Rate for Payer: PHCS Commercial |
$11,095.36
|
| Rate for Payer: United Healthcare All Payer |
$10,170.75
|
|
|
EMP SLV 23 SM CONE 3 SP SLT TL
|
Facility
|
IP
|
$11,557.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,467.30 |
| Max. Negotiated Rate |
$11,095.36 |
| Rate for Payer: Aetna Commercial |
$8,899.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,014.98
|
| Rate for Payer: Cash Price |
$5,778.83
|
| Rate for Payer: Cigna Commercial |
$9,592.87
|
| Rate for Payer: First Health Commercial |
$10,979.79
|
| Rate for Payer: Humana Commercial |
$9,824.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,477.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,529.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,467.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,170.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,668.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,246.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,055.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,974.79
|
| Rate for Payer: PHCS Commercial |
$11,095.36
|
| Rate for Payer: United Healthcare All Payer |
$10,170.75
|
|
|
EMP SLV 23 SM CONE 3 SP SLT TL
|
Facility
|
OP
|
$11,557.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,467.30 |
| Max. Negotiated Rate |
$11,095.36 |
| Rate for Payer: Aetna Commercial |
$8,899.41
|
| Rate for Payer: Anthem Medicaid |
$3,974.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,014.98
|
| Rate for Payer: Cash Price |
$5,778.83
|
| Rate for Payer: Cigna Commercial |
$9,592.87
|
| Rate for Payer: First Health Commercial |
$10,979.79
|
| Rate for Payer: Humana Commercial |
$9,824.02
|
| Rate for Payer: Humana KY Medicaid |
$3,974.68
|
| Rate for Payer: Kentucky WC Medicaid |
$4,015.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,477.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,529.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,467.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,054.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,170.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,668.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,246.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,055.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,974.79
|
| Rate for Payer: PHCS Commercial |
$11,095.36
|
| Rate for Payer: United Healthcare All Payer |
$10,170.75
|
|
|
EMP SLV 23 XL CONE 1 SPOUT
|
Facility
|
OP
|
$11,966.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,589.90 |
| Max. Negotiated Rate |
$11,487.67 |
| Rate for Payer: Aetna Commercial |
$9,214.07
|
| Rate for Payer: Anthem Medicaid |
$4,115.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,333.73
|
| Rate for Payer: Cash Price |
$5,983.16
|
| Rate for Payer: Cigna Commercial |
$9,932.05
|
| Rate for Payer: First Health Commercial |
$11,368.00
|
| Rate for Payer: Humana Commercial |
$10,171.37
|
| Rate for Payer: Humana KY Medicaid |
$4,115.22
|
| Rate for Payer: Kentucky WC Medicaid |
$4,157.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,812.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,831.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,589.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,197.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,530.36
|
| Rate for Payer: Ohio Health Group HMO |
$8,974.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,573.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,410.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,256.76
|
| Rate for Payer: PHCS Commercial |
$11,487.67
|
| Rate for Payer: United Healthcare All Payer |
$10,530.36
|
|
|
EMP SLV 23 XL CONE 1 SPOUT
|
Facility
|
IP
|
$11,966.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,589.90 |
| Max. Negotiated Rate |
$11,487.67 |
| Rate for Payer: Aetna Commercial |
$9,214.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,333.73
|
| Rate for Payer: Cash Price |
$5,983.16
|
| Rate for Payer: Cigna Commercial |
$9,932.05
|
| Rate for Payer: First Health Commercial |
$11,368.00
|
| Rate for Payer: Humana Commercial |
$10,171.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,812.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,831.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,589.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,530.36
|
| Rate for Payer: Ohio Health Group HMO |
$8,974.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,573.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,410.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,256.76
|
| Rate for Payer: PHCS Commercial |
$11,487.67
|
| Rate for Payer: United Healthcare All Payer |
$10,530.36
|
|
|
EMP SLV 23 XL CONE 2 SPOUT
|
Facility
|
OP
|
$11,966.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,589.90 |
| Max. Negotiated Rate |
$11,487.67 |
| Rate for Payer: Aetna Commercial |
$9,214.07
|
| Rate for Payer: Anthem Medicaid |
$4,115.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,333.73
|
| Rate for Payer: Cash Price |
$5,983.16
|
| Rate for Payer: Cigna Commercial |
$9,932.05
|
| Rate for Payer: First Health Commercial |
$11,368.00
|
| Rate for Payer: Humana Commercial |
$10,171.37
|
| Rate for Payer: Humana KY Medicaid |
$4,115.22
|
| Rate for Payer: Kentucky WC Medicaid |
$4,157.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,812.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,831.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,589.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,197.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,530.36
|
| Rate for Payer: Ohio Health Group HMO |
$8,974.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,573.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,410.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,256.76
|
| Rate for Payer: PHCS Commercial |
$11,487.67
|
| Rate for Payer: United Healthcare All Payer |
$10,530.36
|
|
|
EMP SLV 23 XL CONE 2 SPOUT
|
Facility
|
IP
|
$11,966.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,589.90 |
| Max. Negotiated Rate |
$11,487.67 |
| Rate for Payer: Aetna Commercial |
$9,214.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,333.73
|
| Rate for Payer: Cash Price |
$5,983.16
|
| Rate for Payer: Cigna Commercial |
$9,932.05
|
| Rate for Payer: First Health Commercial |
$11,368.00
|
| Rate for Payer: Humana Commercial |
$10,171.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,812.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,831.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,589.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,530.36
|
| Rate for Payer: Ohio Health Group HMO |
$8,974.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,573.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,410.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,256.76
|
| Rate for Payer: PHCS Commercial |
$11,487.67
|
| Rate for Payer: United Healthcare All Payer |
$10,530.36
|
|
|
EMP SLV 23 XL CONE 3 SPOUT
|
Facility
|
OP
|
$11,966.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,589.90 |
| Max. Negotiated Rate |
$11,487.67 |
| Rate for Payer: Aetna Commercial |
$9,214.07
|
| Rate for Payer: Anthem Medicaid |
$4,115.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,333.73
|
| Rate for Payer: Cash Price |
$5,983.16
|
| Rate for Payer: Cigna Commercial |
$9,932.05
|
| Rate for Payer: First Health Commercial |
$11,368.00
|
| Rate for Payer: Humana Commercial |
$10,171.37
|
| Rate for Payer: Humana KY Medicaid |
$4,115.22
|
| Rate for Payer: Kentucky WC Medicaid |
$4,157.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,812.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,831.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,589.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,197.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,530.36
|
| Rate for Payer: Ohio Health Group HMO |
$8,974.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,573.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,410.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,256.76
|
| Rate for Payer: PHCS Commercial |
$11,487.67
|
| Rate for Payer: United Healthcare All Payer |
$10,530.36
|
|
|
EMP SLV 23 XL CONE 3 SPOUT
|
Facility
|
IP
|
$11,966.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,589.90 |
| Max. Negotiated Rate |
$11,487.67 |
| Rate for Payer: Aetna Commercial |
$9,214.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,333.73
|
| Rate for Payer: Cash Price |
$5,983.16
|
| Rate for Payer: Cigna Commercial |
$9,932.05
|
| Rate for Payer: First Health Commercial |
$11,368.00
|
| Rate for Payer: Humana Commercial |
$10,171.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,812.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,831.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,589.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,530.36
|
| Rate for Payer: Ohio Health Group HMO |
$8,974.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,573.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,410.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,256.76
|
| Rate for Payer: PHCS Commercial |
$11,487.67
|
| Rate for Payer: United Healthcare All Payer |
$10,530.36
|
|
