|
EMP SLV 9 LG CONE 1 SPOUT SLOT
|
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 SLV 9 LG CONE 1 SPOUT SLOT
|
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 9 LG CONE 2 SPOUT SLOT
|
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 9 LG CONE 2 SPOUT SLOT
|
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 SLV 9 LG CONE 3 SPOUT SLOT
|
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 9 LG CONE 3 SPOUT SLOT
|
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 SLV 9 MD CONE 1 SPOUT SLOT
|
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 SLV 9 MD CONE 1 SPOUT SLOT
|
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 9 MD CONE 2 SPOUT SLOT
|
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 SLV 9 MD CONE 2 SPOUT SLOT
|
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 9 MD CONE 3 SPOUT SLOT
|
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 SLV 9 MD CONE 3 SPOUT SLOT
|
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 9 SM CONE 1 SPOUT SLOT
|
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 SLV 9 SM CONE 1 SPOUT SLOT
|
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 9 SM CONE 2 SPOUT SLOT
|
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 9 SM CONE 2 SPOUT SLOT
|
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 SLV 9 SM CONE 3 SPOUT SLOT
|
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 9 SM CONE 3 SPOUT SLOT
|
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 STEM 11 LNG REV POL +0 L
|
Facility
|
OP
|
$22,620.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,786.15 |
| Max. Negotiated Rate |
$21,715.68 |
| Rate for Payer: Aetna Commercial |
$17,417.78
|
| Rate for Payer: Anthem Medicaid |
$7,779.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,643.99
|
| Rate for Payer: Cash Price |
$11,310.25
|
| Rate for Payer: Cigna Commercial |
$18,775.01
|
| Rate for Payer: First Health Commercial |
$21,489.47
|
| Rate for Payer: Humana Commercial |
$19,227.42
|
| Rate for Payer: Humana KY Medicaid |
$7,779.19
|
| Rate for Payer: Kentucky WC Medicaid |
$7,858.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,548.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,693.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,786.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,935.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,906.04
|
| Rate for Payer: Ohio Health Group HMO |
$16,965.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,096.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,679.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,608.15
|
| Rate for Payer: PHCS Commercial |
$21,715.68
|
| Rate for Payer: United Healthcare All Payer |
$19,906.04
|
|
|
EMP STEM 11 LNG REV POL +0 L
|
Facility
|
IP
|
$22,620.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,786.15 |
| Max. Negotiated Rate |
$21,715.68 |
| Rate for Payer: Aetna Commercial |
$17,417.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,643.99
|
| Rate for Payer: Cash Price |
$11,310.25
|
| Rate for Payer: Cigna Commercial |
$18,775.01
|
| Rate for Payer: First Health Commercial |
$21,489.47
|
| Rate for Payer: Humana Commercial |
$19,227.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,548.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,693.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,786.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,906.04
|
| Rate for Payer: Ohio Health Group HMO |
$16,965.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,096.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,679.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,608.15
|
| Rate for Payer: PHCS Commercial |
$21,715.68
|
| Rate for Payer: United Healthcare All Payer |
$19,906.04
|
|
|
EMP STEM 11 LNG REV POL +0 R
|
Facility
|
IP
|
$22,620.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,786.15 |
| Max. Negotiated Rate |
$21,715.68 |
| Rate for Payer: Aetna Commercial |
$17,417.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,643.99
|
| Rate for Payer: Cash Price |
$11,310.25
|
| Rate for Payer: Cigna Commercial |
$18,775.01
|
| Rate for Payer: First Health Commercial |
$21,489.47
|
| Rate for Payer: Humana Commercial |
$19,227.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,548.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,693.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,786.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,906.04
|
| Rate for Payer: Ohio Health Group HMO |
$16,965.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,096.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,679.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,608.15
|
| Rate for Payer: PHCS Commercial |
$21,715.68
|
| Rate for Payer: United Healthcare All Payer |
$19,906.04
|
|
|
EMP STEM 11 LNG REV POL +0 R
|
Facility
|
OP
|
$22,620.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,786.15 |
| Max. Negotiated Rate |
$21,715.68 |
| Rate for Payer: Aetna Commercial |
$17,417.78
|
| Rate for Payer: Anthem Medicaid |
$7,779.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,643.99
|
| Rate for Payer: Cash Price |
$11,310.25
|
| Rate for Payer: Cigna Commercial |
$18,775.01
|
| Rate for Payer: First Health Commercial |
$21,489.47
|
| Rate for Payer: Humana Commercial |
$19,227.42
|
| Rate for Payer: Humana KY Medicaid |
$7,779.19
|
| Rate for Payer: Kentucky WC Medicaid |
$7,858.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,548.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,693.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,786.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,935.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,906.04
|
| Rate for Payer: Ohio Health Group HMO |
$16,965.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,096.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,679.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,608.15
|
| Rate for Payer: PHCS Commercial |
$21,715.68
|
| Rate for Payer: United Healthcare All Payer |
$19,906.04
|
|
|
EMP STEM 11 LNG REV POL +10 L
|
Facility
|
OP
|
$25,667.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,700.32 |
| Max. Negotiated Rate |
$24,641.04 |
| Rate for Payer: Aetna Commercial |
$19,764.17
|
| Rate for Payer: Anthem Medicaid |
$8,827.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,020.85
|
| Rate for Payer: Cash Price |
$12,833.88
|
| Rate for Payer: Cigna Commercial |
$21,304.23
|
| Rate for Payer: First Health Commercial |
$24,384.36
|
| Rate for Payer: Humana Commercial |
$21,817.59
|
| Rate for Payer: Humana KY Medicaid |
$8,827.14
|
| Rate for Payer: Kentucky WC Medicaid |
$8,916.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,047.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,942.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,700.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,004.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,587.62
|
| Rate for Payer: Ohio Health Group HMO |
$19,250.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,534.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,330.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,710.75
|
| Rate for Payer: PHCS Commercial |
$24,641.04
|
| Rate for Payer: United Healthcare All Payer |
$22,587.62
|
|
|
EMP STEM 11 LNG REV POL +10 L
|
Facility
|
IP
|
$25,667.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,700.32 |
| Max. Negotiated Rate |
$24,641.04 |
| Rate for Payer: Aetna Commercial |
$19,764.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,020.85
|
| Rate for Payer: Cash Price |
$12,833.88
|
| Rate for Payer: Cigna Commercial |
$21,304.23
|
| Rate for Payer: First Health Commercial |
$24,384.36
|
| Rate for Payer: Humana Commercial |
$21,817.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,047.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,942.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,700.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,587.62
|
| Rate for Payer: Ohio Health Group HMO |
$19,250.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,534.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,330.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,710.75
|
| Rate for Payer: PHCS Commercial |
$24,641.04
|
| Rate for Payer: United Healthcare All Payer |
$22,587.62
|
|
|
EMP STEM 11 LNG REV POL +10 R
|
Facility
|
IP
|
$25,667.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,700.32 |
| Max. Negotiated Rate |
$24,641.04 |
| Rate for Payer: Aetna Commercial |
$19,764.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,020.85
|
| Rate for Payer: Cash Price |
$12,833.88
|
| Rate for Payer: Cigna Commercial |
$21,304.23
|
| Rate for Payer: First Health Commercial |
$24,384.36
|
| Rate for Payer: Humana Commercial |
$21,817.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,047.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,942.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,700.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,587.62
|
| Rate for Payer: Ohio Health Group HMO |
$19,250.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,534.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,330.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,710.75
|
| Rate for Payer: PHCS Commercial |
$24,641.04
|
| Rate for Payer: United Healthcare All Payer |
$22,587.62
|
|
