|
PLU PROMOS REV PE-INSRT 42/12M
|
Facility
|
IP
|
$11,496.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.61 |
| Max. Negotiated Rate |
$11,037.11 |
| Rate for Payer: Aetna Commercial |
$8,852.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,967.65
|
| Rate for Payer: Cash Price |
$5,748.49
|
| Rate for Payer: Cigna Commercial |
$9,542.50
|
| Rate for Payer: First Health Commercial |
$10,922.14
|
| Rate for Payer: Humana Commercial |
$9,772.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,427.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,484.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,449.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,117.35
|
| Rate for Payer: Ohio Health Group HMO |
$8,622.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,299.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,494.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,564.07
|
| Rate for Payer: PHCS Commercial |
$11,037.11
|
| Rate for Payer: United Healthcare All Payer |
$10,117.35
|
|
|
PLU PROMOS REV PE-INSRT 42/12M
|
Facility
|
OP
|
$11,496.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.61 |
| Max. Negotiated Rate |
$11,037.11 |
| Rate for Payer: Aetna Commercial |
$8,852.68
|
| Rate for Payer: Anthem Medicaid |
$3,953.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,967.65
|
| Rate for Payer: Cash Price |
$5,748.49
|
| Rate for Payer: Cigna Commercial |
$9,542.50
|
| Rate for Payer: First Health Commercial |
$10,922.14
|
| Rate for Payer: Humana Commercial |
$9,772.44
|
| Rate for Payer: Humana KY Medicaid |
$3,953.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,994.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,427.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,484.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,449.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,033.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,117.35
|
| Rate for Payer: Ohio Health Group HMO |
$8,622.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,299.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,494.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,564.07
|
| Rate for Payer: PHCS Commercial |
$11,037.11
|
| Rate for Payer: United Healthcare All Payer |
$10,117.35
|
|
|
PLU PROMOS REV PE-INSRT 42/6MM
|
Facility
|
IP
|
$8,229.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,069.82 |
| Max. Negotiated Rate |
$7,900.20 |
| Rate for Payer: Aetna Commercial |
$6,336.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,418.92
|
| Rate for Payer: Cash Price |
$4,114.69
|
| Rate for Payer: Cigna Commercial |
$6,830.39
|
| Rate for Payer: First Health Commercial |
$7,817.91
|
| Rate for Payer: Humana Commercial |
$6,994.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,748.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,073.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,468.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,241.85
|
| Rate for Payer: Ohio Health Group HMO |
$6,172.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,645.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,069.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,551.11
|
| Rate for Payer: PHCS Commercial |
$7,900.20
|
| Rate for Payer: United Healthcare All Payer |
$7,241.85
|
|
|
PLU PROMOS REV PE-INSRT 42/6MM
|
Facility
|
OP
|
$8,229.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,069.82 |
| Max. Negotiated Rate |
$7,900.20 |
| Rate for Payer: Aetna Commercial |
$6,336.62
|
| Rate for Payer: Anthem Medicaid |
$2,830.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,418.92
|
| Rate for Payer: Cash Price |
$4,114.69
|
| Rate for Payer: Cigna Commercial |
$6,830.39
|
| Rate for Payer: First Health Commercial |
$7,817.91
|
| Rate for Payer: Humana Commercial |
$6,994.97
|
| Rate for Payer: Humana KY Medicaid |
$2,830.08
|
| Rate for Payer: Kentucky WC Medicaid |
$2,858.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,748.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,073.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,468.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,886.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,241.85
|
| Rate for Payer: Ohio Health Group HMO |
$6,172.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,645.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,069.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,551.11
|
| Rate for Payer: PHCS Commercial |
$7,900.20
|
| Rate for Payer: United Healthcare All Payer |
$7,241.85
|
|
|
PLU PROMOS REV PE-INSRT 42/9MM
|
Facility
|
OP
|
$8,229.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,069.82 |
| Max. Negotiated Rate |
$7,900.20 |
| Rate for Payer: Aetna Commercial |
$6,336.62
|
| Rate for Payer: Anthem Medicaid |
$2,830.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,418.92
|
| Rate for Payer: Cash Price |
$4,114.69
|
| Rate for Payer: Cigna Commercial |
$6,830.39
|
| Rate for Payer: First Health Commercial |
$7,817.91
|
| Rate for Payer: Humana Commercial |
$6,994.97
|
| Rate for Payer: Humana KY Medicaid |
$2,830.08
|
| Rate for Payer: Kentucky WC Medicaid |
$2,858.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,748.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,073.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,468.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,886.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,241.85
|
| Rate for Payer: Ohio Health Group HMO |
$6,172.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,645.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,069.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,551.11
|
| Rate for Payer: PHCS Commercial |
$7,900.20
|
| Rate for Payer: United Healthcare All Payer |
$7,241.85
|
|
|
PLU PROMOS REV PE-INSRT 42/9MM
|
Facility
|
IP
|
$8,229.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,069.82 |
| Max. Negotiated Rate |
$7,900.20 |
| Rate for Payer: Aetna Commercial |
$6,336.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,418.92
|
| Rate for Payer: Cash Price |
$4,114.69
|
| Rate for Payer: Cigna Commercial |
$6,830.39
|
| Rate for Payer: First Health Commercial |
$7,817.91
|
| Rate for Payer: Humana Commercial |
$6,994.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,748.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,073.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,468.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,241.85
|
| Rate for Payer: Ohio Health Group HMO |
$6,172.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,645.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,069.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,551.11
|
| Rate for Payer: PHCS Commercial |
$7,900.20
|
| Rate for Payer: United Healthcare All Payer |
$7,241.85
|
|
|
PLUS PROMO HUM STEM 1
|
Facility
|
IP
|
$7,912.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.66 |
| Max. Negotiated Rate |
$7,596.23 |
| Rate for Payer: Aetna Commercial |
$6,092.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,171.94
|
| Rate for Payer: Cash Price |
$3,956.37
|
| Rate for Payer: Cigna Commercial |
$6,567.57
|
| Rate for Payer: First Health Commercial |
$7,517.10
|
| Rate for Payer: Humana Commercial |
$6,725.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,488.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,839.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,963.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,934.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.95
|
| Rate for Payer: PHCS Commercial |
$7,596.23
|
| Rate for Payer: United Healthcare All Payer |
$6,963.21
|
|
|
PLUS PROMO HUM STEM 1
|
Facility
|
OP
|
$7,912.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.66 |
| Max. Negotiated Rate |
$7,596.23 |
| Rate for Payer: Aetna Commercial |
$6,092.81
|
| Rate for Payer: Anthem Medicaid |
$2,721.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,171.94
|
| Rate for Payer: Cash Price |
$3,956.37
|
| Rate for Payer: Cigna Commercial |
$6,567.57
|
| Rate for Payer: First Health Commercial |
$7,517.10
|
| Rate for Payer: Humana Commercial |
$6,725.83
|
| Rate for Payer: Humana KY Medicaid |
$2,721.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,748.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,488.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,839.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,775.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,963.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,934.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.95
|
| Rate for Payer: PHCS Commercial |
$7,596.23
|
| Rate for Payer: United Healthcare All Payer |
$6,963.21
|
|
|
PLUS PROMO HUM STEM 2.5
|
Facility
|
IP
|
$7,912.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.66 |
| Max. Negotiated Rate |
$7,596.23 |
| Rate for Payer: Aetna Commercial |
$6,092.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,171.94
|
| Rate for Payer: Cash Price |
$3,956.37
|
| Rate for Payer: Cigna Commercial |
$6,567.57
|
| Rate for Payer: First Health Commercial |
$7,517.10
|
| Rate for Payer: Humana Commercial |
$6,725.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,488.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,839.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,963.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,934.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.95
|
| Rate for Payer: PHCS Commercial |
$7,596.23
|
| Rate for Payer: United Healthcare All Payer |
$6,963.21
|
|
|
PLUS PROMO HUM STEM 2.5
|
Facility
|
OP
|
$7,912.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.66 |
| Max. Negotiated Rate |
$7,596.23 |
| Rate for Payer: Aetna Commercial |
$6,092.81
|
| Rate for Payer: Anthem Medicaid |
$2,721.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,171.94
|
| Rate for Payer: Cash Price |
$3,956.37
|
| Rate for Payer: Cigna Commercial |
$6,567.57
|
| Rate for Payer: First Health Commercial |
$7,517.10
|
| Rate for Payer: Humana Commercial |
$6,725.83
|
| Rate for Payer: Humana KY Medicaid |
$2,721.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,748.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,488.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,839.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,775.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,963.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,934.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.95
|
| Rate for Payer: PHCS Commercial |
$7,596.23
|
| Rate for Payer: United Healthcare All Payer |
$6,963.21
|
|
|
PLUS PROMOS BODY 30MM
|
Facility
|
OP
|
$7,390.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$960.80 |
| Max. Negotiated Rate |
$7,095.16 |
| Rate for Payer: Aetna Commercial |
$5,690.91
|
| Rate for Payer: Anthem Medicaid |
$2,541.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,764.82
|
| Rate for Payer: Cash Price |
$3,695.39
|
| Rate for Payer: Cigna Commercial |
$6,134.36
|
| Rate for Payer: First Health Commercial |
$7,021.25
|
| Rate for Payer: Humana Commercial |
$6,282.17
|
| Rate for Payer: Humana KY Medicaid |
$2,541.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,567.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,060.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,454.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,217.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,592.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,503.90
|
| Rate for Payer: Ohio Health Group HMO |
$5,543.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,478.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$960.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,291.14
|
| Rate for Payer: PHCS Commercial |
$7,095.16
|
| Rate for Payer: United Healthcare All Payer |
$6,503.90
|
|
|
PLUS PROMOS BODY 30MM
|
Facility
|
IP
|
$7,390.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$960.80 |
| Max. Negotiated Rate |
$7,095.16 |
| Rate for Payer: Aetna Commercial |
$5,690.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,764.82
|
| Rate for Payer: Cash Price |
$3,695.39
|
| Rate for Payer: Cigna Commercial |
$6,134.36
|
| Rate for Payer: First Health Commercial |
$7,021.25
|
| Rate for Payer: Humana Commercial |
$6,282.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,060.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,454.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,217.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,503.90
|
| Rate for Payer: Ohio Health Group HMO |
$5,543.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,478.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$960.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,291.14
|
| Rate for Payer: PHCS Commercial |
$7,095.16
|
| Rate for Payer: United Healthcare All Payer |
$6,503.90
|
|
|
PLUS PROMOS BODY 35MM
|
Facility
|
IP
|
$8,822.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,146.92 |
| Max. Negotiated Rate |
$8,469.60 |
| Rate for Payer: Aetna Commercial |
$6,793.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,881.55
|
| Rate for Payer: Cash Price |
$4,411.25
|
| Rate for Payer: Cigna Commercial |
$7,322.68
|
| Rate for Payer: First Health Commercial |
$8,381.38
|
| Rate for Payer: Humana Commercial |
$7,499.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,234.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,511.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,646.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,763.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,616.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,764.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,146.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,734.98
|
| Rate for Payer: PHCS Commercial |
$8,469.60
|
| Rate for Payer: United Healthcare All Payer |
$7,763.80
|
|
|
PLUS PROMOS BODY 35MM
|
Facility
|
OP
|
$8,822.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,146.92 |
| Max. Negotiated Rate |
$8,469.60 |
| Rate for Payer: Aetna Commercial |
$6,793.32
|
| Rate for Payer: Anthem Medicaid |
$3,034.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,881.55
|
| Rate for Payer: Cash Price |
$4,411.25
|
| Rate for Payer: Cigna Commercial |
$7,322.68
|
| Rate for Payer: First Health Commercial |
$8,381.38
|
| Rate for Payer: Humana Commercial |
$7,499.12
|
| Rate for Payer: Humana KY Medicaid |
$3,034.06
|
| Rate for Payer: Kentucky WC Medicaid |
$3,064.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,234.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,511.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,646.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,094.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,763.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,616.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,764.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,146.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,734.98
|
| Rate for Payer: PHCS Commercial |
$8,469.60
|
| Rate for Payer: United Healthcare All Payer |
$7,763.80
|
|
|
PLUS PROMOS BODY 40MM
|
Facility
|
OP
|
$8,822.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,146.92 |
| Max. Negotiated Rate |
$8,469.60 |
| Rate for Payer: Aetna Commercial |
$6,793.32
|
| Rate for Payer: Anthem Medicaid |
$3,034.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,881.55
|
| Rate for Payer: Cash Price |
$4,411.25
|
| Rate for Payer: Cigna Commercial |
$7,322.68
|
| Rate for Payer: First Health Commercial |
$8,381.38
|
| Rate for Payer: Humana Commercial |
$7,499.12
|
| Rate for Payer: Humana KY Medicaid |
$3,034.06
|
| Rate for Payer: Kentucky WC Medicaid |
$3,064.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,234.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,511.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,646.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,094.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,763.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,616.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,764.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,146.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,734.98
|
| Rate for Payer: PHCS Commercial |
$8,469.60
|
| Rate for Payer: United Healthcare All Payer |
$7,763.80
|
|
|
PLUS PROMOS BODY 40MM
|
Facility
|
IP
|
$8,822.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,146.92 |
| Max. Negotiated Rate |
$8,469.60 |
| Rate for Payer: Aetna Commercial |
$6,793.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,881.55
|
| Rate for Payer: Cash Price |
$4,411.25
|
| Rate for Payer: Cigna Commercial |
$7,322.68
|
| Rate for Payer: First Health Commercial |
$8,381.38
|
| Rate for Payer: Humana Commercial |
$7,499.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,234.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,511.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,646.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,763.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,616.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,764.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,146.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,734.98
|
| Rate for Payer: PHCS Commercial |
$8,469.60
|
| Rate for Payer: United Healthcare All Payer |
$7,763.80
|
|
|
PLUS PROMOS GLENO CENTRC 36/+5
|
Facility
|
OP
|
$11,081.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,440.63 |
| Max. Negotiated Rate |
$10,638.53 |
| Rate for Payer: Aetna Commercial |
$8,532.99
|
| Rate for Payer: Anthem Medicaid |
$3,811.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,643.80
|
| Rate for Payer: Cash Price |
$5,540.90
|
| Rate for Payer: Cigna Commercial |
$9,197.89
|
| Rate for Payer: First Health Commercial |
$10,527.71
|
| Rate for Payer: Humana Commercial |
$9,419.53
|
| Rate for Payer: Humana KY Medicaid |
$3,811.03
|
| Rate for Payer: Kentucky WC Medicaid |
$3,849.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,087.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,178.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,324.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,887.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,751.98
|
| Rate for Payer: Ohio Health Group HMO |
$8,311.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,216.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,440.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,435.36
|
| Rate for Payer: PHCS Commercial |
$10,638.53
|
| Rate for Payer: United Healthcare All Payer |
$9,751.98
|
|
|
PLUS PROMOS GLENO CENTRC 36/+5
|
Facility
|
IP
|
$11,081.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,440.63 |
| Max. Negotiated Rate |
$10,638.53 |
| Rate for Payer: Aetna Commercial |
$8,532.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,643.80
|
| Rate for Payer: Cash Price |
$5,540.90
|
| Rate for Payer: Cigna Commercial |
$9,197.89
|
| Rate for Payer: First Health Commercial |
$10,527.71
|
| Rate for Payer: Humana Commercial |
$9,419.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,087.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,178.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,324.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,751.98
|
| Rate for Payer: Ohio Health Group HMO |
$8,311.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,216.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,440.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,435.36
|
| Rate for Payer: PHCS Commercial |
$10,638.53
|
| Rate for Payer: United Healthcare All Payer |
$9,751.98
|
|
|
PLUS PROMOS GLENO CENTRC 42/+5
|
Facility
|
IP
|
$11,831.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,538.14 |
| Max. Negotiated Rate |
$11,358.60 |
| Rate for Payer: Aetna Commercial |
$9,110.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,228.87
|
| Rate for Payer: Cash Price |
$5,915.94
|
| Rate for Payer: Cigna Commercial |
$9,820.46
|
| Rate for Payer: First Health Commercial |
$11,240.29
|
| Rate for Payer: Humana Commercial |
$10,057.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,702.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,731.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,549.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,412.05
|
| Rate for Payer: Ohio Health Group HMO |
$8,873.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,366.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,538.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,667.88
|
| Rate for Payer: PHCS Commercial |
$11,358.60
|
| Rate for Payer: United Healthcare All Payer |
$10,412.05
|
|
|
PLUS PROMOS GLENO CENTRC 42/+5
|
Facility
|
OP
|
$11,831.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,538.14 |
| Max. Negotiated Rate |
$11,358.60 |
| Rate for Payer: Aetna Commercial |
$9,110.55
|
| Rate for Payer: Anthem Medicaid |
$4,068.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,228.87
|
| Rate for Payer: Cash Price |
$5,915.94
|
| Rate for Payer: Cigna Commercial |
$9,820.46
|
| Rate for Payer: First Health Commercial |
$11,240.29
|
| Rate for Payer: Humana Commercial |
$10,057.10
|
| Rate for Payer: Humana KY Medicaid |
$4,068.98
|
| Rate for Payer: Kentucky WC Medicaid |
$4,110.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,702.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,731.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,549.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,150.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,412.05
|
| Rate for Payer: Ohio Health Group HMO |
$8,873.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,366.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,538.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,667.88
|
| Rate for Payer: PHCS Commercial |
$11,358.60
|
| Rate for Payer: United Healthcare All Payer |
$10,412.05
|
|
|
PLUS PROMOS GLENO CENTRIC 36
|
Facility
|
IP
|
$13,337.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,733.88 |
| Max. Negotiated Rate |
$12,804.00 |
| Rate for Payer: Aetna Commercial |
$10,269.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,403.25
|
| Rate for Payer: Cash Price |
$6,668.75
|
| Rate for Payer: Cigna Commercial |
$11,070.12
|
| Rate for Payer: First Health Commercial |
$12,670.62
|
| Rate for Payer: Humana Commercial |
$11,336.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,936.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,843.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,001.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,737.00
|
| Rate for Payer: Ohio Health Group HMO |
$10,003.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,667.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,733.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,134.62
|
| Rate for Payer: PHCS Commercial |
$12,804.00
|
| Rate for Payer: United Healthcare All Payer |
$11,737.00
|
|
|
PLUS PROMOS GLENO CENTRIC 36
|
Facility
|
OP
|
$13,337.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,733.88 |
| Max. Negotiated Rate |
$12,804.00 |
| Rate for Payer: Aetna Commercial |
$10,269.88
|
| Rate for Payer: Anthem Medicaid |
$4,586.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,403.25
|
| Rate for Payer: Cash Price |
$6,668.75
|
| Rate for Payer: Cigna Commercial |
$11,070.12
|
| Rate for Payer: First Health Commercial |
$12,670.62
|
| Rate for Payer: Humana Commercial |
$11,336.88
|
| Rate for Payer: Humana KY Medicaid |
$4,586.77
|
| Rate for Payer: Kentucky WC Medicaid |
$4,633.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,936.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,843.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,001.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,678.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,737.00
|
| Rate for Payer: Ohio Health Group HMO |
$10,003.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,667.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,733.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,134.62
|
| Rate for Payer: PHCS Commercial |
$12,804.00
|
| Rate for Payer: United Healthcare All Payer |
$11,737.00
|
|
|
PLUS PROMOS GLENO CENTRIC 42
|
Facility
|
IP
|
$13,337.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,733.88 |
| Max. Negotiated Rate |
$12,804.00 |
| Rate for Payer: Aetna Commercial |
$10,269.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,403.25
|
| Rate for Payer: Cash Price |
$6,668.75
|
| Rate for Payer: Cigna Commercial |
$11,070.12
|
| Rate for Payer: First Health Commercial |
$12,670.62
|
| Rate for Payer: Humana Commercial |
$11,336.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,936.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,843.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,001.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,737.00
|
| Rate for Payer: Ohio Health Group HMO |
$10,003.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,667.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,733.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,134.62
|
| Rate for Payer: PHCS Commercial |
$12,804.00
|
| Rate for Payer: United Healthcare All Payer |
$11,737.00
|
|
|
PLUS PROMOS GLENO CENTRIC 42
|
Facility
|
OP
|
$13,337.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,733.88 |
| Max. Negotiated Rate |
$12,804.00 |
| Rate for Payer: Aetna Commercial |
$10,269.88
|
| Rate for Payer: Anthem Medicaid |
$4,586.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,403.25
|
| Rate for Payer: Cash Price |
$6,668.75
|
| Rate for Payer: Cigna Commercial |
$11,070.12
|
| Rate for Payer: First Health Commercial |
$12,670.62
|
| Rate for Payer: Humana Commercial |
$11,336.88
|
| Rate for Payer: Humana KY Medicaid |
$4,586.77
|
| Rate for Payer: Kentucky WC Medicaid |
$4,633.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,936.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,843.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,001.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,678.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,737.00
|
| Rate for Payer: Ohio Health Group HMO |
$10,003.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,667.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,733.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,134.62
|
| Rate for Payer: PHCS Commercial |
$12,804.00
|
| Rate for Payer: United Healthcare All Payer |
$11,737.00
|
|
|
PLUS PROMOS GLENO CENTRIC-42
|
Facility
|
IP
|
$11,081.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,440.63 |
| Max. Negotiated Rate |
$10,638.53 |
| Rate for Payer: Aetna Commercial |
$8,532.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,643.80
|
| Rate for Payer: Cash Price |
$5,540.90
|
| Rate for Payer: Cigna Commercial |
$9,197.89
|
| Rate for Payer: First Health Commercial |
$10,527.71
|
| Rate for Payer: Humana Commercial |
$9,419.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,087.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,178.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,324.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,751.98
|
| Rate for Payer: Ohio Health Group HMO |
$8,311.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,216.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,440.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,435.36
|
| Rate for Payer: PHCS Commercial |
$10,638.53
|
| Rate for Payer: United Healthcare All Payer |
$9,751.98
|
|
