|
PLUS PROMOS HUM HD R 25/+7
|
Facility
|
OP
|
$9,753.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,267.92 |
| Max. Negotiated Rate |
$9,363.12 |
| Rate for Payer: Aetna Commercial |
$7,510.00
|
| Rate for Payer: Anthem Medicaid |
$3,354.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,607.54
|
| Rate for Payer: Cash Price |
$4,876.62
|
| Rate for Payer: Cigna Commercial |
$8,095.20
|
| Rate for Payer: First Health Commercial |
$9,265.59
|
| Rate for Payer: Humana Commercial |
$8,290.26
|
| Rate for Payer: Humana KY Medicaid |
$3,354.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,388.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,997.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,197.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,925.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,421.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,582.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,314.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,950.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,267.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,023.51
|
| Rate for Payer: PHCS Commercial |
$9,363.12
|
| Rate for Payer: United Healthcare All Payer |
$8,582.86
|
|
|
PLUS PROMOS HUM HD R 25/H21+4
|
Facility
|
OP
|
$9,753.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,267.92 |
| Max. Negotiated Rate |
$9,363.12 |
| Rate for Payer: Aetna Commercial |
$7,510.00
|
| Rate for Payer: Anthem Medicaid |
$3,354.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,607.54
|
| Rate for Payer: Cash Price |
$4,876.62
|
| Rate for Payer: Cigna Commercial |
$8,095.20
|
| Rate for Payer: First Health Commercial |
$9,265.59
|
| Rate for Payer: Humana Commercial |
$8,290.26
|
| Rate for Payer: Humana KY Medicaid |
$3,354.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,388.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,997.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,197.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,925.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,421.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,582.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,314.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,950.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,267.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,023.51
|
| Rate for Payer: PHCS Commercial |
$9,363.12
|
| Rate for Payer: United Healthcare All Payer |
$8,582.86
|
|
|
PLUS PROMOS HUM HD R 25/H21+4
|
Facility
|
IP
|
$9,753.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,267.92 |
| Max. Negotiated Rate |
$9,363.12 |
| Rate for Payer: Aetna Commercial |
$7,510.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,607.54
|
| Rate for Payer: Cash Price |
$4,876.62
|
| Rate for Payer: Cigna Commercial |
$8,095.20
|
| Rate for Payer: First Health Commercial |
$9,265.59
|
| Rate for Payer: Humana Commercial |
$8,290.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,997.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,197.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,925.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,582.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,314.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,950.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,267.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,023.51
|
| Rate for Payer: PHCS Commercial |
$9,363.12
|
| Rate for Payer: United Healthcare All Payer |
$8,582.86
|
|
|
PLUS PROMOS HUM HD R 26/+7
|
Facility
|
OP
|
$9,753.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,267.92 |
| Max. Negotiated Rate |
$9,363.12 |
| Rate for Payer: Aetna Commercial |
$7,510.00
|
| Rate for Payer: Anthem Medicaid |
$3,354.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,607.54
|
| Rate for Payer: Cash Price |
$4,876.62
|
| Rate for Payer: Cigna Commercial |
$8,095.20
|
| Rate for Payer: First Health Commercial |
$9,265.59
|
| Rate for Payer: Humana Commercial |
$8,290.26
|
| Rate for Payer: Humana KY Medicaid |
$3,354.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,388.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,997.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,197.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,925.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,421.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,582.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,314.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,950.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,267.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,023.51
|
| Rate for Payer: PHCS Commercial |
$9,363.12
|
| Rate for Payer: United Healthcare All Payer |
$8,582.86
|
|
|
PLUS PROMOS HUM HD R 26/+7
|
Facility
|
IP
|
$9,753.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,267.92 |
| Max. Negotiated Rate |
$9,363.12 |
| Rate for Payer: Aetna Commercial |
$7,510.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,607.54
|
| Rate for Payer: Cash Price |
$4,876.62
|
| Rate for Payer: Cigna Commercial |
$8,095.20
|
| Rate for Payer: First Health Commercial |
$9,265.59
|
| Rate for Payer: Humana Commercial |
$8,290.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,997.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,197.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,925.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,582.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,314.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,950.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,267.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,023.51
|
| Rate for Payer: PHCS Commercial |
$9,363.12
|
| Rate for Payer: United Healthcare All Payer |
$8,582.86
|
|
|
PLUS PROMOS HUM HD R 26/H21+4
|
Facility
|
OP
|
$9,753.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,267.92 |
| Max. Negotiated Rate |
$9,363.12 |
| Rate for Payer: Aetna Commercial |
$7,510.00
|
| Rate for Payer: Anthem Medicaid |
$3,354.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,607.54
|
| Rate for Payer: Cash Price |
$4,876.62
|
| Rate for Payer: Cigna Commercial |
$8,095.20
|
| Rate for Payer: First Health Commercial |
$9,265.59
|
| Rate for Payer: Humana Commercial |
$8,290.26
|
| Rate for Payer: Humana KY Medicaid |
$3,354.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,388.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,997.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,197.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,925.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,421.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,582.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,314.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,950.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,267.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,023.51
|
| Rate for Payer: PHCS Commercial |
$9,363.12
|
| Rate for Payer: United Healthcare All Payer |
$8,582.86
|
|
|
PLUS PROMOS HUM HD R 26/H21+4
|
Facility
|
IP
|
$9,753.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,267.92 |
| Max. Negotiated Rate |
$9,363.12 |
| Rate for Payer: Aetna Commercial |
$7,510.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,607.54
|
| Rate for Payer: Cash Price |
$4,876.62
|
| Rate for Payer: Cigna Commercial |
$8,095.20
|
| Rate for Payer: First Health Commercial |
$9,265.59
|
| Rate for Payer: Humana Commercial |
$8,290.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,997.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,197.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,925.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,582.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,314.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,950.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,267.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,023.51
|
| Rate for Payer: PHCS Commercial |
$9,363.12
|
| Rate for Payer: United Healthcare All Payer |
$8,582.86
|
|
|
PLUS PROMOS HUM HD R 26/H21+6
|
Facility
|
OP
|
$9,753.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,267.92 |
| Max. Negotiated Rate |
$9,363.12 |
| Rate for Payer: Aetna Commercial |
$7,510.00
|
| Rate for Payer: Anthem Medicaid |
$3,354.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,607.54
|
| Rate for Payer: Cash Price |
$4,876.62
|
| Rate for Payer: Cigna Commercial |
$8,095.20
|
| Rate for Payer: First Health Commercial |
$9,265.59
|
| Rate for Payer: Humana Commercial |
$8,290.26
|
| Rate for Payer: Humana KY Medicaid |
$3,354.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,388.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,997.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,197.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,925.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,421.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,582.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,314.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,950.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,267.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,023.51
|
| Rate for Payer: PHCS Commercial |
$9,363.12
|
| Rate for Payer: United Healthcare All Payer |
$8,582.86
|
|
|
PLUS PROMOS HUM HD R 26/H21+6
|
Facility
|
IP
|
$9,753.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,267.92 |
| Max. Negotiated Rate |
$9,363.12 |
| Rate for Payer: Aetna Commercial |
$7,510.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,607.54
|
| Rate for Payer: Cash Price |
$4,876.62
|
| Rate for Payer: Cigna Commercial |
$8,095.20
|
| Rate for Payer: First Health Commercial |
$9,265.59
|
| Rate for Payer: Humana Commercial |
$8,290.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,997.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,197.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,925.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,582.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,314.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,950.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,267.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,023.51
|
| Rate for Payer: PHCS Commercial |
$9,363.12
|
| Rate for Payer: United Healthcare All Payer |
$8,582.86
|
|
|
PLUS PROMOS HUM HD R 27/+7
|
Facility
|
OP
|
$8,221.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,068.75 |
| Max. Negotiated Rate |
$7,892.31 |
| Rate for Payer: Aetna Commercial |
$6,330.29
|
| Rate for Payer: Anthem Medicaid |
$2,827.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,412.50
|
| Rate for Payer: Cash Price |
$4,110.58
|
| Rate for Payer: Cigna Commercial |
$6,823.56
|
| Rate for Payer: First Health Commercial |
$7,810.10
|
| Rate for Payer: Humana Commercial |
$6,987.99
|
| Rate for Payer: Humana KY Medicaid |
$2,827.26
|
| Rate for Payer: Kentucky WC Medicaid |
$2,856.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,741.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,067.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,466.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,883.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,234.62
|
| Rate for Payer: Ohio Health Group HMO |
$6,165.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,644.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,068.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,548.56
|
| Rate for Payer: PHCS Commercial |
$7,892.31
|
| Rate for Payer: United Healthcare All Payer |
$7,234.62
|
|
|
PLUS PROMOS HUM HD R 27/+7
|
Facility
|
IP
|
$8,221.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,068.75 |
| Max. Negotiated Rate |
$7,892.31 |
| Rate for Payer: Aetna Commercial |
$6,330.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,412.50
|
| Rate for Payer: Cash Price |
$4,110.58
|
| Rate for Payer: Cigna Commercial |
$6,823.56
|
| Rate for Payer: First Health Commercial |
$7,810.10
|
| Rate for Payer: Humana Commercial |
$6,987.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,741.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,067.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,466.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,234.62
|
| Rate for Payer: Ohio Health Group HMO |
$6,165.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,644.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,068.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,548.56
|
| Rate for Payer: PHCS Commercial |
$7,892.31
|
| Rate for Payer: United Healthcare All Payer |
$7,234.62
|
|
|
PLUS PROMOS HUM HD R 28/H16+7
|
Facility
|
IP
|
$9,753.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,267.92 |
| Max. Negotiated Rate |
$9,363.12 |
| Rate for Payer: Aetna Commercial |
$7,510.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,607.54
|
| Rate for Payer: Cash Price |
$4,876.62
|
| Rate for Payer: Cigna Commercial |
$8,095.20
|
| Rate for Payer: First Health Commercial |
$9,265.59
|
| Rate for Payer: Humana Commercial |
$8,290.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,997.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,197.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,925.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,582.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,314.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,950.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,267.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,023.51
|
| Rate for Payer: PHCS Commercial |
$9,363.12
|
| Rate for Payer: United Healthcare All Payer |
$8,582.86
|
|
|
PLUS PROMOS HUM HD R 28/H16+7
|
Facility
|
OP
|
$9,753.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,267.92 |
| Max. Negotiated Rate |
$9,363.12 |
| Rate for Payer: Aetna Commercial |
$7,510.00
|
| Rate for Payer: Anthem Medicaid |
$3,354.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,607.54
|
| Rate for Payer: Cash Price |
$4,876.62
|
| Rate for Payer: Cigna Commercial |
$8,095.20
|
| Rate for Payer: First Health Commercial |
$9,265.59
|
| Rate for Payer: Humana Commercial |
$8,290.26
|
| Rate for Payer: Humana KY Medicaid |
$3,354.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,388.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,997.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,197.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,925.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,421.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,582.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,314.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,950.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,267.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,023.51
|
| Rate for Payer: PHCS Commercial |
$9,363.12
|
| Rate for Payer: United Healthcare All Payer |
$8,582.86
|
|
|
PLUS PROMOS HUM STEM 0
|
Facility
|
OP
|
$8,275.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.87 |
| Max. Negotiated Rate |
$7,944.87 |
| Rate for Payer: Aetna Commercial |
$6,372.45
|
| Rate for Payer: Anthem Medicaid |
$2,846.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,455.21
|
| Rate for Payer: Cash Price |
$4,137.96
|
| Rate for Payer: Cigna Commercial |
$6,869.01
|
| Rate for Payer: First Health Commercial |
$7,862.11
|
| Rate for Payer: Humana Commercial |
$7,034.52
|
| Rate for Payer: Humana KY Medicaid |
$2,846.09
|
| Rate for Payer: Kentucky WC Medicaid |
$2,875.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,786.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,107.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,903.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.53
|
| Rate for Payer: PHCS Commercial |
$7,944.87
|
| Rate for Payer: United Healthcare All Payer |
$7,282.80
|
|
|
PLUS PROMOS HUM STEM 0
|
Facility
|
IP
|
$8,275.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.87 |
| Max. Negotiated Rate |
$7,944.87 |
| Rate for Payer: Aetna Commercial |
$6,372.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,455.21
|
| Rate for Payer: Cash Price |
$4,137.96
|
| Rate for Payer: Cigna Commercial |
$6,869.01
|
| Rate for Payer: First Health Commercial |
$7,862.11
|
| Rate for Payer: Humana Commercial |
$7,034.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,786.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,107.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.53
|
| Rate for Payer: PHCS Commercial |
$7,944.87
|
| Rate for Payer: United Healthcare All Payer |
$7,282.80
|
|
|
PLUS PROMOS HUM STEM 01
|
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 PROMOS HUM STEM 01
|
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 HUM STEM 1.5
|
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 HUM STEM 1.5
|
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 PROMOS HUM STEM 2
|
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 PROMOS HUM STEM 2
|
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 HUM STEM 2.5
|
Facility
|
IP
|
$7,289.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$947.64 |
| Max. Negotiated Rate |
$6,997.92 |
| Rate for Payer: Aetna Commercial |
$5,612.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,685.81
|
| Rate for Payer: Cash Price |
$3,644.75
|
| Rate for Payer: Cigna Commercial |
$6,050.28
|
| Rate for Payer: First Health Commercial |
$6,925.02
|
| Rate for Payer: Humana Commercial |
$6,196.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,977.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,379.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,186.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,414.76
|
| Rate for Payer: Ohio Health Group HMO |
$5,467.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,457.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$947.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,259.74
|
| Rate for Payer: PHCS Commercial |
$6,997.92
|
| Rate for Payer: United Healthcare All Payer |
$6,414.76
|
|
|
PLUS PROMOS HUM STEM 2.5
|
Facility
|
OP
|
$7,289.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$947.64 |
| Max. Negotiated Rate |
$6,997.92 |
| Rate for Payer: Aetna Commercial |
$5,612.92
|
| Rate for Payer: Anthem Medicaid |
$2,506.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,685.81
|
| Rate for Payer: Cash Price |
$3,644.75
|
| Rate for Payer: Cigna Commercial |
$6,050.28
|
| Rate for Payer: First Health Commercial |
$6,925.02
|
| Rate for Payer: Humana Commercial |
$6,196.08
|
| Rate for Payer: Humana KY Medicaid |
$2,506.86
|
| Rate for Payer: Kentucky WC Medicaid |
$2,532.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,977.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,379.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,186.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,557.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,414.76
|
| Rate for Payer: Ohio Health Group HMO |
$5,467.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,457.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$947.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,259.74
|
| Rate for Payer: PHCS Commercial |
$6,997.92
|
| Rate for Payer: United Healthcare All Payer |
$6,414.76
|
|
|
PLUS PROMOS HUM STEM 3
|
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 HUM STEM 3
|
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
|
|
