|
PREPARE DONOR LUNG SINGLE
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 32855
|
| Hospital Charge Code |
76101234
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.24 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,500.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Healthspan PPO |
$264.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$265.18
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,050.00
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
|
|
PREPARE DONOR LUNG SINGLE
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 32855
|
| Hospital Charge Code |
76101234
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
PREPARE DONOR LUNG SINGLE(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 32855
|
| Hospital Charge Code |
761P1234
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.24 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,500.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Healthspan PPO |
$264.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$265.18
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,050.00
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
|
|
PRE PEN 0.25ML AMPUL
|
Facility
|
OP
|
$590.40
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003370
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.75 |
| Max. Negotiated Rate |
$566.78 |
| Rate for Payer: Aetna Commercial |
$454.61
|
| Rate for Payer: Anthem Medicaid |
$203.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$460.51
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cigna Commercial |
$490.03
|
| Rate for Payer: First Health Commercial |
$560.88
|
| Rate for Payer: Humana Commercial |
$501.84
|
| Rate for Payer: Humana KY Medicaid |
$203.04
|
| Rate for Payer: Kentucky WC Medicaid |
$205.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$484.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$435.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$207.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$519.55
|
| Rate for Payer: Ohio Health Group HMO |
$442.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$118.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$183.02
|
| Rate for Payer: PHCS Commercial |
$566.78
|
| Rate for Payer: United Healthcare All Payer |
$519.55
|
|
|
PRE PEN 0.25ML AMPUL
|
Facility
|
IP
|
$590.40
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003370
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.75 |
| Max. Negotiated Rate |
$566.78 |
| Rate for Payer: Aetna Commercial |
$454.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$460.51
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cigna Commercial |
$490.03
|
| Rate for Payer: First Health Commercial |
$560.88
|
| Rate for Payer: Humana Commercial |
$501.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$484.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$435.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$519.55
|
| Rate for Payer: Ohio Health Group HMO |
$442.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$118.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$183.02
|
| Rate for Payer: PHCS Commercial |
$566.78
|
| Rate for Payer: United Healthcare All Payer |
$519.55
|
|
|
PREP FECAL MICROB INSTILLATION
|
Facility
|
OP
|
$1,532.20
|
|
|
Service Code
|
HCPCS 44705
|
| Hospital Charge Code |
76101863
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$199.19 |
| Max. Negotiated Rate |
$1,470.91 |
| Rate for Payer: Aetna Commercial |
$1,179.79
|
| Rate for Payer: Anthem Medicaid |
$526.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,195.12
|
| Rate for Payer: Cash Price |
$766.10
|
| Rate for Payer: Cigna Commercial |
$1,271.73
|
| Rate for Payer: First Health Commercial |
$1,455.59
|
| Rate for Payer: Humana Commercial |
$1,302.37
|
| Rate for Payer: Humana KY Medicaid |
$526.92
|
| Rate for Payer: Kentucky WC Medicaid |
$532.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,256.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,130.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$459.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$537.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,348.34
|
| Rate for Payer: Ohio Health Group HMO |
$1,149.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$306.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$474.98
|
| Rate for Payer: PHCS Commercial |
$1,470.91
|
| Rate for Payer: United Healthcare All Payer |
$1,348.34
|
|
|
PREP FECAL MICROB INSTILLATION
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 44705
|
| Hospital Charge Code |
761P1863
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Anthem Medicaid |
$59.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$59.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$101.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$60.19
|
| Rate for Payer: Molina Healthcare Passport |
$59.01
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.60
|
|
|
PREP FECAL MICROB INSTILLATION
|
Facility
|
OP
|
$1,357.20
|
|
|
Service Code
|
HCPCS 44705
|
| Hospital Charge Code |
761T1863
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$176.44 |
| Max. Negotiated Rate |
$1,302.91 |
| Rate for Payer: Aetna Commercial |
$1,045.04
|
| Rate for Payer: Anthem Medicaid |
$466.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,058.62
|
| Rate for Payer: Cash Price |
$678.60
|
| Rate for Payer: Cigna Commercial |
$1,126.48
|
| Rate for Payer: First Health Commercial |
$1,289.34
|
| Rate for Payer: Humana Commercial |
$1,153.62
|
| Rate for Payer: Humana KY Medicaid |
$466.74
|
| Rate for Payer: Kentucky WC Medicaid |
$471.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,112.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,001.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$407.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$476.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,194.34
|
| Rate for Payer: Ohio Health Group HMO |
$1,017.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$271.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$176.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$420.73
|
| Rate for Payer: PHCS Commercial |
$1,302.91
|
| Rate for Payer: United Healthcare All Payer |
$1,194.34
|
|
|
PREP FECAL MICROB INSTILLATION
|
Professional
|
Both
|
$1,532.20
|
|
|
Service Code
|
HCPCS 44705
|
| Hospital Charge Code |
76101863
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,532.20 |
| Rate for Payer: Anthem Medicaid |
$59.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,532.20
|
| Rate for Payer: Cash Price |
$766.10
|
| Rate for Payer: Cash Price |
$766.10
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$59.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$101.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$60.19
|
| Rate for Payer: Molina Healthcare Passport |
$59.01
|
| Rate for Payer: Multiplan PHCS |
$919.32
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,072.54
|
| Rate for Payer: UHCCP Medicaid |
$536.27
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.60
|
|
|
PREP FECAL MICROB INSTILLATION
|
Facility
|
IP
|
$1,357.20
|
|
|
Service Code
|
HCPCS 44705
|
| Hospital Charge Code |
761T1863
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$176.44 |
| Max. Negotiated Rate |
$1,302.91 |
| Rate for Payer: Aetna Commercial |
$1,045.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,058.62
|
| Rate for Payer: Cash Price |
$678.60
|
| Rate for Payer: Cigna Commercial |
$1,126.48
|
| Rate for Payer: First Health Commercial |
$1,289.34
|
| Rate for Payer: Humana Commercial |
$1,153.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,112.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,001.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$407.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,194.34
|
| Rate for Payer: Ohio Health Group HMO |
$1,017.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$271.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$176.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$420.73
|
| Rate for Payer: PHCS Commercial |
$1,302.91
|
| Rate for Payer: United Healthcare All Payer |
$1,194.34
|
|
|
PREP FECAL MICROB INSTILLATION
|
Facility
|
IP
|
$1,532.20
|
|
|
Service Code
|
HCPCS 44705
|
| Hospital Charge Code |
76101863
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$199.19 |
| Max. Negotiated Rate |
$1,470.91 |
| Rate for Payer: Aetna Commercial |
$1,179.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,195.12
|
| Rate for Payer: Cash Price |
$766.10
|
| Rate for Payer: Cigna Commercial |
$1,271.73
|
| Rate for Payer: First Health Commercial |
$1,455.59
|
| Rate for Payer: Humana Commercial |
$1,302.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,256.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,130.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$459.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,348.34
|
| Rate for Payer: Ohio Health Group HMO |
$1,149.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$306.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$474.98
|
| Rate for Payer: PHCS Commercial |
$1,470.91
|
| Rate for Payer: United Healthcare All Payer |
$1,348.34
|
|
|
PREPIDIL (DINOPROSTON .5MG/1EA
|
Facility
|
IP
|
$965.90
|
|
|
Service Code
|
NDC 9335901
|
| Hospital Charge Code |
25001223
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.57 |
| Max. Negotiated Rate |
$927.26 |
| Rate for Payer: Aetna Commercial |
$743.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$753.40
|
| Rate for Payer: Cash Price |
$482.95
|
| Rate for Payer: Cigna Commercial |
$801.70
|
| Rate for Payer: First Health Commercial |
$917.60
|
| Rate for Payer: Humana Commercial |
$821.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$792.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$712.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$289.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$849.99
|
| Rate for Payer: Ohio Health Group HMO |
$724.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$193.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$125.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$299.43
|
| Rate for Payer: PHCS Commercial |
$927.26
|
| Rate for Payer: United Healthcare All Payer |
$849.99
|
|
|
PREPIDIL (DINOPROSTON .5MG/1EA
|
Facility
|
OP
|
$965.90
|
|
|
Service Code
|
NDC 9335901
|
| Hospital Charge Code |
25001223
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.57 |
| Max. Negotiated Rate |
$927.26 |
| Rate for Payer: Aetna Commercial |
$743.74
|
| Rate for Payer: Anthem Medicaid |
$332.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$753.40
|
| Rate for Payer: Cash Price |
$482.95
|
| Rate for Payer: Cigna Commercial |
$801.70
|
| Rate for Payer: First Health Commercial |
$917.60
|
| Rate for Payer: Humana Commercial |
$821.02
|
| Rate for Payer: Humana KY Medicaid |
$332.17
|
| Rate for Payer: Kentucky WC Medicaid |
$335.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$792.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$712.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$289.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$338.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$849.99
|
| Rate for Payer: Ohio Health Group HMO |
$724.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$193.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$125.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$299.43
|
| Rate for Payer: PHCS Commercial |
$927.26
|
| Rate for Payer: United Healthcare All Payer |
$849.99
|
|
|
PREP IM ENCHANCE TOT HIP KIT
|
Facility
|
OP
|
$2,099.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$272.87 |
| Max. Negotiated Rate |
$2,015.04 |
| Rate for Payer: United Healthcare All Payer |
$1,847.12
|
| Rate for Payer: Aetna Commercial |
$1,616.23
|
| Rate for Payer: Anthem Medicaid |
$721.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,637.22
|
| Rate for Payer: Cash Price |
$1,049.50
|
| Rate for Payer: Cigna Commercial |
$1,742.17
|
| Rate for Payer: First Health Commercial |
$1,994.05
|
| Rate for Payer: Humana Commercial |
$1,784.15
|
| Rate for Payer: Humana KY Medicaid |
$721.85
|
| Rate for Payer: Kentucky WC Medicaid |
$729.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,721.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$629.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$736.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,847.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,574.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$419.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$272.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$650.69
|
| Rate for Payer: PHCS Commercial |
$2,015.04
|
|
|
PREP IM ENCHANCE TOT HIP KIT
|
Facility
|
IP
|
$2,099.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$272.87 |
| Max. Negotiated Rate |
$2,015.04 |
| Rate for Payer: Aetna Commercial |
$1,616.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,637.22
|
| Rate for Payer: Cash Price |
$1,049.50
|
| Rate for Payer: Cigna Commercial |
$1,742.17
|
| Rate for Payer: First Health Commercial |
$1,994.05
|
| Rate for Payer: Humana Commercial |
$1,784.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,721.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$629.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,847.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,574.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$419.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$272.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$650.69
|
| Rate for Payer: PHCS Commercial |
$2,015.04
|
| Rate for Payer: United Healthcare All Payer |
$1,847.12
|
|
|
PRESERVATION MB INSRT S1 9.5MM
|
Facility
|
OP
|
$5,551.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$721.71 |
| Max. Negotiated Rate |
$5,329.54 |
| Rate for Payer: Aetna Commercial |
$4,274.73
|
| Rate for Payer: Anthem Medicaid |
$1,909.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,330.25
|
| Rate for Payer: Cash Price |
$2,775.80
|
| Rate for Payer: Cigna Commercial |
$4,607.83
|
| Rate for Payer: First Health Commercial |
$5,274.02
|
| Rate for Payer: Humana Commercial |
$4,718.86
|
| Rate for Payer: Humana KY Medicaid |
$1,909.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,928.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,552.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,097.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,665.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,947.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,885.41
|
| Rate for Payer: Ohio Health Group HMO |
$4,163.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,110.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$721.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,721.00
|
| Rate for Payer: PHCS Commercial |
$5,329.54
|
| Rate for Payer: United Healthcare All Payer |
$4,885.41
|
|
|
PRESERVATION MB INSRT S1 9.5MM
|
Facility
|
IP
|
$5,551.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$721.71 |
| Max. Negotiated Rate |
$5,329.54 |
| Rate for Payer: Aetna Commercial |
$4,274.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,330.25
|
| Rate for Payer: Cash Price |
$2,775.80
|
| Rate for Payer: Cigna Commercial |
$4,607.83
|
| Rate for Payer: First Health Commercial |
$5,274.02
|
| Rate for Payer: Humana Commercial |
$4,718.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,552.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,097.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,665.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,885.41
|
| Rate for Payer: Ohio Health Group HMO |
$4,163.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,110.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$721.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,721.00
|
| Rate for Payer: PHCS Commercial |
$5,329.54
|
| Rate for Payer: United Healthcare All Payer |
$4,885.41
|
|
|
PRESERVATION MB INSRT S2 9.5MM
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
PRESERVATION MB INSRT S2 9.5MM
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
PRESERVATION MB INSRT S3 9.5MM
|
Facility
|
IP
|
$5,551.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$721.71 |
| Max. Negotiated Rate |
$5,329.54 |
| Rate for Payer: Aetna Commercial |
$4,274.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,330.25
|
| Rate for Payer: Cash Price |
$2,775.80
|
| Rate for Payer: Cigna Commercial |
$4,607.83
|
| Rate for Payer: First Health Commercial |
$5,274.02
|
| Rate for Payer: Humana Commercial |
$4,718.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,552.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,097.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,665.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,885.41
|
| Rate for Payer: Ohio Health Group HMO |
$4,163.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,110.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$721.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,721.00
|
| Rate for Payer: PHCS Commercial |
$5,329.54
|
| Rate for Payer: United Healthcare All Payer |
$4,885.41
|
|
|
PRESERVATION MB INSRT S3 9.5MM
|
Facility
|
OP
|
$5,551.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$721.71 |
| Max. Negotiated Rate |
$5,329.54 |
| Rate for Payer: Aetna Commercial |
$4,274.73
|
| Rate for Payer: Anthem Medicaid |
$1,909.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,330.25
|
| Rate for Payer: Cash Price |
$2,775.80
|
| Rate for Payer: Cigna Commercial |
$4,607.83
|
| Rate for Payer: First Health Commercial |
$5,274.02
|
| Rate for Payer: Humana Commercial |
$4,718.86
|
| Rate for Payer: Humana KY Medicaid |
$1,909.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,928.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,552.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,097.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,665.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,947.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,885.41
|
| Rate for Payer: Ohio Health Group HMO |
$4,163.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,110.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$721.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,721.00
|
| Rate for Payer: PHCS Commercial |
$5,329.54
|
| Rate for Payer: United Healthcare All Payer |
$4,885.41
|
|
|
PRESERVATION MB INSRT S4 9.5MM
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
PRESERVATION MB INSRT S4 9.5MM
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
PRESERVATION MB INSRT S5 9.5MM
|
Facility
|
IP
|
$5,551.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$721.71 |
| Max. Negotiated Rate |
$5,329.54 |
| Rate for Payer: Aetna Commercial |
$4,274.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,330.25
|
| Rate for Payer: Cash Price |
$2,775.80
|
| Rate for Payer: Cigna Commercial |
$4,607.83
|
| Rate for Payer: First Health Commercial |
$5,274.02
|
| Rate for Payer: Humana Commercial |
$4,718.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,552.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,097.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,665.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,885.41
|
| Rate for Payer: Ohio Health Group HMO |
$4,163.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,110.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$721.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,721.00
|
| Rate for Payer: PHCS Commercial |
$5,329.54
|
| Rate for Payer: United Healthcare All Payer |
$4,885.41
|
|
|
PRESERVATION MB INSRT S5 9.5MM
|
Facility
|
OP
|
$5,551.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$721.71 |
| Max. Negotiated Rate |
$5,329.54 |
| Rate for Payer: Aetna Commercial |
$4,274.73
|
| Rate for Payer: Anthem Medicaid |
$1,909.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,330.25
|
| Rate for Payer: Cash Price |
$2,775.80
|
| Rate for Payer: Cigna Commercial |
$4,607.83
|
| Rate for Payer: First Health Commercial |
$5,274.02
|
| Rate for Payer: Humana Commercial |
$4,718.86
|
| Rate for Payer: Humana KY Medicaid |
$1,909.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,928.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,552.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,097.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,665.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,947.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,885.41
|
| Rate for Payer: Ohio Health Group HMO |
$4,163.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,110.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$721.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,721.00
|
| Rate for Payer: PHCS Commercial |
$5,329.54
|
| Rate for Payer: United Healthcare All Payer |
$4,885.41
|
|
