|
PRESERVATION UNI FEM CEM SZ 1
|
Facility
|
IP
|
$15,731.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,045.10 |
| Max. Negotiated Rate |
$15,102.26 |
| Rate for Payer: Aetna Commercial |
$12,113.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,270.59
|
| Rate for Payer: Cash Price |
$7,865.76
|
| Rate for Payer: Cigna Commercial |
$13,057.16
|
| Rate for Payer: First Health Commercial |
$14,944.94
|
| Rate for Payer: Humana Commercial |
$13,371.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,899.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,609.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,719.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,843.74
|
| Rate for Payer: Ohio Health Group HMO |
$11,798.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,146.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,045.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,876.77
|
| Rate for Payer: PHCS Commercial |
$15,102.26
|
| Rate for Payer: United Healthcare All Payer |
$13,843.74
|
|
|
PRESERVATION UNI FEM CEM SZ 1
|
Facility
|
OP
|
$15,731.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,045.10 |
| Max. Negotiated Rate |
$15,102.26 |
| Rate for Payer: Aetna Commercial |
$12,113.27
|
| Rate for Payer: Anthem Medicaid |
$5,410.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,270.59
|
| Rate for Payer: Cash Price |
$7,865.76
|
| Rate for Payer: Cigna Commercial |
$13,057.16
|
| Rate for Payer: First Health Commercial |
$14,944.94
|
| Rate for Payer: Humana Commercial |
$13,371.79
|
| Rate for Payer: Humana KY Medicaid |
$5,410.07
|
| Rate for Payer: Kentucky WC Medicaid |
$5,465.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,899.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,609.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,719.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,518.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,843.74
|
| Rate for Payer: Ohio Health Group HMO |
$11,798.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,146.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,045.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,876.77
|
| Rate for Payer: PHCS Commercial |
$15,102.26
|
| Rate for Payer: United Healthcare All Payer |
$13,843.74
|
|
|
PRESERVATION UNI FEM CEM SZ 2
|
Facility
|
OP
|
$16,224.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,109.12 |
| Max. Negotiated Rate |
$15,575.04 |
| Rate for Payer: Aetna Commercial |
$12,492.48
|
| Rate for Payer: Anthem Medicaid |
$5,579.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,654.72
|
| Rate for Payer: Cash Price |
$8,112.00
|
| Rate for Payer: Cigna Commercial |
$13,465.92
|
| Rate for Payer: First Health Commercial |
$15,412.80
|
| Rate for Payer: Humana Commercial |
$13,790.40
|
| Rate for Payer: Humana KY Medicaid |
$5,579.43
|
| Rate for Payer: Kentucky WC Medicaid |
$5,636.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,303.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,973.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,867.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,691.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,277.12
|
| Rate for Payer: Ohio Health Group HMO |
$12,168.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,244.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,109.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,029.44
|
| Rate for Payer: PHCS Commercial |
$15,575.04
|
| Rate for Payer: United Healthcare All Payer |
$14,277.12
|
|
|
PRESERVATION UNI FEM CEM SZ 2
|
Facility
|
IP
|
$16,224.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,109.12 |
| Max. Negotiated Rate |
$15,575.04 |
| Rate for Payer: Aetna Commercial |
$12,492.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,654.72
|
| Rate for Payer: Cash Price |
$8,112.00
|
| Rate for Payer: Cigna Commercial |
$13,465.92
|
| Rate for Payer: First Health Commercial |
$15,412.80
|
| Rate for Payer: Humana Commercial |
$13,790.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,303.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,973.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,867.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,277.12
|
| Rate for Payer: Ohio Health Group HMO |
$12,168.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,244.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,109.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,029.44
|
| Rate for Payer: PHCS Commercial |
$15,575.04
|
| Rate for Payer: United Healthcare All Payer |
$14,277.12
|
|
|
PRESERVATION UNI FEM CEM SZ 3
|
Facility
|
OP
|
$15,731.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,045.10 |
| Max. Negotiated Rate |
$15,102.26 |
| Rate for Payer: Aetna Commercial |
$12,113.27
|
| Rate for Payer: Anthem Medicaid |
$5,410.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,270.59
|
| Rate for Payer: Cash Price |
$7,865.76
|
| Rate for Payer: Cigna Commercial |
$13,057.16
|
| Rate for Payer: First Health Commercial |
$14,944.94
|
| Rate for Payer: Humana Commercial |
$13,371.79
|
| Rate for Payer: Humana KY Medicaid |
$5,410.07
|
| Rate for Payer: Kentucky WC Medicaid |
$5,465.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,899.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,609.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,719.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,518.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,843.74
|
| Rate for Payer: Ohio Health Group HMO |
$11,798.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,146.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,045.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,876.77
|
| Rate for Payer: PHCS Commercial |
$15,102.26
|
| Rate for Payer: United Healthcare All Payer |
$13,843.74
|
|
|
PRESERVATION UNI FEM CEM SZ 3
|
Facility
|
IP
|
$15,731.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,045.10 |
| Max. Negotiated Rate |
$15,102.26 |
| Rate for Payer: Aetna Commercial |
$12,113.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,270.59
|
| Rate for Payer: Cash Price |
$7,865.76
|
| Rate for Payer: Cigna Commercial |
$13,057.16
|
| Rate for Payer: First Health Commercial |
$14,944.94
|
| Rate for Payer: Humana Commercial |
$13,371.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,899.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,609.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,719.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,843.74
|
| Rate for Payer: Ohio Health Group HMO |
$11,798.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,146.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,045.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,876.77
|
| Rate for Payer: PHCS Commercial |
$15,102.26
|
| Rate for Payer: United Healthcare All Payer |
$13,843.74
|
|
|
PRESERVATION UNI FEM CEM SZ 4
|
Facility
|
OP
|
$16,224.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,109.12 |
| Max. Negotiated Rate |
$15,575.04 |
| Rate for Payer: Aetna Commercial |
$12,492.48
|
| Rate for Payer: Anthem Medicaid |
$5,579.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,654.72
|
| Rate for Payer: Cash Price |
$8,112.00
|
| Rate for Payer: Cigna Commercial |
$13,465.92
|
| Rate for Payer: First Health Commercial |
$15,412.80
|
| Rate for Payer: Humana Commercial |
$13,790.40
|
| Rate for Payer: Humana KY Medicaid |
$5,579.43
|
| Rate for Payer: Kentucky WC Medicaid |
$5,636.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,303.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,973.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,867.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,691.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,277.12
|
| Rate for Payer: Ohio Health Group HMO |
$12,168.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,244.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,109.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,029.44
|
| Rate for Payer: PHCS Commercial |
$15,575.04
|
| Rate for Payer: United Healthcare All Payer |
$14,277.12
|
|
|
PRESERVATION UNI FEM CEM SZ 4
|
Facility
|
IP
|
$16,224.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,109.12 |
| Max. Negotiated Rate |
$15,575.04 |
| Rate for Payer: Aetna Commercial |
$12,492.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,654.72
|
| Rate for Payer: Cash Price |
$8,112.00
|
| Rate for Payer: Cigna Commercial |
$13,465.92
|
| Rate for Payer: First Health Commercial |
$15,412.80
|
| Rate for Payer: Humana Commercial |
$13,790.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,303.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,973.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,867.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,277.12
|
| Rate for Payer: Ohio Health Group HMO |
$12,168.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,244.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,109.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,029.44
|
| Rate for Payer: PHCS Commercial |
$15,575.04
|
| Rate for Payer: United Healthcare All Payer |
$14,277.12
|
|
|
PRESERVATION UNI FEM CEM SZ 5
|
Facility
|
OP
|
$15,731.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,045.10 |
| Max. Negotiated Rate |
$15,102.26 |
| Rate for Payer: Aetna Commercial |
$12,113.27
|
| Rate for Payer: Anthem Medicaid |
$5,410.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,270.59
|
| Rate for Payer: Cash Price |
$7,865.76
|
| Rate for Payer: Cigna Commercial |
$13,057.16
|
| Rate for Payer: First Health Commercial |
$14,944.94
|
| Rate for Payer: Humana Commercial |
$13,371.79
|
| Rate for Payer: Humana KY Medicaid |
$5,410.07
|
| Rate for Payer: Kentucky WC Medicaid |
$5,465.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,899.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,609.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,719.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,518.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,843.74
|
| Rate for Payer: Ohio Health Group HMO |
$11,798.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,146.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,045.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,876.77
|
| Rate for Payer: PHCS Commercial |
$15,102.26
|
| Rate for Payer: United Healthcare All Payer |
$13,843.74
|
|
|
PRESERVATION UNI FEM CEM SZ 5
|
Facility
|
IP
|
$15,731.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,045.10 |
| Max. Negotiated Rate |
$15,102.26 |
| Rate for Payer: Aetna Commercial |
$12,113.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,270.59
|
| Rate for Payer: Cash Price |
$7,865.76
|
| Rate for Payer: Cigna Commercial |
$13,057.16
|
| Rate for Payer: First Health Commercial |
$14,944.94
|
| Rate for Payer: Humana Commercial |
$13,371.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,899.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,609.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,719.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,843.74
|
| Rate for Payer: Ohio Health Group HMO |
$11,798.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,146.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,045.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,876.77
|
| Rate for Payer: PHCS Commercial |
$15,102.26
|
| Rate for Payer: United Healthcare All Payer |
$13,843.74
|
|
|
PRESERVATN INS LM/RL S1 11.5MM
|
Facility
|
OP
|
$5,336.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.68 |
| Max. Negotiated Rate |
$5,122.56 |
| Rate for Payer: Aetna Commercial |
$4,108.72
|
| Rate for Payer: Anthem Medicaid |
$1,835.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,162.08
|
| Rate for Payer: Cash Price |
$2,668.00
|
| Rate for Payer: Cigna Commercial |
$4,428.88
|
| Rate for Payer: First Health Commercial |
$5,069.20
|
| Rate for Payer: Humana Commercial |
$4,535.60
|
| Rate for Payer: Humana KY Medicaid |
$1,835.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,853.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,375.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,937.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,600.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,871.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,695.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,002.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,067.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,654.16
|
| Rate for Payer: PHCS Commercial |
$5,122.56
|
| Rate for Payer: United Healthcare All Payer |
$4,695.68
|
|
|
PRESERVATN INS LM/RL S1 11.5MM
|
Facility
|
IP
|
$5,336.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.68 |
| Max. Negotiated Rate |
$5,122.56 |
| Rate for Payer: Aetna Commercial |
$4,108.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,162.08
|
| Rate for Payer: Cash Price |
$2,668.00
|
| Rate for Payer: Cigna Commercial |
$4,428.88
|
| Rate for Payer: First Health Commercial |
$5,069.20
|
| Rate for Payer: Humana Commercial |
$4,535.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,375.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,937.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,600.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,695.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,002.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,067.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,654.16
|
| Rate for Payer: PHCS Commercial |
$5,122.56
|
| Rate for Payer: United Healthcare All Payer |
$4,695.68
|
|
|
PRESERVATN INS LM/RL S1 9.5MM
|
Facility
|
OP
|
$5,336.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.68 |
| Max. Negotiated Rate |
$5,122.56 |
| Rate for Payer: Aetna Commercial |
$4,108.72
|
| Rate for Payer: Anthem Medicaid |
$1,835.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,162.08
|
| Rate for Payer: Cash Price |
$2,668.00
|
| Rate for Payer: Cigna Commercial |
$4,428.88
|
| Rate for Payer: First Health Commercial |
$5,069.20
|
| Rate for Payer: Humana Commercial |
$4,535.60
|
| Rate for Payer: Humana KY Medicaid |
$1,835.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,853.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,375.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,937.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,600.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,871.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,695.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,002.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,067.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,654.16
|
| Rate for Payer: PHCS Commercial |
$5,122.56
|
| Rate for Payer: United Healthcare All Payer |
$4,695.68
|
|
|
PRESERVATN INS LM/RL S1 9.5MM
|
Facility
|
IP
|
$5,336.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.68 |
| Max. Negotiated Rate |
$5,122.56 |
| Rate for Payer: Aetna Commercial |
$4,108.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,162.08
|
| Rate for Payer: Cash Price |
$2,668.00
|
| Rate for Payer: Cigna Commercial |
$4,428.88
|
| Rate for Payer: First Health Commercial |
$5,069.20
|
| Rate for Payer: Humana Commercial |
$4,535.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,375.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,937.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,600.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,695.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,002.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,067.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,654.16
|
| Rate for Payer: PHCS Commercial |
$5,122.56
|
| Rate for Payer: United Healthcare All Payer |
$4,695.68
|
|
|
PRESERVATN INS LM/RL S2 11.5MM
|
Facility
|
OP
|
$5,336.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.68 |
| Max. Negotiated Rate |
$5,122.56 |
| Rate for Payer: Aetna Commercial |
$4,108.72
|
| Rate for Payer: Anthem Medicaid |
$1,835.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,162.08
|
| Rate for Payer: Cash Price |
$2,668.00
|
| Rate for Payer: Cigna Commercial |
$4,428.88
|
| Rate for Payer: First Health Commercial |
$5,069.20
|
| Rate for Payer: Humana Commercial |
$4,535.60
|
| Rate for Payer: Humana KY Medicaid |
$1,835.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,853.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,375.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,937.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,600.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,871.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,695.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,002.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,067.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,654.16
|
| Rate for Payer: PHCS Commercial |
$5,122.56
|
| Rate for Payer: United Healthcare All Payer |
$4,695.68
|
|
|
PRESERVATN INS LM/RL S2 11.5MM
|
Facility
|
IP
|
$5,336.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.68 |
| Max. Negotiated Rate |
$5,122.56 |
| Rate for Payer: Aetna Commercial |
$4,108.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,162.08
|
| Rate for Payer: Cash Price |
$2,668.00
|
| Rate for Payer: Cigna Commercial |
$4,428.88
|
| Rate for Payer: First Health Commercial |
$5,069.20
|
| Rate for Payer: Humana Commercial |
$4,535.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,375.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,937.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,600.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,695.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,002.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,067.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,654.16
|
| Rate for Payer: PHCS Commercial |
$5,122.56
|
| Rate for Payer: United Healthcare All Payer |
$4,695.68
|
|
|
PRESERVATN INS LM/RL S2 9.5MM
|
Facility
|
OP
|
$5,336.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.68 |
| Max. Negotiated Rate |
$5,122.56 |
| Rate for Payer: Aetna Commercial |
$4,108.72
|
| Rate for Payer: Anthem Medicaid |
$1,835.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,162.08
|
| Rate for Payer: Cash Price |
$2,668.00
|
| Rate for Payer: Cigna Commercial |
$4,428.88
|
| Rate for Payer: First Health Commercial |
$5,069.20
|
| Rate for Payer: Humana Commercial |
$4,535.60
|
| Rate for Payer: Humana KY Medicaid |
$1,835.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,853.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,375.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,937.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,600.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,871.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,695.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,002.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,067.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,654.16
|
| Rate for Payer: PHCS Commercial |
$5,122.56
|
| Rate for Payer: United Healthcare All Payer |
$4,695.68
|
|
|
PRESERVATN INS LM/RL S2 9.5MM
|
Facility
|
IP
|
$5,336.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.68 |
| Max. Negotiated Rate |
$5,122.56 |
| Rate for Payer: Aetna Commercial |
$4,108.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,162.08
|
| Rate for Payer: Cash Price |
$2,668.00
|
| Rate for Payer: Cigna Commercial |
$4,428.88
|
| Rate for Payer: First Health Commercial |
$5,069.20
|
| Rate for Payer: Humana Commercial |
$4,535.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,375.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,937.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,600.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,695.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,002.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,067.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,654.16
|
| Rate for Payer: PHCS Commercial |
$5,122.56
|
| Rate for Payer: United Healthcare All Payer |
$4,695.68
|
|
|
PRESERVATN INS LM/RL S3 11.5MM
|
Facility
|
IP
|
$5,336.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.68 |
| Max. Negotiated Rate |
$5,122.56 |
| Rate for Payer: Aetna Commercial |
$4,108.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,162.08
|
| Rate for Payer: Cash Price |
$2,668.00
|
| Rate for Payer: Cigna Commercial |
$4,428.88
|
| Rate for Payer: First Health Commercial |
$5,069.20
|
| Rate for Payer: Humana Commercial |
$4,535.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,375.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,937.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,600.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,695.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,002.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,067.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,654.16
|
| Rate for Payer: PHCS Commercial |
$5,122.56
|
| Rate for Payer: United Healthcare All Payer |
$4,695.68
|
|
|
PRESERVATN INS LM/RL S3 11.5MM
|
Facility
|
OP
|
$5,336.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.68 |
| Max. Negotiated Rate |
$5,122.56 |
| Rate for Payer: Aetna Commercial |
$4,108.72
|
| Rate for Payer: Anthem Medicaid |
$1,835.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,162.08
|
| Rate for Payer: Cash Price |
$2,668.00
|
| Rate for Payer: Cigna Commercial |
$4,428.88
|
| Rate for Payer: First Health Commercial |
$5,069.20
|
| Rate for Payer: Humana Commercial |
$4,535.60
|
| Rate for Payer: Humana KY Medicaid |
$1,835.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,853.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,375.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,937.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,600.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,871.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,695.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,002.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,067.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,654.16
|
| Rate for Payer: PHCS Commercial |
$5,122.56
|
| Rate for Payer: United Healthcare All Payer |
$4,695.68
|
|
|
PRESERVATN INS LM/RL S3 9.5MM
|
Facility
|
OP
|
$5,336.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.68 |
| Max. Negotiated Rate |
$5,122.56 |
| Rate for Payer: Aetna Commercial |
$4,108.72
|
| Rate for Payer: Anthem Medicaid |
$1,835.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,162.08
|
| Rate for Payer: Cash Price |
$2,668.00
|
| Rate for Payer: Cigna Commercial |
$4,428.88
|
| Rate for Payer: First Health Commercial |
$5,069.20
|
| Rate for Payer: Humana Commercial |
$4,535.60
|
| Rate for Payer: Humana KY Medicaid |
$1,835.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,853.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,375.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,937.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,600.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,871.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,695.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,002.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,067.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,654.16
|
| Rate for Payer: PHCS Commercial |
$5,122.56
|
| Rate for Payer: United Healthcare All Payer |
$4,695.68
|
|
|
PRESERVATN INS LM/RL S3 9.5MM
|
Facility
|
IP
|
$5,336.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.68 |
| Max. Negotiated Rate |
$5,122.56 |
| Rate for Payer: Aetna Commercial |
$4,108.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,162.08
|
| Rate for Payer: Cash Price |
$2,668.00
|
| Rate for Payer: Cigna Commercial |
$4,428.88
|
| Rate for Payer: First Health Commercial |
$5,069.20
|
| Rate for Payer: Humana Commercial |
$4,535.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,375.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,937.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,600.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,695.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,002.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,067.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,654.16
|
| Rate for Payer: PHCS Commercial |
$5,122.56
|
| Rate for Payer: United Healthcare All Payer |
$4,695.68
|
|
|
PRESERVATN INS LM/RL S4 11.5MM
|
Facility
|
OP
|
$5,336.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.68 |
| Max. Negotiated Rate |
$5,122.56 |
| Rate for Payer: Aetna Commercial |
$4,108.72
|
| Rate for Payer: Anthem Medicaid |
$1,835.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,162.08
|
| Rate for Payer: Cash Price |
$2,668.00
|
| Rate for Payer: Cigna Commercial |
$4,428.88
|
| Rate for Payer: First Health Commercial |
$5,069.20
|
| Rate for Payer: Humana Commercial |
$4,535.60
|
| Rate for Payer: Humana KY Medicaid |
$1,835.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,853.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,375.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,937.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,600.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,871.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,695.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,002.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,067.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,654.16
|
| Rate for Payer: PHCS Commercial |
$5,122.56
|
| Rate for Payer: United Healthcare All Payer |
$4,695.68
|
|
|
PRESERVATN INS LM/RL S4 11.5MM
|
Facility
|
IP
|
$5,336.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.68 |
| Max. Negotiated Rate |
$5,122.56 |
| Rate for Payer: Aetna Commercial |
$4,108.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,162.08
|
| Rate for Payer: Cash Price |
$2,668.00
|
| Rate for Payer: Cigna Commercial |
$4,428.88
|
| Rate for Payer: First Health Commercial |
$5,069.20
|
| Rate for Payer: Humana Commercial |
$4,535.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,375.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,937.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,600.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,695.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,002.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,067.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,654.16
|
| Rate for Payer: PHCS Commercial |
$5,122.56
|
| Rate for Payer: United Healthcare All Payer |
$4,695.68
|
|
|
PRESERVATN INS LM/RL S4 9.5MM
|
Facility
|
OP
|
$5,336.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.68 |
| Max. Negotiated Rate |
$5,122.56 |
| Rate for Payer: Aetna Commercial |
$4,108.72
|
| Rate for Payer: Anthem Medicaid |
$1,835.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,162.08
|
| Rate for Payer: Cash Price |
$2,668.00
|
| Rate for Payer: Cigna Commercial |
$4,428.88
|
| Rate for Payer: First Health Commercial |
$5,069.20
|
| Rate for Payer: Humana Commercial |
$4,535.60
|
| Rate for Payer: Humana KY Medicaid |
$1,835.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,853.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,375.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,937.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,600.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,871.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,695.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,002.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,067.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,654.16
|
| Rate for Payer: PHCS Commercial |
$5,122.56
|
| Rate for Payer: United Healthcare All Payer |
$4,695.68
|
|
