|
PRESERVATN INS LM/RL S4 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 S5 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 S5 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 S5 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 S5 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 RM/LL 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 RM/LL 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 RM/LL 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 RM/LL 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 RM/LL 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 RM/LL 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 RM/LL 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 RM/LL 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 RM/LL 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 RM/LL 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 RM/LL 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 RM/LL 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 RM/LL 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 RM/LL 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 RM/LL 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
|
|
|
PRESERVATN INS RM/LL S4 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 RM/LL S5 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 RM/LL S5 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 RM/LL S5 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 RM/LL S5 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
|
|
