|
PRESERVATN MB INSRT S1 11.5MM
|
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
|
|
|
PRESERVATN MB INSRT S1 11.5MM
|
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
|
|
|
PRESERVATN MB INSRT S2 11.5MM
|
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
|
|
|
PRESERVATN MB INSRT S2 11.5MM
|
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
|
|
|
PRESERVATN MB INSRT S3 11.5MM
|
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
|
|
|
PRESERVATN MB INSRT S3 11.5MM
|
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
|
|
|
PRESERVATN MB INSRT S4 11.5MM
|
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
|
|
|
PRESERVATN MB INSRT S4 11.5MM
|
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
|
|
|
PRESERVATN MB INSRT S5 11.5MM
|
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
|
|
|
PRESERVATN MB INSRT S5 11.5MM
|
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
|
|
|
PRESERVATN MB TIB TRY LM/RL S1
|
Facility
|
OP
|
$9,606.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,248.85 |
| Max. Negotiated Rate |
$9,222.26 |
| Rate for Payer: Aetna Commercial |
$7,397.02
|
| Rate for Payer: Anthem Medicaid |
$3,303.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,493.09
|
| Rate for Payer: Cash Price |
$4,803.26
|
| Rate for Payer: Cigna Commercial |
$7,973.41
|
| Rate for Payer: First Health Commercial |
$9,126.19
|
| Rate for Payer: Humana Commercial |
$8,165.54
|
| Rate for Payer: Humana KY Medicaid |
$3,303.68
|
| Rate for Payer: Kentucky WC Medicaid |
$3,337.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,877.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,089.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,881.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,369.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,453.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,204.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,921.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,248.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,978.02
|
| Rate for Payer: PHCS Commercial |
$9,222.26
|
| Rate for Payer: United Healthcare All Payer |
$8,453.74
|
|
|
PRESERVATN MB TIB TRY LM/RL S1
|
Facility
|
IP
|
$9,606.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,248.85 |
| Max. Negotiated Rate |
$9,222.26 |
| Rate for Payer: Aetna Commercial |
$7,397.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,493.09
|
| Rate for Payer: Cash Price |
$4,803.26
|
| Rate for Payer: Cigna Commercial |
$7,973.41
|
| Rate for Payer: First Health Commercial |
$9,126.19
|
| Rate for Payer: Humana Commercial |
$8,165.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,877.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,089.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,881.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,453.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,204.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,921.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,248.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,978.02
|
| Rate for Payer: PHCS Commercial |
$9,222.26
|
| Rate for Payer: United Healthcare All Payer |
$8,453.74
|
|
|
PRESERVATN MB TIB TRY LM/RL S2
|
Facility
|
OP
|
$9,606.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,248.85 |
| Max. Negotiated Rate |
$9,222.26 |
| Rate for Payer: Aetna Commercial |
$7,397.02
|
| Rate for Payer: Anthem Medicaid |
$3,303.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,493.09
|
| Rate for Payer: Cash Price |
$4,803.26
|
| Rate for Payer: Cigna Commercial |
$7,973.41
|
| Rate for Payer: First Health Commercial |
$9,126.19
|
| Rate for Payer: Humana Commercial |
$8,165.54
|
| Rate for Payer: Humana KY Medicaid |
$3,303.68
|
| Rate for Payer: Kentucky WC Medicaid |
$3,337.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,877.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,089.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,881.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,369.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,453.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,204.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,921.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,248.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,978.02
|
| Rate for Payer: PHCS Commercial |
$9,222.26
|
| Rate for Payer: United Healthcare All Payer |
$8,453.74
|
|
|
PRESERVATN MB TIB TRY LM/RL S2
|
Facility
|
IP
|
$9,606.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,248.85 |
| Max. Negotiated Rate |
$9,222.26 |
| Rate for Payer: Aetna Commercial |
$7,397.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,493.09
|
| Rate for Payer: Cash Price |
$4,803.26
|
| Rate for Payer: Cigna Commercial |
$7,973.41
|
| Rate for Payer: First Health Commercial |
$9,126.19
|
| Rate for Payer: Humana Commercial |
$8,165.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,877.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,089.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,881.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,453.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,204.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,921.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,248.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,978.02
|
| Rate for Payer: PHCS Commercial |
$9,222.26
|
| Rate for Payer: United Healthcare All Payer |
$8,453.74
|
|
|
PRESERVATN MB TIB TRY LM/RL S3
|
Facility
|
OP
|
$9,606.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,248.85 |
| Max. Negotiated Rate |
$9,222.26 |
| Rate for Payer: Aetna Commercial |
$7,397.02
|
| Rate for Payer: Anthem Medicaid |
$3,303.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,493.09
|
| Rate for Payer: Cash Price |
$4,803.26
|
| Rate for Payer: Cigna Commercial |
$7,973.41
|
| Rate for Payer: First Health Commercial |
$9,126.19
|
| Rate for Payer: Humana Commercial |
$8,165.54
|
| Rate for Payer: Humana KY Medicaid |
$3,303.68
|
| Rate for Payer: Kentucky WC Medicaid |
$3,337.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,877.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,089.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,881.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,369.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,453.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,204.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,921.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,248.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,978.02
|
| Rate for Payer: PHCS Commercial |
$9,222.26
|
| Rate for Payer: United Healthcare All Payer |
$8,453.74
|
|
|
PRESERVATN MB TIB TRY LM/RL S3
|
Facility
|
IP
|
$9,606.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,248.85 |
| Max. Negotiated Rate |
$9,222.26 |
| Rate for Payer: Aetna Commercial |
$7,397.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,493.09
|
| Rate for Payer: Cash Price |
$4,803.26
|
| Rate for Payer: Cigna Commercial |
$7,973.41
|
| Rate for Payer: First Health Commercial |
$9,126.19
|
| Rate for Payer: Humana Commercial |
$8,165.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,877.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,089.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,881.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,453.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,204.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,921.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,248.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,978.02
|
| Rate for Payer: PHCS Commercial |
$9,222.26
|
| Rate for Payer: United Healthcare All Payer |
$8,453.74
|
|
|
PRESERVATN MB TIB TRY LM/RL S4
|
Facility
|
OP
|
$9,606.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,248.85 |
| Max. Negotiated Rate |
$9,222.26 |
| Rate for Payer: Aetna Commercial |
$7,397.02
|
| Rate for Payer: Anthem Medicaid |
$3,303.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,493.09
|
| Rate for Payer: Cash Price |
$4,803.26
|
| Rate for Payer: Cigna Commercial |
$7,973.41
|
| Rate for Payer: First Health Commercial |
$9,126.19
|
| Rate for Payer: Humana Commercial |
$8,165.54
|
| Rate for Payer: Humana KY Medicaid |
$3,303.68
|
| Rate for Payer: Kentucky WC Medicaid |
$3,337.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,877.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,089.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,881.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,369.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,453.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,204.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,921.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,248.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,978.02
|
| Rate for Payer: PHCS Commercial |
$9,222.26
|
| Rate for Payer: United Healthcare All Payer |
$8,453.74
|
|
|
PRESERVATN MB TIB TRY LM/RL S4
|
Facility
|
IP
|
$9,606.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,248.85 |
| Max. Negotiated Rate |
$9,222.26 |
| Rate for Payer: Aetna Commercial |
$7,397.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,493.09
|
| Rate for Payer: Cash Price |
$4,803.26
|
| Rate for Payer: Cigna Commercial |
$7,973.41
|
| Rate for Payer: First Health Commercial |
$9,126.19
|
| Rate for Payer: Humana Commercial |
$8,165.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,877.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,089.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,881.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,453.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,204.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,921.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,248.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,978.02
|
| Rate for Payer: PHCS Commercial |
$9,222.26
|
| Rate for Payer: United Healthcare All Payer |
$8,453.74
|
|
|
PRESERVATN MB TIB TRY LM/RL S5
|
Facility
|
IP
|
$9,606.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,248.85 |
| Max. Negotiated Rate |
$9,222.26 |
| Rate for Payer: Aetna Commercial |
$7,397.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,493.09
|
| Rate for Payer: Cash Price |
$4,803.26
|
| Rate for Payer: Cigna Commercial |
$7,973.41
|
| Rate for Payer: First Health Commercial |
$9,126.19
|
| Rate for Payer: Humana Commercial |
$8,165.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,877.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,089.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,881.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,453.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,204.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,921.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,248.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,978.02
|
| Rate for Payer: PHCS Commercial |
$9,222.26
|
| Rate for Payer: United Healthcare All Payer |
$8,453.74
|
|
|
PRESERVATN MB TIB TRY LM/RL S5
|
Facility
|
OP
|
$9,606.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,248.85 |
| Max. Negotiated Rate |
$9,222.26 |
| Rate for Payer: Aetna Commercial |
$7,397.02
|
| Rate for Payer: Anthem Medicaid |
$3,303.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,493.09
|
| Rate for Payer: Cash Price |
$4,803.26
|
| Rate for Payer: Cigna Commercial |
$7,973.41
|
| Rate for Payer: First Health Commercial |
$9,126.19
|
| Rate for Payer: Humana Commercial |
$8,165.54
|
| Rate for Payer: Humana KY Medicaid |
$3,303.68
|
| Rate for Payer: Kentucky WC Medicaid |
$3,337.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,877.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,089.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,881.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,369.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,453.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,204.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,921.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,248.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,978.02
|
| Rate for Payer: PHCS Commercial |
$9,222.26
|
| Rate for Payer: United Healthcare All Payer |
$8,453.74
|
|
|
PRESERVATN MB TIB TRY RM/LL S1
|
Facility
|
IP
|
$9,606.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,248.85 |
| Max. Negotiated Rate |
$9,222.26 |
| Rate for Payer: Aetna Commercial |
$7,397.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,493.09
|
| Rate for Payer: Cash Price |
$4,803.26
|
| Rate for Payer: Cigna Commercial |
$7,973.41
|
| Rate for Payer: First Health Commercial |
$9,126.19
|
| Rate for Payer: Humana Commercial |
$8,165.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,877.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,089.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,881.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,453.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,204.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,921.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,248.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,978.02
|
| Rate for Payer: PHCS Commercial |
$9,222.26
|
| Rate for Payer: United Healthcare All Payer |
$8,453.74
|
|
|
PRESERVATN MB TIB TRY RM/LL S1
|
Facility
|
OP
|
$9,606.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,248.85 |
| Max. Negotiated Rate |
$9,222.26 |
| Rate for Payer: Aetna Commercial |
$7,397.02
|
| Rate for Payer: Anthem Medicaid |
$3,303.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,493.09
|
| Rate for Payer: Cash Price |
$4,803.26
|
| Rate for Payer: Cigna Commercial |
$7,973.41
|
| Rate for Payer: First Health Commercial |
$9,126.19
|
| Rate for Payer: Humana Commercial |
$8,165.54
|
| Rate for Payer: Humana KY Medicaid |
$3,303.68
|
| Rate for Payer: Kentucky WC Medicaid |
$3,337.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,877.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,089.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,881.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,369.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,453.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,204.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,921.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,248.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,978.02
|
| Rate for Payer: PHCS Commercial |
$9,222.26
|
| Rate for Payer: United Healthcare All Payer |
$8,453.74
|
|
|
PRESERVATN MB TIB TRY RM/LL S2
|
Facility
|
IP
|
$9,606.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,248.85 |
| Max. Negotiated Rate |
$9,222.26 |
| Rate for Payer: Aetna Commercial |
$7,397.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,493.09
|
| Rate for Payer: Cash Price |
$4,803.26
|
| Rate for Payer: Cigna Commercial |
$7,973.41
|
| Rate for Payer: First Health Commercial |
$9,126.19
|
| Rate for Payer: Humana Commercial |
$8,165.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,877.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,089.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,881.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,453.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,204.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,921.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,248.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,978.02
|
| Rate for Payer: PHCS Commercial |
$9,222.26
|
| Rate for Payer: United Healthcare All Payer |
$8,453.74
|
|
|
PRESERVATN MB TIB TRY RM/LL S2
|
Facility
|
OP
|
$9,606.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,248.85 |
| Max. Negotiated Rate |
$9,222.26 |
| Rate for Payer: Aetna Commercial |
$7,397.02
|
| Rate for Payer: Anthem Medicaid |
$3,303.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,493.09
|
| Rate for Payer: Cash Price |
$4,803.26
|
| Rate for Payer: Cigna Commercial |
$7,973.41
|
| Rate for Payer: First Health Commercial |
$9,126.19
|
| Rate for Payer: Humana Commercial |
$8,165.54
|
| Rate for Payer: Humana KY Medicaid |
$3,303.68
|
| Rate for Payer: Kentucky WC Medicaid |
$3,337.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,877.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,089.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,881.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,369.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,453.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,204.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,921.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,248.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,978.02
|
| Rate for Payer: PHCS Commercial |
$9,222.26
|
| Rate for Payer: United Healthcare All Payer |
$8,453.74
|
|
|
PRESERVATN MB TIB TRY RM/LL S3
|
Facility
|
OP
|
$9,606.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,248.85 |
| Max. Negotiated Rate |
$9,222.26 |
| Rate for Payer: Aetna Commercial |
$7,397.02
|
| Rate for Payer: Anthem Medicaid |
$3,303.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,493.09
|
| Rate for Payer: Cash Price |
$4,803.26
|
| Rate for Payer: Cigna Commercial |
$7,973.41
|
| Rate for Payer: First Health Commercial |
$9,126.19
|
| Rate for Payer: Humana Commercial |
$8,165.54
|
| Rate for Payer: Humana KY Medicaid |
$3,303.68
|
| Rate for Payer: Kentucky WC Medicaid |
$3,337.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,877.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,089.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,881.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,369.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,453.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,204.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,921.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,248.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,978.02
|
| Rate for Payer: PHCS Commercial |
$9,222.26
|
| Rate for Payer: United Healthcare All Payer |
$8,453.74
|
|
