|
PRESERVATN MB TIB TRY RM/LL 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 RM/LL 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 RM/LL 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 RM/LL 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 RM/LL 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 POLY LMRL SZ1 11.5M
|
Facility
|
IP
|
$9,218.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,198.36 |
| Max. Negotiated Rate |
$8,849.43 |
| Rate for Payer: Aetna Commercial |
$7,097.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,190.16
|
| Rate for Payer: Cash Price |
$4,609.08
|
| Rate for Payer: Cigna Commercial |
$7,651.07
|
| Rate for Payer: First Health Commercial |
$8,757.25
|
| Rate for Payer: Humana Commercial |
$7,835.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,558.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,803.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,765.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,111.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,913.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,843.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,198.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,857.63
|
| Rate for Payer: PHCS Commercial |
$8,849.43
|
| Rate for Payer: United Healthcare All Payer |
$8,111.98
|
|
|
PRESERVATN POLY LMRL SZ1 11.5M
|
Facility
|
OP
|
$9,218.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,198.36 |
| Max. Negotiated Rate |
$8,849.43 |
| Rate for Payer: Aetna Commercial |
$7,097.98
|
| Rate for Payer: Anthem Medicaid |
$3,170.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,190.16
|
| Rate for Payer: Cash Price |
$4,609.08
|
| Rate for Payer: Cigna Commercial |
$7,651.07
|
| Rate for Payer: First Health Commercial |
$8,757.25
|
| Rate for Payer: Humana Commercial |
$7,835.44
|
| Rate for Payer: Humana KY Medicaid |
$3,170.13
|
| Rate for Payer: Kentucky WC Medicaid |
$3,202.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,558.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,803.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,765.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,233.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,111.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,913.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,843.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,198.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,857.63
|
| Rate for Payer: PHCS Commercial |
$8,849.43
|
| Rate for Payer: United Healthcare All Payer |
$8,111.98
|
|
|
PRESERVATN POLY LMRL SZ 1 7MM
|
Facility
|
OP
|
$9,218.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,198.36 |
| Max. Negotiated Rate |
$8,849.43 |
| Rate for Payer: Aetna Commercial |
$7,097.98
|
| Rate for Payer: Anthem Medicaid |
$3,170.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,190.16
|
| Rate for Payer: Cash Price |
$4,609.08
|
| Rate for Payer: Cigna Commercial |
$7,651.07
|
| Rate for Payer: First Health Commercial |
$8,757.25
|
| Rate for Payer: Humana Commercial |
$7,835.44
|
| Rate for Payer: Humana KY Medicaid |
$3,170.13
|
| Rate for Payer: Kentucky WC Medicaid |
$3,202.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,558.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,803.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,765.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,233.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,111.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,913.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,843.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,198.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,857.63
|
| Rate for Payer: PHCS Commercial |
$8,849.43
|
| Rate for Payer: United Healthcare All Payer |
$8,111.98
|
|
|
PRESERVATN POLY LMRL SZ 1 7MM
|
Facility
|
IP
|
$9,218.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,198.36 |
| Max. Negotiated Rate |
$8,849.43 |
| Rate for Payer: Aetna Commercial |
$7,097.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,190.16
|
| Rate for Payer: Cash Price |
$4,609.08
|
| Rate for Payer: Cigna Commercial |
$7,651.07
|
| Rate for Payer: First Health Commercial |
$8,757.25
|
| Rate for Payer: Humana Commercial |
$7,835.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,558.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,803.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,765.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,111.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,913.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,843.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,198.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,857.63
|
| Rate for Payer: PHCS Commercial |
$8,849.43
|
| Rate for Payer: United Healthcare All Payer |
$8,111.98
|
|
|
PRESERVATN POLY LMRL SZ 1 9.5M
|
Facility
|
IP
|
$9,216.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,198.17 |
| Max. Negotiated Rate |
$8,848.03 |
| Rate for Payer: Aetna Commercial |
$7,096.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,189.03
|
| Rate for Payer: Cash Price |
$4,608.35
|
| Rate for Payer: Cigna Commercial |
$7,649.86
|
| Rate for Payer: First Health Commercial |
$8,755.86
|
| Rate for Payer: Humana Commercial |
$7,834.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,557.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,801.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,765.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,110.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,912.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,843.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,198.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,857.18
|
| Rate for Payer: PHCS Commercial |
$8,848.03
|
| Rate for Payer: United Healthcare All Payer |
$8,110.70
|
|
|
PRESERVATN POLY LMRL SZ 1 9.5M
|
Facility
|
OP
|
$9,216.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,198.17 |
| Max. Negotiated Rate |
$8,848.03 |
| Rate for Payer: Aetna Commercial |
$7,096.86
|
| Rate for Payer: Anthem Medicaid |
$3,169.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,189.03
|
| Rate for Payer: Cash Price |
$4,608.35
|
| Rate for Payer: Cigna Commercial |
$7,649.86
|
| Rate for Payer: First Health Commercial |
$8,755.86
|
| Rate for Payer: Humana Commercial |
$7,834.20
|
| Rate for Payer: Humana KY Medicaid |
$3,169.62
|
| Rate for Payer: Kentucky WC Medicaid |
$3,201.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,557.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,801.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,765.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,233.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,110.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,912.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,843.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,198.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,857.18
|
| Rate for Payer: PHCS Commercial |
$8,848.03
|
| Rate for Payer: United Healthcare All Payer |
$8,110.70
|
|
|
PRESERVATN POLY LMRL SZ2 11.5M
|
Facility
|
IP
|
$9,218.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,198.36 |
| Max. Negotiated Rate |
$8,849.43 |
| Rate for Payer: Aetna Commercial |
$7,097.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,190.16
|
| Rate for Payer: Cash Price |
$4,609.08
|
| Rate for Payer: Cigna Commercial |
$7,651.07
|
| Rate for Payer: First Health Commercial |
$8,757.25
|
| Rate for Payer: Humana Commercial |
$7,835.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,558.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,803.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,765.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,111.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,913.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,843.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,198.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,857.63
|
| Rate for Payer: PHCS Commercial |
$8,849.43
|
| Rate for Payer: United Healthcare All Payer |
$8,111.98
|
|
|
PRESERVATN POLY LMRL SZ2 11.5M
|
Facility
|
OP
|
$9,218.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,198.36 |
| Max. Negotiated Rate |
$8,849.43 |
| Rate for Payer: Aetna Commercial |
$7,097.98
|
| Rate for Payer: Anthem Medicaid |
$3,170.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,190.16
|
| Rate for Payer: Cash Price |
$4,609.08
|
| Rate for Payer: Cigna Commercial |
$7,651.07
|
| Rate for Payer: First Health Commercial |
$8,757.25
|
| Rate for Payer: Humana Commercial |
$7,835.44
|
| Rate for Payer: Humana KY Medicaid |
$3,170.13
|
| Rate for Payer: Kentucky WC Medicaid |
$3,202.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,558.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,803.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,765.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,233.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,111.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,913.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,843.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,198.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,857.63
|
| Rate for Payer: PHCS Commercial |
$8,849.43
|
| Rate for Payer: United Healthcare All Payer |
$8,111.98
|
|
|
PRESERVATN POLY LMRL SZ 2 7MM
|
Facility
|
OP
|
$9,218.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,198.36 |
| Max. Negotiated Rate |
$8,849.43 |
| Rate for Payer: Aetna Commercial |
$7,097.98
|
| Rate for Payer: Anthem Medicaid |
$3,170.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,190.16
|
| Rate for Payer: Cash Price |
$4,609.08
|
| Rate for Payer: Cigna Commercial |
$7,651.07
|
| Rate for Payer: First Health Commercial |
$8,757.25
|
| Rate for Payer: Humana Commercial |
$7,835.44
|
| Rate for Payer: Humana KY Medicaid |
$3,170.13
|
| Rate for Payer: Kentucky WC Medicaid |
$3,202.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,558.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,803.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,765.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,233.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,111.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,913.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,843.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,198.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,857.63
|
| Rate for Payer: PHCS Commercial |
$8,849.43
|
| Rate for Payer: United Healthcare All Payer |
$8,111.98
|
|
|
PRESERVATN POLY LMRL SZ 2 7MM
|
Facility
|
IP
|
$9,218.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,198.36 |
| Max. Negotiated Rate |
$8,849.43 |
| Rate for Payer: Aetna Commercial |
$7,097.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,190.16
|
| Rate for Payer: Cash Price |
$4,609.08
|
| Rate for Payer: Cigna Commercial |
$7,651.07
|
| Rate for Payer: First Health Commercial |
$8,757.25
|
| Rate for Payer: Humana Commercial |
$7,835.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,558.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,803.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,765.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,111.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,913.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,843.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,198.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,857.63
|
| Rate for Payer: PHCS Commercial |
$8,849.43
|
| Rate for Payer: United Healthcare All Payer |
$8,111.98
|
|
|
PRESERVATN POLY LMRL SZ 2 9.5M
|
Facility
|
OP
|
$9,218.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,198.36 |
| Max. Negotiated Rate |
$8,849.43 |
| Rate for Payer: Aetna Commercial |
$7,097.98
|
| Rate for Payer: Anthem Medicaid |
$3,170.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,190.16
|
| Rate for Payer: Cash Price |
$4,609.08
|
| Rate for Payer: Cigna Commercial |
$7,651.07
|
| Rate for Payer: First Health Commercial |
$8,757.25
|
| Rate for Payer: Humana Commercial |
$7,835.44
|
| Rate for Payer: Humana KY Medicaid |
$3,170.13
|
| Rate for Payer: Kentucky WC Medicaid |
$3,202.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,558.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,803.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,765.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,233.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,111.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,913.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,843.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,198.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,857.63
|
| Rate for Payer: PHCS Commercial |
$8,849.43
|
| Rate for Payer: United Healthcare All Payer |
$8,111.98
|
|
|
PRESERVATN POLY LMRL SZ 2 9.5M
|
Facility
|
IP
|
$9,218.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,198.36 |
| Max. Negotiated Rate |
$8,849.43 |
| Rate for Payer: Aetna Commercial |
$7,097.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,190.16
|
| Rate for Payer: Cash Price |
$4,609.08
|
| Rate for Payer: Cigna Commercial |
$7,651.07
|
| Rate for Payer: First Health Commercial |
$8,757.25
|
| Rate for Payer: Humana Commercial |
$7,835.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,558.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,803.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,765.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,111.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,913.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,843.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,198.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,857.63
|
| Rate for Payer: PHCS Commercial |
$8,849.43
|
| Rate for Payer: United Healthcare All Payer |
$8,111.98
|
|
|
PRESERVATN POLY LMRL SZ3 11.5M
|
Facility
|
OP
|
$9,218.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,198.36 |
| Max. Negotiated Rate |
$8,849.43 |
| Rate for Payer: Aetna Commercial |
$7,097.98
|
| Rate for Payer: Anthem Medicaid |
$3,170.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,190.16
|
| Rate for Payer: Cash Price |
$4,609.08
|
| Rate for Payer: Cigna Commercial |
$7,651.07
|
| Rate for Payer: First Health Commercial |
$8,757.25
|
| Rate for Payer: Humana Commercial |
$7,835.44
|
| Rate for Payer: Humana KY Medicaid |
$3,170.13
|
| Rate for Payer: Kentucky WC Medicaid |
$3,202.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,558.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,803.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,765.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,233.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,111.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,913.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,843.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,198.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,857.63
|
| Rate for Payer: PHCS Commercial |
$8,849.43
|
| Rate for Payer: United Healthcare All Payer |
$8,111.98
|
|
|
PRESERVATN POLY LMRL SZ3 11.5M
|
Facility
|
IP
|
$9,218.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,198.36 |
| Max. Negotiated Rate |
$8,849.43 |
| Rate for Payer: Aetna Commercial |
$7,097.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,190.16
|
| Rate for Payer: Cash Price |
$4,609.08
|
| Rate for Payer: Cigna Commercial |
$7,651.07
|
| Rate for Payer: First Health Commercial |
$8,757.25
|
| Rate for Payer: Humana Commercial |
$7,835.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,558.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,803.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,765.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,111.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,913.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,843.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,198.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,857.63
|
| Rate for Payer: PHCS Commercial |
$8,849.43
|
| Rate for Payer: United Healthcare All Payer |
$8,111.98
|
|
|
PRESERVATN POLY LMRL SZ 3 7MM
|
Facility
|
IP
|
$9,218.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,198.36 |
| Max. Negotiated Rate |
$8,849.43 |
| Rate for Payer: Aetna Commercial |
$7,097.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,190.16
|
| Rate for Payer: Cash Price |
$4,609.08
|
| Rate for Payer: Cigna Commercial |
$7,651.07
|
| Rate for Payer: First Health Commercial |
$8,757.25
|
| Rate for Payer: Humana Commercial |
$7,835.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,558.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,803.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,765.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,111.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,913.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,843.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,198.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,857.63
|
| Rate for Payer: PHCS Commercial |
$8,849.43
|
| Rate for Payer: United Healthcare All Payer |
$8,111.98
|
|
|
PRESERVATN POLY LMRL SZ 3 7MM
|
Facility
|
OP
|
$9,218.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,198.36 |
| Max. Negotiated Rate |
$8,849.43 |
| Rate for Payer: Aetna Commercial |
$7,097.98
|
| Rate for Payer: Anthem Medicaid |
$3,170.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,190.16
|
| Rate for Payer: Cash Price |
$4,609.08
|
| Rate for Payer: Cigna Commercial |
$7,651.07
|
| Rate for Payer: First Health Commercial |
$8,757.25
|
| Rate for Payer: Humana Commercial |
$7,835.44
|
| Rate for Payer: Humana KY Medicaid |
$3,170.13
|
| Rate for Payer: Kentucky WC Medicaid |
$3,202.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,558.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,803.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,765.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,233.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,111.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,913.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,843.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,198.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,857.63
|
| Rate for Payer: PHCS Commercial |
$8,849.43
|
| Rate for Payer: United Healthcare All Payer |
$8,111.98
|
|
|
PRESERVATN POLY LMRL SZ 3 9.5M
|
Facility
|
IP
|
$9,218.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,198.36 |
| Max. Negotiated Rate |
$8,849.43 |
| Rate for Payer: Aetna Commercial |
$7,097.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,190.16
|
| Rate for Payer: Cash Price |
$4,609.08
|
| Rate for Payer: Cigna Commercial |
$7,651.07
|
| Rate for Payer: First Health Commercial |
$8,757.25
|
| Rate for Payer: Humana Commercial |
$7,835.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,558.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,803.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,765.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,111.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,913.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,843.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,198.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,857.63
|
| Rate for Payer: PHCS Commercial |
$8,849.43
|
| Rate for Payer: United Healthcare All Payer |
$8,111.98
|
|
|
PRESERVATN POLY LMRL SZ 3 9.5M
|
Facility
|
OP
|
$9,218.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,198.36 |
| Max. Negotiated Rate |
$8,849.43 |
| Rate for Payer: Aetna Commercial |
$7,097.98
|
| Rate for Payer: Anthem Medicaid |
$3,170.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,190.16
|
| Rate for Payer: Cash Price |
$4,609.08
|
| Rate for Payer: Cigna Commercial |
$7,651.07
|
| Rate for Payer: First Health Commercial |
$8,757.25
|
| Rate for Payer: Humana Commercial |
$7,835.44
|
| Rate for Payer: Humana KY Medicaid |
$3,170.13
|
| Rate for Payer: Kentucky WC Medicaid |
$3,202.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,558.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,803.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,765.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,233.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,111.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,913.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,843.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,198.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,857.63
|
| Rate for Payer: PHCS Commercial |
$8,849.43
|
| Rate for Payer: United Healthcare All Payer |
$8,111.98
|
|
|
PRESERVATN POLY LMRL SZ4 11.5M
|
Facility
|
IP
|
$9,218.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,198.36 |
| Max. Negotiated Rate |
$8,849.43 |
| Rate for Payer: Aetna Commercial |
$7,097.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,190.16
|
| Rate for Payer: Cash Price |
$4,609.08
|
| Rate for Payer: Cigna Commercial |
$7,651.07
|
| Rate for Payer: First Health Commercial |
$8,757.25
|
| Rate for Payer: Humana Commercial |
$7,835.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,558.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,803.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,765.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,111.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,913.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,843.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,198.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,857.63
|
| Rate for Payer: PHCS Commercial |
$8,849.43
|
| Rate for Payer: United Healthcare All Payer |
$8,111.98
|
|
|
PRESERVATN POLY LMRL SZ4 11.5M
|
Facility
|
OP
|
$9,218.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,198.36 |
| Max. Negotiated Rate |
$8,849.43 |
| Rate for Payer: Aetna Commercial |
$7,097.98
|
| Rate for Payer: Anthem Medicaid |
$3,170.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,190.16
|
| Rate for Payer: Cash Price |
$4,609.08
|
| Rate for Payer: Cigna Commercial |
$7,651.07
|
| Rate for Payer: First Health Commercial |
$8,757.25
|
| Rate for Payer: Humana Commercial |
$7,835.44
|
| Rate for Payer: Humana KY Medicaid |
$3,170.13
|
| Rate for Payer: Kentucky WC Medicaid |
$3,202.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,558.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,803.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,765.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,233.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,111.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,913.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,843.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,198.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,857.63
|
| Rate for Payer: PHCS Commercial |
$8,849.43
|
| Rate for Payer: United Healthcare All Payer |
$8,111.98
|
|
