|
PRESERVATN POLY LMRL SZ 4 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 4 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 4 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 4 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 SZ5 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 SZ5 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 5 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 5 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 5 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 5 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 RMLL 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 RMLL 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 RMLL 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 RMLL 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 RMLL 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 RMLL 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 RMLL 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 RMLL 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 RMLL 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 RMLL 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 RMLL 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 RMLL 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 RMLL 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 RMLL 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 RMLL 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
|
|
