|
PLU PROMOS MONBLK STEM 02/30MM
|
Facility
|
OP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem Medicaid |
$5,712.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Humana KY Medicaid |
$5,712.18
|
| Rate for Payer: Kentucky WC Medicaid |
$5,770.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,826.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
PLU PROMOS MONBLK STEM 02/35MM
|
Facility
|
IP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
PLU PROMOS MONBLK STEM 02/35MM
|
Facility
|
OP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem Medicaid |
$5,712.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Humana KY Medicaid |
$5,712.18
|
| Rate for Payer: Kentucky WC Medicaid |
$5,770.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,826.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
PLU PROMOS MONBLK STEM 02/40MM
|
Facility
|
OP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem Medicaid |
$5,712.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Humana KY Medicaid |
$5,712.18
|
| Rate for Payer: Kentucky WC Medicaid |
$5,770.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,826.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
PLU PROMOS MONBLK STEM 02/40MM
|
Facility
|
IP
|
$16,610.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,983.00 |
| Max. Negotiated Rate |
$15,945.60 |
| Rate for Payer: Aetna Commercial |
$12,789.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,955.80
|
| Rate for Payer: Cash Price |
$8,305.00
|
| Rate for Payer: Cigna Commercial |
$13,786.30
|
| Rate for Payer: First Health Commercial |
$15,779.50
|
| Rate for Payer: Humana Commercial |
$14,118.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,620.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,258.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,983.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,616.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,450.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,460.90
|
| Rate for Payer: PHCS Commercial |
$15,945.60
|
| Rate for Payer: United Healthcare All Payer |
$14,616.80
|
|
|
PLU PROMOS REV PE-INSRT 36/12M
|
Facility
|
OP
|
$7,875.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,362.65 |
| Max. Negotiated Rate |
$7,560.47 |
| Rate for Payer: Aetna Commercial |
$6,064.13
|
| Rate for Payer: Anthem Medicaid |
$2,708.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,142.88
|
| Rate for Payer: Cash Price |
$3,937.74
|
| Rate for Payer: Cigna Commercial |
$6,536.66
|
| Rate for Payer: First Health Commercial |
$7,481.72
|
| Rate for Payer: Humana Commercial |
$6,694.17
|
| Rate for Payer: Humana KY Medicaid |
$2,708.38
|
| Rate for Payer: Kentucky WC Medicaid |
$2,735.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,457.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,812.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,362.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,762.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,930.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,906.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,300.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,851.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,434.09
|
| Rate for Payer: PHCS Commercial |
$7,560.47
|
| Rate for Payer: United Healthcare All Payer |
$6,930.43
|
|
|
PLU PROMOS REV PE-INSRT 36/12M
|
Facility
|
IP
|
$7,875.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,362.65 |
| Max. Negotiated Rate |
$7,560.47 |
| Rate for Payer: Aetna Commercial |
$6,064.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,142.88
|
| Rate for Payer: Cash Price |
$3,937.74
|
| Rate for Payer: Cigna Commercial |
$6,536.66
|
| Rate for Payer: First Health Commercial |
$7,481.72
|
| Rate for Payer: Humana Commercial |
$6,694.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,457.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,812.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,362.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,930.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,906.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,300.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,851.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,434.09
|
| Rate for Payer: PHCS Commercial |
$7,560.47
|
| Rate for Payer: United Healthcare All Payer |
$6,930.43
|
|
|
PLU PROMOS REV PE-INSRT 36/6MM
|
Facility
|
OP
|
$7,875.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,362.65 |
| Max. Negotiated Rate |
$7,560.47 |
| Rate for Payer: Aetna Commercial |
$6,064.13
|
| Rate for Payer: Anthem Medicaid |
$2,708.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,142.88
|
| Rate for Payer: Cash Price |
$3,937.74
|
| Rate for Payer: Cigna Commercial |
$6,536.66
|
| Rate for Payer: First Health Commercial |
$7,481.72
|
| Rate for Payer: Humana Commercial |
$6,694.17
|
| Rate for Payer: Humana KY Medicaid |
$2,708.38
|
| Rate for Payer: Kentucky WC Medicaid |
$2,735.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,457.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,812.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,362.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,762.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,930.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,906.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,300.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,851.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,434.09
|
| Rate for Payer: PHCS Commercial |
$7,560.47
|
| Rate for Payer: United Healthcare All Payer |
$6,930.43
|
|
|
PLU PROMOS REV PE-INSRT 36/6MM
|
Facility
|
IP
|
$7,875.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,362.65 |
| Max. Negotiated Rate |
$7,560.47 |
| Rate for Payer: Aetna Commercial |
$6,064.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,142.88
|
| Rate for Payer: Cash Price |
$3,937.74
|
| Rate for Payer: Cigna Commercial |
$6,536.66
|
| Rate for Payer: First Health Commercial |
$7,481.72
|
| Rate for Payer: Humana Commercial |
$6,694.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,457.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,812.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,362.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,930.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,906.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,300.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,851.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,434.09
|
| Rate for Payer: PHCS Commercial |
$7,560.47
|
| Rate for Payer: United Healthcare All Payer |
$6,930.43
|
|
|
PLU PROMOS REV PE-INSRT 36/9MM
|
Facility
|
IP
|
$7,875.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,362.65 |
| Max. Negotiated Rate |
$7,560.47 |
| Rate for Payer: Aetna Commercial |
$6,064.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,142.88
|
| Rate for Payer: Cash Price |
$3,937.74
|
| Rate for Payer: Cigna Commercial |
$6,536.66
|
| Rate for Payer: First Health Commercial |
$7,481.72
|
| Rate for Payer: Humana Commercial |
$6,694.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,457.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,812.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,362.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,930.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,906.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,300.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,851.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,434.09
|
| Rate for Payer: PHCS Commercial |
$7,560.47
|
| Rate for Payer: United Healthcare All Payer |
$6,930.43
|
|
|
PLU PROMOS REV PE-INSRT 36/9MM
|
Facility
|
OP
|
$7,875.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,362.65 |
| Max. Negotiated Rate |
$7,560.47 |
| Rate for Payer: Aetna Commercial |
$6,064.13
|
| Rate for Payer: Anthem Medicaid |
$2,708.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,142.88
|
| Rate for Payer: Cash Price |
$3,937.74
|
| Rate for Payer: Cigna Commercial |
$6,536.66
|
| Rate for Payer: First Health Commercial |
$7,481.72
|
| Rate for Payer: Humana Commercial |
$6,694.17
|
| Rate for Payer: Humana KY Medicaid |
$2,708.38
|
| Rate for Payer: Kentucky WC Medicaid |
$2,735.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,457.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,812.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,362.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,762.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,930.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,906.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,300.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,851.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,434.09
|
| Rate for Payer: PHCS Commercial |
$7,560.47
|
| Rate for Payer: United Healthcare All Payer |
$6,930.43
|
|
|
PLU PROMOS REV PE-INSRT 42/12M
|
Facility
|
OP
|
$11,741.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,522.57 |
| Max. Negotiated Rate |
$11,272.22 |
| Rate for Payer: Aetna Commercial |
$9,041.26
|
| Rate for Payer: Anthem Medicaid |
$4,038.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,158.68
|
| Rate for Payer: Cash Price |
$5,870.95
|
| Rate for Payer: Cigna Commercial |
$9,745.78
|
| Rate for Payer: First Health Commercial |
$11,154.81
|
| Rate for Payer: Humana Commercial |
$9,980.61
|
| Rate for Payer: Humana KY Medicaid |
$4,038.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,079.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,628.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,665.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,522.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,119.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,332.87
|
| Rate for Payer: Ohio Health Group HMO |
$8,806.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,393.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,215.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,101.91
|
| Rate for Payer: PHCS Commercial |
$11,272.22
|
| Rate for Payer: United Healthcare All Payer |
$10,332.87
|
|
|
PLU PROMOS REV PE-INSRT 42/12M
|
Facility
|
IP
|
$11,741.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,522.57 |
| Max. Negotiated Rate |
$11,272.22 |
| Rate for Payer: Aetna Commercial |
$9,041.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,158.68
|
| Rate for Payer: Cash Price |
$5,870.95
|
| Rate for Payer: Cigna Commercial |
$9,745.78
|
| Rate for Payer: First Health Commercial |
$11,154.81
|
| Rate for Payer: Humana Commercial |
$9,980.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,628.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,665.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,522.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,332.87
|
| Rate for Payer: Ohio Health Group HMO |
$8,806.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,393.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,215.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,101.91
|
| Rate for Payer: PHCS Commercial |
$11,272.22
|
| Rate for Payer: United Healthcare All Payer |
$10,332.87
|
|
|
PLU PROMOS REV PE-INSRT 42/6MM
|
Facility
|
OP
|
$8,429.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,528.81 |
| Max. Negotiated Rate |
$8,092.20 |
| Rate for Payer: Aetna Commercial |
$6,490.62
|
| Rate for Payer: Anthem Medicaid |
$2,898.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,574.92
|
| Rate for Payer: Cash Price |
$4,214.69
|
| Rate for Payer: Cigna Commercial |
$6,996.39
|
| Rate for Payer: First Health Commercial |
$8,007.91
|
| Rate for Payer: Humana Commercial |
$7,164.97
|
| Rate for Payer: Humana KY Medicaid |
$2,898.86
|
| Rate for Payer: Kentucky WC Medicaid |
$2,928.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,912.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,220.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,528.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,957.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,417.85
|
| Rate for Payer: Ohio Health Group HMO |
$6,322.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,743.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,333.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,816.27
|
| Rate for Payer: PHCS Commercial |
$8,092.20
|
| Rate for Payer: United Healthcare All Payer |
$7,417.85
|
|
|
PLU PROMOS REV PE-INSRT 42/6MM
|
Facility
|
IP
|
$8,429.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,528.81 |
| Max. Negotiated Rate |
$8,092.20 |
| Rate for Payer: Aetna Commercial |
$6,490.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,574.92
|
| Rate for Payer: Cash Price |
$4,214.69
|
| Rate for Payer: Cigna Commercial |
$6,996.39
|
| Rate for Payer: First Health Commercial |
$8,007.91
|
| Rate for Payer: Humana Commercial |
$7,164.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,912.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,220.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,528.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,417.85
|
| Rate for Payer: Ohio Health Group HMO |
$6,322.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,743.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,333.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,816.27
|
| Rate for Payer: PHCS Commercial |
$8,092.20
|
| Rate for Payer: United Healthcare All Payer |
$7,417.85
|
|
|
PLU PROMOS REV PE-INSRT 42/9MM
|
Facility
|
OP
|
$8,429.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,528.81 |
| Max. Negotiated Rate |
$8,092.20 |
| Rate for Payer: Aetna Commercial |
$6,490.62
|
| Rate for Payer: Anthem Medicaid |
$2,898.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,574.92
|
| Rate for Payer: Cash Price |
$4,214.69
|
| Rate for Payer: Cigna Commercial |
$6,996.39
|
| Rate for Payer: First Health Commercial |
$8,007.91
|
| Rate for Payer: Humana Commercial |
$7,164.97
|
| Rate for Payer: Humana KY Medicaid |
$2,898.86
|
| Rate for Payer: Kentucky WC Medicaid |
$2,928.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,912.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,220.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,528.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,957.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,417.85
|
| Rate for Payer: Ohio Health Group HMO |
$6,322.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,743.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,333.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,816.27
|
| Rate for Payer: PHCS Commercial |
$8,092.20
|
| Rate for Payer: United Healthcare All Payer |
$7,417.85
|
|
|
PLU PROMOS REV PE-INSRT 42/9MM
|
Facility
|
IP
|
$8,429.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,528.81 |
| Max. Negotiated Rate |
$8,092.20 |
| Rate for Payer: Aetna Commercial |
$6,490.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,574.92
|
| Rate for Payer: Cash Price |
$4,214.69
|
| Rate for Payer: Cigna Commercial |
$6,996.39
|
| Rate for Payer: First Health Commercial |
$8,007.91
|
| Rate for Payer: Humana Commercial |
$7,164.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,912.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,220.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,528.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,417.85
|
| Rate for Payer: Ohio Health Group HMO |
$6,322.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,743.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,333.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,816.27
|
| Rate for Payer: PHCS Commercial |
$8,092.20
|
| Rate for Payer: United Healthcare All Payer |
$7,417.85
|
|
|
PLUS PROMO HUM STEM 1
|
Facility
|
IP
|
$8,112.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.82 |
| Max. Negotiated Rate |
$7,788.23 |
| Rate for Payer: Aetna Commercial |
$6,246.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,327.94
|
| Rate for Payer: Cash Price |
$4,056.37
|
| Rate for Payer: Cigna Commercial |
$6,733.57
|
| Rate for Payer: First Health Commercial |
$7,707.10
|
| Rate for Payer: Humana Commercial |
$6,895.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,652.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,987.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,433.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,139.21
|
| Rate for Payer: Ohio Health Group HMO |
$6,084.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,490.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,058.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,597.79
|
| Rate for Payer: PHCS Commercial |
$7,788.23
|
| Rate for Payer: United Healthcare All Payer |
$7,139.21
|
|
|
PLUS PROMO HUM STEM 1
|
Facility
|
OP
|
$8,112.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.82 |
| Max. Negotiated Rate |
$7,788.23 |
| Rate for Payer: Aetna Commercial |
$6,246.81
|
| Rate for Payer: Anthem Medicaid |
$2,789.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,327.94
|
| Rate for Payer: Cash Price |
$4,056.37
|
| Rate for Payer: Cigna Commercial |
$6,733.57
|
| Rate for Payer: First Health Commercial |
$7,707.10
|
| Rate for Payer: Humana Commercial |
$6,895.83
|
| Rate for Payer: Humana KY Medicaid |
$2,789.97
|
| Rate for Payer: Kentucky WC Medicaid |
$2,818.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,652.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,987.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,433.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,845.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,139.21
|
| Rate for Payer: Ohio Health Group HMO |
$6,084.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,490.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,058.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,597.79
|
| Rate for Payer: PHCS Commercial |
$7,788.23
|
| Rate for Payer: United Healthcare All Payer |
$7,139.21
|
|
|
PLUS PROMO HUM STEM 2.5
|
Facility
|
IP
|
$8,112.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.82 |
| Max. Negotiated Rate |
$7,788.23 |
| Rate for Payer: Aetna Commercial |
$6,246.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,327.94
|
| Rate for Payer: Cash Price |
$4,056.37
|
| Rate for Payer: Cigna Commercial |
$6,733.57
|
| Rate for Payer: First Health Commercial |
$7,707.10
|
| Rate for Payer: Humana Commercial |
$6,895.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,652.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,987.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,433.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,139.21
|
| Rate for Payer: Ohio Health Group HMO |
$6,084.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,490.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,058.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,597.79
|
| Rate for Payer: PHCS Commercial |
$7,788.23
|
| Rate for Payer: United Healthcare All Payer |
$7,139.21
|
|
|
PLUS PROMO HUM STEM 2.5
|
Facility
|
OP
|
$8,112.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.82 |
| Max. Negotiated Rate |
$7,788.23 |
| Rate for Payer: Aetna Commercial |
$6,246.81
|
| Rate for Payer: Anthem Medicaid |
$2,789.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,327.94
|
| Rate for Payer: Cash Price |
$4,056.37
|
| Rate for Payer: Cigna Commercial |
$6,733.57
|
| Rate for Payer: First Health Commercial |
$7,707.10
|
| Rate for Payer: Humana Commercial |
$6,895.83
|
| Rate for Payer: Humana KY Medicaid |
$2,789.97
|
| Rate for Payer: Kentucky WC Medicaid |
$2,818.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,652.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,987.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,433.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,845.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,139.21
|
| Rate for Payer: Ohio Health Group HMO |
$6,084.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,490.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,058.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,597.79
|
| Rate for Payer: PHCS Commercial |
$7,788.23
|
| Rate for Payer: United Healthcare All Payer |
$7,139.21
|
|
|
PLUS PROMOS BODY 30MM
|
Facility
|
IP
|
$7,590.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,277.24 |
| Max. Negotiated Rate |
$7,287.16 |
| Rate for Payer: Aetna Commercial |
$5,844.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,920.82
|
| Rate for Payer: Cash Price |
$3,795.39
|
| Rate for Payer: Cigna Commercial |
$6,300.36
|
| Rate for Payer: First Health Commercial |
$7,211.25
|
| Rate for Payer: Humana Commercial |
$6,452.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,224.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,602.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,277.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,679.90
|
| Rate for Payer: Ohio Health Group HMO |
$5,693.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,072.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,603.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,237.65
|
| Rate for Payer: PHCS Commercial |
$7,287.16
|
| Rate for Payer: United Healthcare All Payer |
$6,679.90
|
|
|
PLUS PROMOS BODY 30MM
|
Facility
|
OP
|
$7,590.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,277.24 |
| Max. Negotiated Rate |
$7,287.16 |
| Rate for Payer: Aetna Commercial |
$5,844.91
|
| Rate for Payer: Anthem Medicaid |
$2,610.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,920.82
|
| Rate for Payer: Cash Price |
$3,795.39
|
| Rate for Payer: Cigna Commercial |
$6,300.36
|
| Rate for Payer: First Health Commercial |
$7,211.25
|
| Rate for Payer: Humana Commercial |
$6,452.17
|
| Rate for Payer: Humana KY Medicaid |
$2,610.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,637.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,224.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,602.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,277.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,662.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,679.90
|
| Rate for Payer: Ohio Health Group HMO |
$5,693.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,072.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,603.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,237.65
|
| Rate for Payer: PHCS Commercial |
$7,287.16
|
| Rate for Payer: United Healthcare All Payer |
$6,679.90
|
|
|
PLUS PROMOS BODY 35MM
|
Facility
|
OP
|
$9,022.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,706.75 |
| Max. Negotiated Rate |
$8,661.60 |
| Rate for Payer: Aetna Commercial |
$6,947.32
|
| Rate for Payer: Anthem Medicaid |
$3,102.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,037.55
|
| Rate for Payer: Cash Price |
$4,511.25
|
| Rate for Payer: Cigna Commercial |
$7,488.68
|
| Rate for Payer: First Health Commercial |
$8,571.38
|
| Rate for Payer: Humana Commercial |
$7,669.12
|
| Rate for Payer: Humana KY Medicaid |
$3,102.84
|
| Rate for Payer: Kentucky WC Medicaid |
$3,134.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,398.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,658.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,706.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,165.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,939.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,766.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,218.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,849.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,225.52
|
| Rate for Payer: PHCS Commercial |
$8,661.60
|
| Rate for Payer: United Healthcare All Payer |
$7,939.80
|
|
|
PLUS PROMOS BODY 35MM
|
Facility
|
IP
|
$9,022.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,706.75 |
| Max. Negotiated Rate |
$8,661.60 |
| Rate for Payer: Aetna Commercial |
$6,947.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,037.55
|
| Rate for Payer: Cash Price |
$4,511.25
|
| Rate for Payer: Cigna Commercial |
$7,488.68
|
| Rate for Payer: First Health Commercial |
$8,571.38
|
| Rate for Payer: Humana Commercial |
$7,669.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,398.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,658.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,706.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,939.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,766.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,218.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,849.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,225.52
|
| Rate for Payer: PHCS Commercial |
$8,661.60
|
| Rate for Payer: United Healthcare All Payer |
$7,939.80
|
|
