|
PLUS PROMOS HUM HD R 22/H18+4
|
Facility
|
IP
|
$8,910.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.08 |
| Max. Negotiated Rate |
$8,553.85 |
| Rate for Payer: Aetna Commercial |
$6,860.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,950.00
|
| Rate for Payer: Cash Price |
$4,455.13
|
| Rate for Payer: Cigna Commercial |
$7,395.52
|
| Rate for Payer: First Health Commercial |
$8,464.75
|
| Rate for Payer: Humana Commercial |
$7,573.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,306.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,575.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,841.03
|
| Rate for Payer: Ohio Health Group HMO |
$6,682.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,128.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,751.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,148.08
|
| Rate for Payer: PHCS Commercial |
$8,553.85
|
| Rate for Payer: United Healthcare All Payer |
$7,841.03
|
|
|
PLUS PROMOS HUM HD R 22/H18+4
|
Facility
|
OP
|
$8,910.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.08 |
| Max. Negotiated Rate |
$8,553.85 |
| Rate for Payer: Aetna Commercial |
$6,860.90
|
| Rate for Payer: Anthem Medicaid |
$3,064.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,950.00
|
| Rate for Payer: Cash Price |
$4,455.13
|
| Rate for Payer: Cigna Commercial |
$7,395.52
|
| Rate for Payer: First Health Commercial |
$8,464.75
|
| Rate for Payer: Humana Commercial |
$7,573.72
|
| Rate for Payer: Humana KY Medicaid |
$3,064.24
|
| Rate for Payer: Kentucky WC Medicaid |
$3,095.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,306.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,575.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,125.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,841.03
|
| Rate for Payer: Ohio Health Group HMO |
$6,682.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,128.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,751.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,148.08
|
| Rate for Payer: PHCS Commercial |
$8,553.85
|
| Rate for Payer: United Healthcare All Payer |
$7,841.03
|
|
|
PLUS PROMOS HUM HD R 23/+7
|
Facility
|
OP
|
$9,953.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,985.97 |
| Max. Negotiated Rate |
$9,555.12 |
| Rate for Payer: Aetna Commercial |
$7,664.00
|
| Rate for Payer: Anthem Medicaid |
$3,422.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,763.53
|
| Rate for Payer: Cash Price |
$4,976.62
|
| Rate for Payer: Cigna Commercial |
$8,261.20
|
| Rate for Payer: First Health Commercial |
$9,455.59
|
| Rate for Payer: Humana Commercial |
$8,460.26
|
| Rate for Payer: Humana KY Medicaid |
$3,422.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,457.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,161.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,345.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,985.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,491.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,758.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,464.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,962.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,659.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,867.74
|
| Rate for Payer: PHCS Commercial |
$9,555.12
|
| Rate for Payer: United Healthcare All Payer |
$8,758.86
|
|
|
PLUS PROMOS HUM HD R 23/+7
|
Facility
|
IP
|
$9,953.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,985.97 |
| Max. Negotiated Rate |
$9,555.12 |
| Rate for Payer: Aetna Commercial |
$7,664.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,763.53
|
| Rate for Payer: Cash Price |
$4,976.62
|
| Rate for Payer: Cigna Commercial |
$8,261.20
|
| Rate for Payer: First Health Commercial |
$9,455.59
|
| Rate for Payer: Humana Commercial |
$8,460.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,161.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,345.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,985.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,758.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,464.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,962.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,659.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,867.74
|
| Rate for Payer: PHCS Commercial |
$9,555.12
|
| Rate for Payer: United Healthcare All Payer |
$8,758.86
|
|
|
PLUS PROMOS HUM HD R 23/H19+4
|
Facility
|
IP
|
$9,953.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,985.97 |
| Max. Negotiated Rate |
$9,555.12 |
| Rate for Payer: Aetna Commercial |
$7,664.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,763.53
|
| Rate for Payer: Cash Price |
$4,976.62
|
| Rate for Payer: Cigna Commercial |
$8,261.20
|
| Rate for Payer: First Health Commercial |
$9,455.59
|
| Rate for Payer: Humana Commercial |
$8,460.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,161.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,345.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,985.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,758.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,464.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,962.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,659.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,867.74
|
| Rate for Payer: PHCS Commercial |
$9,555.12
|
| Rate for Payer: United Healthcare All Payer |
$8,758.86
|
|
|
PLUS PROMOS HUM HD R 23/H19+4
|
Facility
|
OP
|
$9,953.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,985.97 |
| Max. Negotiated Rate |
$9,555.12 |
| Rate for Payer: Aetna Commercial |
$7,664.00
|
| Rate for Payer: Anthem Medicaid |
$3,422.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,763.53
|
| Rate for Payer: Cash Price |
$4,976.62
|
| Rate for Payer: Cigna Commercial |
$8,261.20
|
| Rate for Payer: First Health Commercial |
$9,455.59
|
| Rate for Payer: Humana Commercial |
$8,460.26
|
| Rate for Payer: Humana KY Medicaid |
$3,422.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,457.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,161.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,345.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,985.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,491.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,758.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,464.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,962.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,659.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,867.74
|
| Rate for Payer: PHCS Commercial |
$9,555.12
|
| Rate for Payer: United Healthcare All Payer |
$8,758.86
|
|
|
PLUS PROMOS HUM HD R 24/+7
|
Facility
|
IP
|
$9,953.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,985.97 |
| Max. Negotiated Rate |
$9,555.12 |
| Rate for Payer: Aetna Commercial |
$7,664.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,763.53
|
| Rate for Payer: Cash Price |
$4,976.62
|
| Rate for Payer: Cigna Commercial |
$8,261.20
|
| Rate for Payer: First Health Commercial |
$9,455.59
|
| Rate for Payer: Humana Commercial |
$8,460.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,161.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,345.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,985.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,758.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,464.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,962.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,659.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,867.74
|
| Rate for Payer: PHCS Commercial |
$9,555.12
|
| Rate for Payer: United Healthcare All Payer |
$8,758.86
|
|
|
PLUS PROMOS HUM HD R 24/+7
|
Facility
|
OP
|
$9,953.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,985.97 |
| Max. Negotiated Rate |
$9,555.12 |
| Rate for Payer: Aetna Commercial |
$7,664.00
|
| Rate for Payer: Anthem Medicaid |
$3,422.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,763.53
|
| Rate for Payer: Cash Price |
$4,976.62
|
| Rate for Payer: Cigna Commercial |
$8,261.20
|
| Rate for Payer: First Health Commercial |
$9,455.59
|
| Rate for Payer: Humana Commercial |
$8,460.26
|
| Rate for Payer: Humana KY Medicaid |
$3,422.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,457.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,161.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,345.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,985.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,491.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,758.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,464.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,962.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,659.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,867.74
|
| Rate for Payer: PHCS Commercial |
$9,555.12
|
| Rate for Payer: United Healthcare All Payer |
$8,758.86
|
|
|
PLUS PROMOS HUM HD R 24/H20+4
|
Facility
|
IP
|
$8,910.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.08 |
| Max. Negotiated Rate |
$8,553.85 |
| Rate for Payer: Aetna Commercial |
$6,860.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,950.00
|
| Rate for Payer: Cash Price |
$4,455.13
|
| Rate for Payer: Cigna Commercial |
$7,395.52
|
| Rate for Payer: First Health Commercial |
$8,464.75
|
| Rate for Payer: Humana Commercial |
$7,573.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,306.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,575.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,841.03
|
| Rate for Payer: Ohio Health Group HMO |
$6,682.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,128.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,751.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,148.08
|
| Rate for Payer: PHCS Commercial |
$8,553.85
|
| Rate for Payer: United Healthcare All Payer |
$7,841.03
|
|
|
PLUS PROMOS HUM HD R 24/H20+4
|
Facility
|
OP
|
$8,910.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.08 |
| Max. Negotiated Rate |
$8,553.85 |
| Rate for Payer: Aetna Commercial |
$6,860.90
|
| Rate for Payer: Anthem Medicaid |
$3,064.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,950.00
|
| Rate for Payer: Cash Price |
$4,455.13
|
| Rate for Payer: Cigna Commercial |
$7,395.52
|
| Rate for Payer: First Health Commercial |
$8,464.75
|
| Rate for Payer: Humana Commercial |
$7,573.72
|
| Rate for Payer: Humana KY Medicaid |
$3,064.24
|
| Rate for Payer: Kentucky WC Medicaid |
$3,095.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,306.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,575.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,125.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,841.03
|
| Rate for Payer: Ohio Health Group HMO |
$6,682.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,128.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,751.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,148.08
|
| Rate for Payer: PHCS Commercial |
$8,553.85
|
| Rate for Payer: United Healthcare All Payer |
$7,841.03
|
|
|
PLUS PROMOS HUM HD R 25/+7
|
Facility
|
IP
|
$9,953.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,985.97 |
| Max. Negotiated Rate |
$9,555.12 |
| Rate for Payer: Aetna Commercial |
$7,664.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,763.53
|
| Rate for Payer: Cash Price |
$4,976.62
|
| Rate for Payer: Cigna Commercial |
$8,261.20
|
| Rate for Payer: First Health Commercial |
$9,455.59
|
| Rate for Payer: Humana Commercial |
$8,460.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,161.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,345.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,985.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,758.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,464.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,962.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,659.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,867.74
|
| Rate for Payer: PHCS Commercial |
$9,555.12
|
| Rate for Payer: United Healthcare All Payer |
$8,758.86
|
|
|
PLUS PROMOS HUM HD R 25/+7
|
Facility
|
OP
|
$9,953.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,985.97 |
| Max. Negotiated Rate |
$9,555.12 |
| Rate for Payer: Aetna Commercial |
$7,664.00
|
| Rate for Payer: Anthem Medicaid |
$3,422.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,763.53
|
| Rate for Payer: Cash Price |
$4,976.62
|
| Rate for Payer: Cigna Commercial |
$8,261.20
|
| Rate for Payer: First Health Commercial |
$9,455.59
|
| Rate for Payer: Humana Commercial |
$8,460.26
|
| Rate for Payer: Humana KY Medicaid |
$3,422.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,457.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,161.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,345.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,985.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,491.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,758.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,464.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,962.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,659.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,867.74
|
| Rate for Payer: PHCS Commercial |
$9,555.12
|
| Rate for Payer: United Healthcare All Payer |
$8,758.86
|
|
|
PLUS PROMOS HUM HD R 25/H21+4
|
Facility
|
IP
|
$9,953.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,985.97 |
| Max. Negotiated Rate |
$9,555.12 |
| Rate for Payer: Aetna Commercial |
$7,664.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,763.53
|
| Rate for Payer: Cash Price |
$4,976.62
|
| Rate for Payer: Cigna Commercial |
$8,261.20
|
| Rate for Payer: First Health Commercial |
$9,455.59
|
| Rate for Payer: Humana Commercial |
$8,460.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,161.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,345.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,985.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,758.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,464.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,962.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,659.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,867.74
|
| Rate for Payer: PHCS Commercial |
$9,555.12
|
| Rate for Payer: United Healthcare All Payer |
$8,758.86
|
|
|
PLUS PROMOS HUM HD R 25/H21+4
|
Facility
|
OP
|
$9,953.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,985.97 |
| Max. Negotiated Rate |
$9,555.12 |
| Rate for Payer: Aetna Commercial |
$7,664.00
|
| Rate for Payer: Anthem Medicaid |
$3,422.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,763.53
|
| Rate for Payer: Cash Price |
$4,976.62
|
| Rate for Payer: Cigna Commercial |
$8,261.20
|
| Rate for Payer: First Health Commercial |
$9,455.59
|
| Rate for Payer: Humana Commercial |
$8,460.26
|
| Rate for Payer: Humana KY Medicaid |
$3,422.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,457.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,161.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,345.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,985.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,491.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,758.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,464.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,962.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,659.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,867.74
|
| Rate for Payer: PHCS Commercial |
$9,555.12
|
| Rate for Payer: United Healthcare All Payer |
$8,758.86
|
|
|
PLUS PROMOS HUM HD R 26/+7
|
Facility
|
IP
|
$9,953.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,985.97 |
| Max. Negotiated Rate |
$9,555.12 |
| Rate for Payer: Aetna Commercial |
$7,664.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,763.53
|
| Rate for Payer: Cash Price |
$4,976.62
|
| Rate for Payer: Cigna Commercial |
$8,261.20
|
| Rate for Payer: First Health Commercial |
$9,455.59
|
| Rate for Payer: Humana Commercial |
$8,460.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,161.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,345.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,985.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,758.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,464.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,962.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,659.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,867.74
|
| Rate for Payer: PHCS Commercial |
$9,555.12
|
| Rate for Payer: United Healthcare All Payer |
$8,758.86
|
|
|
PLUS PROMOS HUM HD R 26/+7
|
Facility
|
OP
|
$9,953.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,985.97 |
| Max. Negotiated Rate |
$9,555.12 |
| Rate for Payer: Aetna Commercial |
$7,664.00
|
| Rate for Payer: Anthem Medicaid |
$3,422.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,763.53
|
| Rate for Payer: Cash Price |
$4,976.62
|
| Rate for Payer: Cigna Commercial |
$8,261.20
|
| Rate for Payer: First Health Commercial |
$9,455.59
|
| Rate for Payer: Humana Commercial |
$8,460.26
|
| Rate for Payer: Humana KY Medicaid |
$3,422.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,457.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,161.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,345.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,985.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,491.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,758.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,464.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,962.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,659.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,867.74
|
| Rate for Payer: PHCS Commercial |
$9,555.12
|
| Rate for Payer: United Healthcare All Payer |
$8,758.86
|
|
|
PLUS PROMOS HUM HD R 26/H21+4
|
Facility
|
IP
|
$9,953.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,985.97 |
| Max. Negotiated Rate |
$9,555.12 |
| Rate for Payer: Aetna Commercial |
$7,664.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,763.53
|
| Rate for Payer: Cash Price |
$4,976.62
|
| Rate for Payer: Cigna Commercial |
$8,261.20
|
| Rate for Payer: First Health Commercial |
$9,455.59
|
| Rate for Payer: Humana Commercial |
$8,460.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,161.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,345.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,985.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,758.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,464.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,962.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,659.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,867.74
|
| Rate for Payer: PHCS Commercial |
$9,555.12
|
| Rate for Payer: United Healthcare All Payer |
$8,758.86
|
|
|
PLUS PROMOS HUM HD R 26/H21+4
|
Facility
|
OP
|
$9,953.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,985.97 |
| Max. Negotiated Rate |
$9,555.12 |
| Rate for Payer: Aetna Commercial |
$7,664.00
|
| Rate for Payer: Anthem Medicaid |
$3,422.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,763.53
|
| Rate for Payer: Cash Price |
$4,976.62
|
| Rate for Payer: Cigna Commercial |
$8,261.20
|
| Rate for Payer: First Health Commercial |
$9,455.59
|
| Rate for Payer: Humana Commercial |
$8,460.26
|
| Rate for Payer: Humana KY Medicaid |
$3,422.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,457.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,161.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,345.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,985.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,491.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,758.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,464.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,962.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,659.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,867.74
|
| Rate for Payer: PHCS Commercial |
$9,555.12
|
| Rate for Payer: United Healthcare All Payer |
$8,758.86
|
|
|
PLUS PROMOS HUM HD R 26/H21+6
|
Facility
|
IP
|
$9,953.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,985.97 |
| Max. Negotiated Rate |
$9,555.12 |
| Rate for Payer: Aetna Commercial |
$7,664.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,763.53
|
| Rate for Payer: Cash Price |
$4,976.62
|
| Rate for Payer: Cigna Commercial |
$8,261.20
|
| Rate for Payer: First Health Commercial |
$9,455.59
|
| Rate for Payer: Humana Commercial |
$8,460.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,161.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,345.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,985.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,758.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,464.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,962.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,659.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,867.74
|
| Rate for Payer: PHCS Commercial |
$9,555.12
|
| Rate for Payer: United Healthcare All Payer |
$8,758.86
|
|
|
PLUS PROMOS HUM HD R 26/H21+6
|
Facility
|
OP
|
$9,953.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,985.97 |
| Max. Negotiated Rate |
$9,555.12 |
| Rate for Payer: Aetna Commercial |
$7,664.00
|
| Rate for Payer: Anthem Medicaid |
$3,422.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,763.53
|
| Rate for Payer: Cash Price |
$4,976.62
|
| Rate for Payer: Cigna Commercial |
$8,261.20
|
| Rate for Payer: First Health Commercial |
$9,455.59
|
| Rate for Payer: Humana Commercial |
$8,460.26
|
| Rate for Payer: Humana KY Medicaid |
$3,422.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,457.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,161.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,345.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,985.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,491.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,758.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,464.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,962.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,659.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,867.74
|
| Rate for Payer: PHCS Commercial |
$9,555.12
|
| Rate for Payer: United Healthcare All Payer |
$8,758.86
|
|
|
PLUS PROMOS HUM HD R 27/+7
|
Facility
|
IP
|
$8,421.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,526.35 |
| Max. Negotiated Rate |
$8,084.31 |
| Rate for Payer: Aetna Commercial |
$6,484.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,568.50
|
| Rate for Payer: Cash Price |
$4,210.58
|
| Rate for Payer: Cigna Commercial |
$6,989.56
|
| Rate for Payer: First Health Commercial |
$8,000.10
|
| Rate for Payer: Humana Commercial |
$7,157.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,905.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,410.62
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,736.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,326.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,810.60
|
| Rate for Payer: PHCS Commercial |
$8,084.31
|
| Rate for Payer: United Healthcare All Payer |
$7,410.62
|
|
|
PLUS PROMOS HUM HD R 27/+7
|
Facility
|
OP
|
$8,421.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,526.35 |
| Max. Negotiated Rate |
$8,084.31 |
| Rate for Payer: Aetna Commercial |
$6,484.29
|
| Rate for Payer: Anthem Medicaid |
$2,896.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,568.50
|
| Rate for Payer: Cash Price |
$4,210.58
|
| Rate for Payer: Cigna Commercial |
$6,989.56
|
| Rate for Payer: First Health Commercial |
$8,000.10
|
| Rate for Payer: Humana Commercial |
$7,157.99
|
| Rate for Payer: Humana KY Medicaid |
$2,896.04
|
| Rate for Payer: Kentucky WC Medicaid |
$2,925.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,905.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,954.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,410.62
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,736.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,326.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,810.60
|
| Rate for Payer: PHCS Commercial |
$8,084.31
|
| Rate for Payer: United Healthcare All Payer |
$7,410.62
|
|
|
PLUS PROMOS HUM HD R 28/H16+7
|
Facility
|
OP
|
$9,953.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,985.97 |
| Max. Negotiated Rate |
$9,555.12 |
| Rate for Payer: Aetna Commercial |
$7,664.00
|
| Rate for Payer: Anthem Medicaid |
$3,422.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,763.53
|
| Rate for Payer: Cash Price |
$4,976.62
|
| Rate for Payer: Cigna Commercial |
$8,261.20
|
| Rate for Payer: First Health Commercial |
$9,455.59
|
| Rate for Payer: Humana Commercial |
$8,460.26
|
| Rate for Payer: Humana KY Medicaid |
$3,422.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,457.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,161.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,345.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,985.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,491.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,758.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,464.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,962.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,659.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,867.74
|
| Rate for Payer: PHCS Commercial |
$9,555.12
|
| Rate for Payer: United Healthcare All Payer |
$8,758.86
|
|
|
PLUS PROMOS HUM HD R 28/H16+7
|
Facility
|
IP
|
$9,953.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,985.97 |
| Max. Negotiated Rate |
$9,555.12 |
| Rate for Payer: Aetna Commercial |
$7,664.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,763.53
|
| Rate for Payer: Cash Price |
$4,976.62
|
| Rate for Payer: Cigna Commercial |
$8,261.20
|
| Rate for Payer: First Health Commercial |
$9,455.59
|
| Rate for Payer: Humana Commercial |
$8,460.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,161.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,345.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,985.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,758.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,464.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,962.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,659.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,867.74
|
| Rate for Payer: PHCS Commercial |
$9,555.12
|
| Rate for Payer: United Healthcare All Payer |
$8,758.86
|
|
|
PLUS PROMOS HUM STEM 0
|
Facility
|
OP
|
$8,475.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.77 |
| Max. Negotiated Rate |
$8,136.87 |
| Rate for Payer: Aetna Commercial |
$6,526.45
|
| Rate for Payer: Anthem Medicaid |
$2,914.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,611.21
|
| Rate for Payer: Cash Price |
$4,237.96
|
| Rate for Payer: Cigna Commercial |
$7,035.01
|
| Rate for Payer: First Health Commercial |
$8,052.11
|
| Rate for Payer: Humana Commercial |
$7,204.52
|
| Rate for Payer: Humana KY Medicaid |
$2,914.87
|
| Rate for Payer: Kentucky WC Medicaid |
$2,944.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,950.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,255.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,973.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,374.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,848.38
|
| Rate for Payer: PHCS Commercial |
$8,136.87
|
| Rate for Payer: United Healthcare All Payer |
$7,458.80
|
|
