|
PLUS PROMOS HUM STEM 0
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PLUS PROMOS HUM STEM 01
|
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 PROMOS HUM STEM 01
|
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 HUM STEM 1.5
|
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 PROMOS HUM STEM 1.5
|
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 HUM STEM 2
|
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 PROMOS HUM STEM 2
|
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 HUM STEM 2.5
|
Facility
|
OP
|
$7,489.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,246.85 |
| Max. Negotiated Rate |
$7,189.92 |
| Rate for Payer: Aetna Commercial |
$5,766.91
|
| Rate for Payer: Anthem Medicaid |
$2,575.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,841.81
|
| Rate for Payer: Cash Price |
$3,744.75
|
| Rate for Payer: Cigna Commercial |
$6,216.28
|
| Rate for Payer: First Health Commercial |
$7,115.02
|
| Rate for Payer: Humana Commercial |
$6,366.07
|
| Rate for Payer: Humana KY Medicaid |
$2,575.64
|
| Rate for Payer: Kentucky WC Medicaid |
$2,601.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,141.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,527.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,246.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,627.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,590.76
|
| Rate for Payer: Ohio Health Group HMO |
$5,617.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,991.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,515.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,167.76
|
| Rate for Payer: PHCS Commercial |
$7,189.92
|
| Rate for Payer: United Healthcare All Payer |
$6,590.76
|
|
|
PLUS PROMOS HUM STEM 2.5
|
Facility
|
IP
|
$7,489.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,246.85 |
| Max. Negotiated Rate |
$7,189.92 |
| Rate for Payer: Aetna Commercial |
$5,766.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,841.81
|
| Rate for Payer: Cash Price |
$3,744.75
|
| Rate for Payer: Cigna Commercial |
$6,216.28
|
| Rate for Payer: First Health Commercial |
$7,115.02
|
| Rate for Payer: Humana Commercial |
$6,366.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,141.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,527.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,246.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,590.76
|
| Rate for Payer: Ohio Health Group HMO |
$5,617.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,991.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,515.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,167.76
|
| Rate for Payer: PHCS Commercial |
$7,189.92
|
| Rate for Payer: United Healthcare All Payer |
$6,590.76
|
|
|
PLUS PROMOS HUM STEM 3
|
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 PROMOS HUM STEM 3
|
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 HUM STEM 3.5
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PLUS PROMOS HUM STEM 3.5
|
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
|
|
|
PLUS PROMOS HUM STEM SZ 4
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PLUS PROMOS HUM STEM SZ 4
|
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
|
|
|
PLUS PROMOS REV. BODY 36/10MM
|
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
|
|
|
PLUS PROMOS REV. BODY 36/10MM
|
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
|
|
|
PLUS PROMOS REV. BODY 36/15MM
|
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
|
|
|
PLUS PROMOS REV. BODY 36/15MM
|
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
|
|
|
PLUS PROMOS REV. BODY 36/5MM
|
Facility
|
OP
|
$10,205.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,061.53 |
| Max. Negotiated Rate |
$9,796.90 |
| Rate for Payer: Aetna Commercial |
$7,857.93
|
| Rate for Payer: Anthem Medicaid |
$3,509.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,959.98
|
| Rate for Payer: Cash Price |
$5,102.55
|
| Rate for Payer: Cigna Commercial |
$8,470.23
|
| Rate for Payer: First Health Commercial |
$9,694.84
|
| Rate for Payer: Humana Commercial |
$8,674.33
|
| Rate for Payer: Humana KY Medicaid |
$3,509.53
|
| Rate for Payer: Kentucky WC Medicaid |
$3,545.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,368.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,531.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,061.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,579.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,980.49
|
| Rate for Payer: Ohio Health Group HMO |
$7,653.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,164.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,878.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,041.52
|
| Rate for Payer: PHCS Commercial |
$9,796.90
|
| Rate for Payer: United Healthcare All Payer |
$8,980.49
|
|
|
PLUS PROMOS REV. BODY 36/5MM
|
Facility
|
IP
|
$10,205.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,061.53 |
| Max. Negotiated Rate |
$9,796.90 |
| Rate for Payer: Aetna Commercial |
$7,857.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,959.98
|
| Rate for Payer: Cash Price |
$5,102.55
|
| Rate for Payer: Cigna Commercial |
$8,470.23
|
| Rate for Payer: First Health Commercial |
$9,694.84
|
| Rate for Payer: Humana Commercial |
$8,674.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,368.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,531.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,061.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,980.49
|
| Rate for Payer: Ohio Health Group HMO |
$7,653.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,164.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,878.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,041.52
|
| Rate for Payer: PHCS Commercial |
$9,796.90
|
| Rate for Payer: United Healthcare All Payer |
$8,980.49
|
|
|
PLUS PROMOS REV. BODY 42/10MM
|
Facility
|
IP
|
$10,205.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,061.53 |
| Max. Negotiated Rate |
$9,796.90 |
| Rate for Payer: Aetna Commercial |
$7,857.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,959.98
|
| Rate for Payer: Cash Price |
$5,102.55
|
| Rate for Payer: Cigna Commercial |
$8,470.23
|
| Rate for Payer: First Health Commercial |
$9,694.84
|
| Rate for Payer: Humana Commercial |
$8,674.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,368.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,531.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,061.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,980.49
|
| Rate for Payer: Ohio Health Group HMO |
$7,653.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,164.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,878.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,041.52
|
| Rate for Payer: PHCS Commercial |
$9,796.90
|
| Rate for Payer: United Healthcare All Payer |
$8,980.49
|
|
|
PLUS PROMOS REV. BODY 42/10MM
|
Facility
|
OP
|
$10,205.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,061.53 |
| Max. Negotiated Rate |
$9,796.90 |
| Rate for Payer: Aetna Commercial |
$7,857.93
|
| Rate for Payer: Anthem Medicaid |
$3,509.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,959.98
|
| Rate for Payer: Cash Price |
$5,102.55
|
| Rate for Payer: Cigna Commercial |
$8,470.23
|
| Rate for Payer: First Health Commercial |
$9,694.84
|
| Rate for Payer: Humana Commercial |
$8,674.33
|
| Rate for Payer: Humana KY Medicaid |
$3,509.53
|
| Rate for Payer: Kentucky WC Medicaid |
$3,545.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,368.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,531.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,061.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,579.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,980.49
|
| Rate for Payer: Ohio Health Group HMO |
$7,653.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,164.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,878.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,041.52
|
| Rate for Payer: PHCS Commercial |
$9,796.90
|
| Rate for Payer: United Healthcare All Payer |
$8,980.49
|
|
|
PLUS PROMOS REV. BODY 42/15MM
|
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
|
|
|
PLUS PROMOS REV. BODY 42/15MM
|
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
|
|
