|
PRESERVATION MB INSRT S1 9.5MM
|
Facility
|
OP
|
$5,591.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,677.30 |
| Max. Negotiated Rate |
$5,367.36 |
| Rate for Payer: Aetna Commercial |
$4,305.07
|
| Rate for Payer: Anthem Medicaid |
$1,922.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,360.98
|
| Rate for Payer: Cash Price |
$2,795.50
|
| Rate for Payer: Cigna Commercial |
$4,640.53
|
| Rate for Payer: First Health Commercial |
$5,311.45
|
| Rate for Payer: Humana Commercial |
$4,752.35
|
| Rate for Payer: Humana KY Medicaid |
$1,922.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1,942.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,584.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,126.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,677.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,961.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,920.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,193.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,472.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,864.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,857.79
|
| Rate for Payer: PHCS Commercial |
$5,367.36
|
| Rate for Payer: United Healthcare All Payer |
$4,920.08
|
|
|
PRESERVATION MB INSRT S1 9.5MM
|
Facility
|
IP
|
$5,591.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,677.30 |
| Max. Negotiated Rate |
$5,367.36 |
| Rate for Payer: Aetna Commercial |
$4,305.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,360.98
|
| Rate for Payer: Cash Price |
$2,795.50
|
| Rate for Payer: Cigna Commercial |
$4,640.53
|
| Rate for Payer: First Health Commercial |
$5,311.45
|
| Rate for Payer: Humana Commercial |
$4,752.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,584.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,126.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,677.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,920.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,193.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,472.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,864.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,857.79
|
| Rate for Payer: PHCS Commercial |
$5,367.36
|
| Rate for Payer: United Healthcare All Payer |
$4,920.08
|
|
|
PRESERVATION MB INSRT S2 9.5MM
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
PRESERVATION MB INSRT S2 9.5MM
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
PRESERVATION MB INSRT S3 9.5MM
|
Facility
|
OP
|
$5,591.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,677.30 |
| Max. Negotiated Rate |
$5,367.36 |
| Rate for Payer: Aetna Commercial |
$4,305.07
|
| Rate for Payer: Anthem Medicaid |
$1,922.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,360.98
|
| Rate for Payer: Cash Price |
$2,795.50
|
| Rate for Payer: Cigna Commercial |
$4,640.53
|
| Rate for Payer: First Health Commercial |
$5,311.45
|
| Rate for Payer: Humana Commercial |
$4,752.35
|
| Rate for Payer: Humana KY Medicaid |
$1,922.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1,942.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,584.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,126.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,677.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,961.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,920.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,193.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,472.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,864.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,857.79
|
| Rate for Payer: PHCS Commercial |
$5,367.36
|
| Rate for Payer: United Healthcare All Payer |
$4,920.08
|
|
|
PRESERVATION MB INSRT S3 9.5MM
|
Facility
|
IP
|
$5,591.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,677.30 |
| Max. Negotiated Rate |
$5,367.36 |
| Rate for Payer: Aetna Commercial |
$4,305.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,360.98
|
| Rate for Payer: Cash Price |
$2,795.50
|
| Rate for Payer: Cigna Commercial |
$4,640.53
|
| Rate for Payer: First Health Commercial |
$5,311.45
|
| Rate for Payer: Humana Commercial |
$4,752.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,584.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,126.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,677.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,920.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,193.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,472.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,864.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,857.79
|
| Rate for Payer: PHCS Commercial |
$5,367.36
|
| Rate for Payer: United Healthcare All Payer |
$4,920.08
|
|
|
PRESERVATION MB INSRT S4 9.5MM
|
Facility
|
OP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem Medicaid |
$2,286.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Humana KY Medicaid |
$2,286.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,332.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
PRESERVATION MB INSRT S4 9.5MM
|
Facility
|
IP
|
$6,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.00 |
| Max. Negotiated Rate |
$6,384.00 |
| Rate for Payer: Aetna Commercial |
$5,120.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.00
|
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: First Health Commercial |
$6,317.50
|
| Rate for Payer: Humana Commercial |
$5,652.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,907.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,987.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,785.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,588.50
|
| Rate for Payer: PHCS Commercial |
$6,384.00
|
| Rate for Payer: United Healthcare All Payer |
$5,852.00
|
|
|
PRESERVATION MB INSRT S5 9.5MM
|
Facility
|
IP
|
$5,591.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,677.30 |
| Max. Negotiated Rate |
$5,367.36 |
| Rate for Payer: Aetna Commercial |
$4,305.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,360.98
|
| Rate for Payer: Cash Price |
$2,795.50
|
| Rate for Payer: Cigna Commercial |
$4,640.53
|
| Rate for Payer: First Health Commercial |
$5,311.45
|
| Rate for Payer: Humana Commercial |
$4,752.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,584.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,126.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,677.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,920.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,193.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,472.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,864.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,857.79
|
| Rate for Payer: PHCS Commercial |
$5,367.36
|
| Rate for Payer: United Healthcare All Payer |
$4,920.08
|
|
|
PRESERVATION MB INSRT S5 9.5MM
|
Facility
|
OP
|
$5,591.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,677.30 |
| Max. Negotiated Rate |
$5,367.36 |
| Rate for Payer: Aetna Commercial |
$4,305.07
|
| Rate for Payer: Anthem Medicaid |
$1,922.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,360.98
|
| Rate for Payer: Cash Price |
$2,795.50
|
| Rate for Payer: Cigna Commercial |
$4,640.53
|
| Rate for Payer: First Health Commercial |
$5,311.45
|
| Rate for Payer: Humana Commercial |
$4,752.35
|
| Rate for Payer: Humana KY Medicaid |
$1,922.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1,942.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,584.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,126.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,677.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,961.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,920.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,193.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,472.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,864.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,857.79
|
| Rate for Payer: PHCS Commercial |
$5,367.36
|
| Rate for Payer: United Healthcare All Payer |
$4,920.08
|
|
|
PRESERVATION UNI FEM CEM SZ 1
|
Facility
|
IP
|
$16,251.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,875.55 |
| Max. Negotiated Rate |
$15,601.77 |
| Rate for Payer: Aetna Commercial |
$12,513.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,676.44
|
| Rate for Payer: Cash Price |
$8,125.92
|
| Rate for Payer: Cigna Commercial |
$13,489.03
|
| Rate for Payer: First Health Commercial |
$15,439.25
|
| Rate for Payer: Humana Commercial |
$13,814.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,326.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,993.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,875.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,301.62
|
| Rate for Payer: Ohio Health Group HMO |
$12,188.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,001.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,139.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,213.77
|
| Rate for Payer: PHCS Commercial |
$15,601.77
|
| Rate for Payer: United Healthcare All Payer |
$14,301.62
|
|
|
PRESERVATION UNI FEM CEM SZ 1
|
Facility
|
OP
|
$16,251.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,875.55 |
| Max. Negotiated Rate |
$15,601.77 |
| Rate for Payer: Aetna Commercial |
$12,513.92
|
| Rate for Payer: Anthem Medicaid |
$5,589.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,676.44
|
| Rate for Payer: Cash Price |
$8,125.92
|
| Rate for Payer: Cigna Commercial |
$13,489.03
|
| Rate for Payer: First Health Commercial |
$15,439.25
|
| Rate for Payer: Humana Commercial |
$13,814.06
|
| Rate for Payer: Humana KY Medicaid |
$5,589.01
|
| Rate for Payer: Kentucky WC Medicaid |
$5,645.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,326.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,993.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,875.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,701.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,301.62
|
| Rate for Payer: Ohio Health Group HMO |
$12,188.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,001.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,139.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,213.77
|
| Rate for Payer: PHCS Commercial |
$15,601.77
|
| Rate for Payer: United Healthcare All Payer |
$14,301.62
|
|
|
PRESERVATION UNI FEM CEM SZ 2
|
Facility
|
IP
|
$16,758.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,027.40 |
| Max. Negotiated Rate |
$16,087.68 |
| Rate for Payer: Aetna Commercial |
$12,903.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,071.24
|
| Rate for Payer: Cash Price |
$8,379.00
|
| Rate for Payer: Cigna Commercial |
$13,909.14
|
| Rate for Payer: First Health Commercial |
$15,920.10
|
| Rate for Payer: Humana Commercial |
$14,244.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,741.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,367.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,027.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,747.04
|
| Rate for Payer: Ohio Health Group HMO |
$12,568.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,406.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,579.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,563.02
|
| Rate for Payer: PHCS Commercial |
$16,087.68
|
| Rate for Payer: United Healthcare All Payer |
$14,747.04
|
|
|
PRESERVATION UNI FEM CEM SZ 2
|
Facility
|
OP
|
$16,758.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,027.40 |
| Max. Negotiated Rate |
$16,087.68 |
| Rate for Payer: Aetna Commercial |
$12,903.66
|
| Rate for Payer: Anthem Medicaid |
$5,763.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,071.24
|
| Rate for Payer: Cash Price |
$8,379.00
|
| Rate for Payer: Cigna Commercial |
$13,909.14
|
| Rate for Payer: First Health Commercial |
$15,920.10
|
| Rate for Payer: Humana Commercial |
$14,244.30
|
| Rate for Payer: Humana KY Medicaid |
$5,763.08
|
| Rate for Payer: Kentucky WC Medicaid |
$5,821.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,741.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,367.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,027.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,878.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,747.04
|
| Rate for Payer: Ohio Health Group HMO |
$12,568.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,406.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,579.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,563.02
|
| Rate for Payer: PHCS Commercial |
$16,087.68
|
| Rate for Payer: United Healthcare All Payer |
$14,747.04
|
|
|
PRESERVATION UNI FEM CEM SZ 3
|
Facility
|
IP
|
$16,251.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,875.55 |
| Max. Negotiated Rate |
$15,601.77 |
| Rate for Payer: Aetna Commercial |
$12,513.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,676.44
|
| Rate for Payer: Cash Price |
$8,125.92
|
| Rate for Payer: Cigna Commercial |
$13,489.03
|
| Rate for Payer: First Health Commercial |
$15,439.25
|
| Rate for Payer: Humana Commercial |
$13,814.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,326.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,993.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,875.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,301.62
|
| Rate for Payer: Ohio Health Group HMO |
$12,188.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,001.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,139.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,213.77
|
| Rate for Payer: PHCS Commercial |
$15,601.77
|
| Rate for Payer: United Healthcare All Payer |
$14,301.62
|
|
|
PRESERVATION UNI FEM CEM SZ 3
|
Facility
|
OP
|
$16,251.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,875.55 |
| Max. Negotiated Rate |
$15,601.77 |
| Rate for Payer: Aetna Commercial |
$12,513.92
|
| Rate for Payer: Anthem Medicaid |
$5,589.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,676.44
|
| Rate for Payer: Cash Price |
$8,125.92
|
| Rate for Payer: Cigna Commercial |
$13,489.03
|
| Rate for Payer: First Health Commercial |
$15,439.25
|
| Rate for Payer: Humana Commercial |
$13,814.06
|
| Rate for Payer: Humana KY Medicaid |
$5,589.01
|
| Rate for Payer: Kentucky WC Medicaid |
$5,645.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,326.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,993.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,875.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,701.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,301.62
|
| Rate for Payer: Ohio Health Group HMO |
$12,188.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,001.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,139.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,213.77
|
| Rate for Payer: PHCS Commercial |
$15,601.77
|
| Rate for Payer: United Healthcare All Payer |
$14,301.62
|
|
|
PRESERVATION UNI FEM CEM SZ 4
|
Facility
|
IP
|
$16,758.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,027.40 |
| Max. Negotiated Rate |
$16,087.68 |
| Rate for Payer: Aetna Commercial |
$12,903.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,071.24
|
| Rate for Payer: Cash Price |
$8,379.00
|
| Rate for Payer: Cigna Commercial |
$13,909.14
|
| Rate for Payer: First Health Commercial |
$15,920.10
|
| Rate for Payer: Humana Commercial |
$14,244.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,741.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,367.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,027.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,747.04
|
| Rate for Payer: Ohio Health Group HMO |
$12,568.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,406.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,579.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,563.02
|
| Rate for Payer: PHCS Commercial |
$16,087.68
|
| Rate for Payer: United Healthcare All Payer |
$14,747.04
|
|
|
PRESERVATION UNI FEM CEM SZ 4
|
Facility
|
OP
|
$16,758.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,027.40 |
| Max. Negotiated Rate |
$16,087.68 |
| Rate for Payer: Aetna Commercial |
$12,903.66
|
| Rate for Payer: Anthem Medicaid |
$5,763.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,071.24
|
| Rate for Payer: Cash Price |
$8,379.00
|
| Rate for Payer: Cigna Commercial |
$13,909.14
|
| Rate for Payer: First Health Commercial |
$15,920.10
|
| Rate for Payer: Humana Commercial |
$14,244.30
|
| Rate for Payer: Humana KY Medicaid |
$5,763.08
|
| Rate for Payer: Kentucky WC Medicaid |
$5,821.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,741.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,367.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,027.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,878.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,747.04
|
| Rate for Payer: Ohio Health Group HMO |
$12,568.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,406.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,579.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,563.02
|
| Rate for Payer: PHCS Commercial |
$16,087.68
|
| Rate for Payer: United Healthcare All Payer |
$14,747.04
|
|
|
PRESERVATION UNI FEM CEM SZ 5
|
Facility
|
OP
|
$16,251.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,875.55 |
| Max. Negotiated Rate |
$15,601.77 |
| Rate for Payer: Aetna Commercial |
$12,513.92
|
| Rate for Payer: Anthem Medicaid |
$5,589.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,676.44
|
| Rate for Payer: Cash Price |
$8,125.92
|
| Rate for Payer: Cigna Commercial |
$13,489.03
|
| Rate for Payer: First Health Commercial |
$15,439.25
|
| Rate for Payer: Humana Commercial |
$13,814.06
|
| Rate for Payer: Humana KY Medicaid |
$5,589.01
|
| Rate for Payer: Kentucky WC Medicaid |
$5,645.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,326.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,993.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,875.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,701.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,301.62
|
| Rate for Payer: Ohio Health Group HMO |
$12,188.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,001.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,139.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,213.77
|
| Rate for Payer: PHCS Commercial |
$15,601.77
|
| Rate for Payer: United Healthcare All Payer |
$14,301.62
|
|
|
PRESERVATION UNI FEM CEM SZ 5
|
Facility
|
IP
|
$16,251.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,875.55 |
| Max. Negotiated Rate |
$15,601.77 |
| Rate for Payer: Aetna Commercial |
$12,513.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,676.44
|
| Rate for Payer: Cash Price |
$8,125.92
|
| Rate for Payer: Cigna Commercial |
$13,489.03
|
| Rate for Payer: First Health Commercial |
$15,439.25
|
| Rate for Payer: Humana Commercial |
$13,814.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,326.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,993.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,875.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,301.62
|
| Rate for Payer: Ohio Health Group HMO |
$12,188.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,001.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,139.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,213.77
|
| Rate for Payer: PHCS Commercial |
$15,601.77
|
| Rate for Payer: United Healthcare All Payer |
$14,301.62
|
|
|
PRESERVATN INS LM/RL S1 11.5MM
|
Facility
|
OP
|
$5,360.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.00 |
| Max. Negotiated Rate |
$5,145.60 |
| Rate for Payer: Aetna Commercial |
$4,127.20
|
| Rate for Payer: Anthem Medicaid |
$1,843.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,180.80
|
| Rate for Payer: Cash Price |
$2,680.00
|
| Rate for Payer: Cigna Commercial |
$4,448.80
|
| Rate for Payer: First Health Commercial |
$5,092.00
|
| Rate for Payer: Humana Commercial |
$4,556.00
|
| Rate for Payer: Humana KY Medicaid |
$1,843.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,862.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,395.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,955.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,608.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,880.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,716.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,020.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,663.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,698.40
|
| Rate for Payer: PHCS Commercial |
$5,145.60
|
| Rate for Payer: United Healthcare All Payer |
$4,716.80
|
|
|
PRESERVATN INS LM/RL S1 11.5MM
|
Facility
|
IP
|
$5,360.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.00 |
| Max. Negotiated Rate |
$5,145.60 |
| Rate for Payer: Aetna Commercial |
$4,127.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,180.80
|
| Rate for Payer: Cash Price |
$2,680.00
|
| Rate for Payer: Cigna Commercial |
$4,448.80
|
| Rate for Payer: First Health Commercial |
$5,092.00
|
| Rate for Payer: Humana Commercial |
$4,556.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,395.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,955.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,608.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,716.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,020.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,663.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,698.40
|
| Rate for Payer: PHCS Commercial |
$5,145.60
|
| Rate for Payer: United Healthcare All Payer |
$4,716.80
|
|
|
PRESERVATN INS LM/RL S1 9.5MM
|
Facility
|
OP
|
$5,360.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.00 |
| Max. Negotiated Rate |
$5,145.60 |
| Rate for Payer: Aetna Commercial |
$4,127.20
|
| Rate for Payer: Anthem Medicaid |
$1,843.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,180.80
|
| Rate for Payer: Cash Price |
$2,680.00
|
| Rate for Payer: Cigna Commercial |
$4,448.80
|
| Rate for Payer: First Health Commercial |
$5,092.00
|
| Rate for Payer: Humana Commercial |
$4,556.00
|
| Rate for Payer: Humana KY Medicaid |
$1,843.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,862.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,395.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,955.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,608.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,880.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,716.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,020.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,663.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,698.40
|
| Rate for Payer: PHCS Commercial |
$5,145.60
|
| Rate for Payer: United Healthcare All Payer |
$4,716.80
|
|
|
PRESERVATN INS LM/RL S1 9.5MM
|
Facility
|
IP
|
$5,360.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.00 |
| Max. Negotiated Rate |
$5,145.60 |
| Rate for Payer: Aetna Commercial |
$4,127.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,180.80
|
| Rate for Payer: Cash Price |
$2,680.00
|
| Rate for Payer: Cigna Commercial |
$4,448.80
|
| Rate for Payer: First Health Commercial |
$5,092.00
|
| Rate for Payer: Humana Commercial |
$4,556.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,395.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,955.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,608.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,716.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,020.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,663.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,698.40
|
| Rate for Payer: PHCS Commercial |
$5,145.60
|
| Rate for Payer: United Healthcare All Payer |
$4,716.80
|
|
|
PRESERVATN INS LM/RL S2 11.5MM
|
Facility
|
IP
|
$5,360.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.00 |
| Max. Negotiated Rate |
$5,145.60 |
| Rate for Payer: Aetna Commercial |
$4,127.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,180.80
|
| Rate for Payer: Cash Price |
$2,680.00
|
| Rate for Payer: Cigna Commercial |
$4,448.80
|
| Rate for Payer: First Health Commercial |
$5,092.00
|
| Rate for Payer: Humana Commercial |
$4,556.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,395.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,955.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,608.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,716.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,020.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,663.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,698.40
|
| Rate for Payer: PHCS Commercial |
$5,145.60
|
| Rate for Payer: United Healthcare All Payer |
$4,716.80
|
|
