|
PRESERVATN INS LM/RL S2 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 S2 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 S2 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 S3 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 S3 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 S3 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 S3 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 S4 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 S4 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 S4 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 S4 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 S5 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 S5 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 S5 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 S5 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 RM/LL 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 RM/LL 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 RM/LL 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 RM/LL 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 RM/LL S2 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 RM/LL 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
|
|
|
PRESERVATN INS RM/LL S2 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 RM/LL S2 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 RM/LL S3 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 RM/LL S3 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
|
|
