|
PRESERVATN INS RM/LL 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 RM/LL 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 RM/LL 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 RM/LL 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 RM/LL 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 RM/LL 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 RM/LL 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 RM/LL 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 RM/LL 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 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 MB INSRT S1 11.5MM
|
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
|
|
|
PRESERVATN MB INSRT S1 11.5MM
|
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
|
|
|
PRESERVATN MB INSRT S2 11.5MM
|
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
|
|
|
PRESERVATN MB INSRT S2 11.5MM
|
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
|
|
|
PRESERVATN MB INSRT S3 11.5MM
|
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
|
|
|
PRESERVATN MB INSRT S3 11.5MM
|
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
|
|
|
PRESERVATN MB INSRT S4 11.5MM
|
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
|
|
|
PRESERVATN MB INSRT S4 11.5MM
|
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
|
|
|
PRESERVATN MB INSRT S5 11.5MM
|
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
|
|
|
PRESERVATN MB INSRT S5 11.5MM
|
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
|
|
|
PRESERVATN MB TIB TRY LM/RL S1
|
Facility
|
IP
|
$9,806.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,941.96 |
| Max. Negotiated Rate |
$9,414.26 |
| Rate for Payer: Aetna Commercial |
$7,551.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,649.09
|
| Rate for Payer: Cash Price |
$4,903.26
|
| Rate for Payer: Cigna Commercial |
$8,139.41
|
| Rate for Payer: First Health Commercial |
$9,316.19
|
| Rate for Payer: Humana Commercial |
$8,335.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,041.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,237.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,941.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,629.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,354.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,845.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,531.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,766.50
|
| Rate for Payer: PHCS Commercial |
$9,414.26
|
| Rate for Payer: United Healthcare All Payer |
$8,629.74
|
|
|
PRESERVATN MB TIB TRY LM/RL S1
|
Facility
|
OP
|
$9,806.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,941.96 |
| Max. Negotiated Rate |
$9,414.26 |
| Rate for Payer: Aetna Commercial |
$7,551.02
|
| Rate for Payer: Anthem Medicaid |
$3,372.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,649.09
|
| Rate for Payer: Cash Price |
$4,903.26
|
| Rate for Payer: Cigna Commercial |
$8,139.41
|
| Rate for Payer: First Health Commercial |
$9,316.19
|
| Rate for Payer: Humana Commercial |
$8,335.54
|
| Rate for Payer: Humana KY Medicaid |
$3,372.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,406.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,041.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,237.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,941.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,440.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,629.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,354.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,845.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,531.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,766.50
|
| Rate for Payer: PHCS Commercial |
$9,414.26
|
| Rate for Payer: United Healthcare All Payer |
$8,629.74
|
|
|
PRESERVATN MB TIB TRY LM/RL S2
|
Facility
|
IP
|
$9,806.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,941.96 |
| Max. Negotiated Rate |
$9,414.26 |
| Rate for Payer: Aetna Commercial |
$7,551.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,649.09
|
| Rate for Payer: Cash Price |
$4,903.26
|
| Rate for Payer: Cigna Commercial |
$8,139.41
|
| Rate for Payer: First Health Commercial |
$9,316.19
|
| Rate for Payer: Humana Commercial |
$8,335.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,041.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,237.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,941.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,629.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,354.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,845.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,531.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,766.50
|
| Rate for Payer: PHCS Commercial |
$9,414.26
|
| Rate for Payer: United Healthcare All Payer |
$8,629.74
|
|
|
PRESERVATN MB TIB TRY LM/RL S2
|
Facility
|
OP
|
$9,806.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,941.96 |
| Max. Negotiated Rate |
$9,414.26 |
| Rate for Payer: Aetna Commercial |
$7,551.02
|
| Rate for Payer: Anthem Medicaid |
$3,372.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,649.09
|
| Rate for Payer: Cash Price |
$4,903.26
|
| Rate for Payer: Cigna Commercial |
$8,139.41
|
| Rate for Payer: First Health Commercial |
$9,316.19
|
| Rate for Payer: Humana Commercial |
$8,335.54
|
| Rate for Payer: Humana KY Medicaid |
$3,372.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,406.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,041.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,237.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,941.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,440.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,629.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,354.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,845.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,531.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,766.50
|
| Rate for Payer: PHCS Commercial |
$9,414.26
|
| Rate for Payer: United Healthcare All Payer |
$8,629.74
|
|
|
PRESERVATN MB TIB TRY LM/RL S3
|
Facility
|
IP
|
$9,806.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,941.96 |
| Max. Negotiated Rate |
$9,414.26 |
| Rate for Payer: Aetna Commercial |
$7,551.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,649.09
|
| Rate for Payer: Cash Price |
$4,903.26
|
| Rate for Payer: Cigna Commercial |
$8,139.41
|
| Rate for Payer: First Health Commercial |
$9,316.19
|
| Rate for Payer: Humana Commercial |
$8,335.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,041.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,237.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,941.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,629.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,354.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,845.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,531.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,766.50
|
| Rate for Payer: PHCS Commercial |
$9,414.26
|
| Rate for Payer: United Healthcare All Payer |
$8,629.74
|
|
