|
COBRA PRIM SO 12/14 SZ 1
|
Facility
|
IP
|
$9,738.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,921.59 |
| Max. Negotiated Rate |
$9,349.08 |
| Rate for Payer: Aetna Commercial |
$7,498.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,596.13
|
| Rate for Payer: Cash Price |
$4,869.31
|
| Rate for Payer: Cigna Commercial |
$8,083.06
|
| Rate for Payer: First Health Commercial |
$9,251.70
|
| Rate for Payer: Humana Commercial |
$8,277.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,985.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,187.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,921.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,569.99
|
| Rate for Payer: Ohio Health Group HMO |
$7,303.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,790.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,472.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,719.65
|
| Rate for Payer: PHCS Commercial |
$9,349.08
|
| Rate for Payer: United Healthcare All Payer |
$8,569.99
|
|
|
COBRA PRIM SO 12/14 SZ 1
|
Facility
|
OP
|
$9,738.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,921.59 |
| Max. Negotiated Rate |
$9,349.08 |
| Rate for Payer: Aetna Commercial |
$7,498.75
|
| Rate for Payer: Anthem Medicaid |
$3,349.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,596.13
|
| Rate for Payer: Cash Price |
$4,869.31
|
| Rate for Payer: Cigna Commercial |
$8,083.06
|
| Rate for Payer: First Health Commercial |
$9,251.70
|
| Rate for Payer: Humana Commercial |
$8,277.84
|
| Rate for Payer: Humana KY Medicaid |
$3,349.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3,383.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,985.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,187.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,921.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,416.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,569.99
|
| Rate for Payer: Ohio Health Group HMO |
$7,303.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,790.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,472.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,719.65
|
| Rate for Payer: PHCS Commercial |
$9,349.08
|
| Rate for Payer: United Healthcare All Payer |
$8,569.99
|
|
|
COBRA PRIM SO 12/14 SZ 2
|
Facility
|
OP
|
$9,738.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,921.59 |
| Max. Negotiated Rate |
$9,349.08 |
| Rate for Payer: Aetna Commercial |
$7,498.75
|
| Rate for Payer: Anthem Medicaid |
$3,349.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,596.13
|
| Rate for Payer: Cash Price |
$4,869.31
|
| Rate for Payer: Cigna Commercial |
$8,083.06
|
| Rate for Payer: First Health Commercial |
$9,251.70
|
| Rate for Payer: Humana Commercial |
$8,277.84
|
| Rate for Payer: Humana KY Medicaid |
$3,349.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3,383.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,985.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,187.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,921.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,416.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,569.99
|
| Rate for Payer: Ohio Health Group HMO |
$7,303.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,790.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,472.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,719.65
|
| Rate for Payer: PHCS Commercial |
$9,349.08
|
| Rate for Payer: United Healthcare All Payer |
$8,569.99
|
|
|
COBRA PRIM SO 12/14 SZ 2
|
Facility
|
IP
|
$9,738.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,921.59 |
| Max. Negotiated Rate |
$9,349.08 |
| Rate for Payer: Aetna Commercial |
$7,498.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,596.13
|
| Rate for Payer: Cash Price |
$4,869.31
|
| Rate for Payer: Cigna Commercial |
$8,083.06
|
| Rate for Payer: First Health Commercial |
$9,251.70
|
| Rate for Payer: Humana Commercial |
$8,277.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,985.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,187.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,921.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,569.99
|
| Rate for Payer: Ohio Health Group HMO |
$7,303.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,790.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,472.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,719.65
|
| Rate for Payer: PHCS Commercial |
$9,349.08
|
| Rate for Payer: United Healthcare All Payer |
$8,569.99
|
|
|
COBRA PRIM SO 12/14 SZ 3
|
Facility
|
IP
|
$9,738.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,921.59 |
| Max. Negotiated Rate |
$9,349.08 |
| Rate for Payer: Aetna Commercial |
$7,498.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,596.13
|
| Rate for Payer: Cash Price |
$4,869.31
|
| Rate for Payer: Cigna Commercial |
$8,083.06
|
| Rate for Payer: First Health Commercial |
$9,251.70
|
| Rate for Payer: Humana Commercial |
$8,277.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,985.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,187.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,921.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,569.99
|
| Rate for Payer: Ohio Health Group HMO |
$7,303.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,790.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,472.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,719.65
|
| Rate for Payer: PHCS Commercial |
$9,349.08
|
| Rate for Payer: United Healthcare All Payer |
$8,569.99
|
|
|
COBRA PRIM SO 12/14 SZ 3
|
Facility
|
OP
|
$9,738.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,921.59 |
| Max. Negotiated Rate |
$9,349.08 |
| Rate for Payer: Aetna Commercial |
$7,498.75
|
| Rate for Payer: Anthem Medicaid |
$3,349.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,596.13
|
| Rate for Payer: Cash Price |
$4,869.31
|
| Rate for Payer: Cigna Commercial |
$8,083.06
|
| Rate for Payer: First Health Commercial |
$9,251.70
|
| Rate for Payer: Humana Commercial |
$8,277.84
|
| Rate for Payer: Humana KY Medicaid |
$3,349.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3,383.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,985.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,187.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,921.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,416.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,569.99
|
| Rate for Payer: Ohio Health Group HMO |
$7,303.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,790.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,472.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,719.65
|
| Rate for Payer: PHCS Commercial |
$9,349.08
|
| Rate for Payer: United Healthcare All Payer |
$8,569.99
|
|
|
COBRA PRIM SO 12/14 SZ 4
|
Facility
|
OP
|
$9,738.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,921.59 |
| Max. Negotiated Rate |
$9,349.08 |
| Rate for Payer: Aetna Commercial |
$7,498.75
|
| Rate for Payer: Anthem Medicaid |
$3,349.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,596.13
|
| Rate for Payer: Cash Price |
$4,869.31
|
| Rate for Payer: Cigna Commercial |
$8,083.06
|
| Rate for Payer: First Health Commercial |
$9,251.70
|
| Rate for Payer: Humana Commercial |
$8,277.84
|
| Rate for Payer: Humana KY Medicaid |
$3,349.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3,383.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,985.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,187.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,921.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,416.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,569.99
|
| Rate for Payer: Ohio Health Group HMO |
$7,303.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,790.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,472.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,719.65
|
| Rate for Payer: PHCS Commercial |
$9,349.08
|
| Rate for Payer: United Healthcare All Payer |
$8,569.99
|
|
|
COBRA PRIM SO 12/14 SZ 4
|
Facility
|
IP
|
$9,738.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,921.59 |
| Max. Negotiated Rate |
$9,349.08 |
| Rate for Payer: Aetna Commercial |
$7,498.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,596.13
|
| Rate for Payer: Cash Price |
$4,869.31
|
| Rate for Payer: Cigna Commercial |
$8,083.06
|
| Rate for Payer: First Health Commercial |
$9,251.70
|
| Rate for Payer: Humana Commercial |
$8,277.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,985.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,187.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,921.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,569.99
|
| Rate for Payer: Ohio Health Group HMO |
$7,303.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,790.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,472.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,719.65
|
| Rate for Payer: PHCS Commercial |
$9,349.08
|
| Rate for Payer: United Healthcare All Payer |
$8,569.99
|
|
|
COBRA PRIM SO 12/14 SZ 5
|
Facility
|
IP
|
$9,738.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,921.59 |
| Max. Negotiated Rate |
$9,349.08 |
| Rate for Payer: Aetna Commercial |
$7,498.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,596.13
|
| Rate for Payer: Cash Price |
$4,869.31
|
| Rate for Payer: Cigna Commercial |
$8,083.06
|
| Rate for Payer: First Health Commercial |
$9,251.70
|
| Rate for Payer: Humana Commercial |
$8,277.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,985.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,187.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,921.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,569.99
|
| Rate for Payer: Ohio Health Group HMO |
$7,303.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,790.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,472.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,719.65
|
| Rate for Payer: PHCS Commercial |
$9,349.08
|
| Rate for Payer: United Healthcare All Payer |
$8,569.99
|
|
|
COBRA PRIM SO 12/14 SZ 5
|
Facility
|
OP
|
$9,738.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,921.59 |
| Max. Negotiated Rate |
$9,349.08 |
| Rate for Payer: Aetna Commercial |
$7,498.75
|
| Rate for Payer: Anthem Medicaid |
$3,349.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,596.13
|
| Rate for Payer: Cash Price |
$4,869.31
|
| Rate for Payer: Cigna Commercial |
$8,083.06
|
| Rate for Payer: First Health Commercial |
$9,251.70
|
| Rate for Payer: Humana Commercial |
$8,277.84
|
| Rate for Payer: Humana KY Medicaid |
$3,349.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3,383.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,985.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,187.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,921.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,416.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,569.99
|
| Rate for Payer: Ohio Health Group HMO |
$7,303.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,790.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,472.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,719.65
|
| Rate for Payer: PHCS Commercial |
$9,349.08
|
| Rate for Payer: United Healthcare All Payer |
$8,569.99
|
|
|
COBRA PZF 2.50*12
|
Facility
|
IP
|
$4,812.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,443.75 |
| Max. Negotiated Rate |
$4,620.00 |
| Rate for Payer: Aetna Commercial |
$3,705.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,753.75
|
| Rate for Payer: Cash Price |
$2,406.25
|
| Rate for Payer: Cigna Commercial |
$3,994.38
|
| Rate for Payer: First Health Commercial |
$4,571.88
|
| Rate for Payer: Humana Commercial |
$4,090.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,946.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,551.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,235.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,609.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,850.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,186.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,320.62
|
| Rate for Payer: PHCS Commercial |
$4,620.00
|
| Rate for Payer: United Healthcare All Payer |
$4,235.00
|
|
|
COBRA PZF 2.50*12
|
Facility
|
OP
|
$4,812.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,443.75 |
| Max. Negotiated Rate |
$4,620.00 |
| Rate for Payer: Aetna Commercial |
$3,705.62
|
| Rate for Payer: Anthem Medicaid |
$1,655.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,753.75
|
| Rate for Payer: Cash Price |
$2,406.25
|
| Rate for Payer: Cigna Commercial |
$3,994.38
|
| Rate for Payer: First Health Commercial |
$4,571.88
|
| Rate for Payer: Humana Commercial |
$4,090.62
|
| Rate for Payer: Humana KY Medicaid |
$1,655.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,671.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,946.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,551.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,688.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,235.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,609.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,850.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,186.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,320.62
|
| Rate for Payer: PHCS Commercial |
$4,620.00
|
| Rate for Payer: United Healthcare All Payer |
$4,235.00
|
|
|
COBRA PZF 2.50*15
|
Facility
|
OP
|
$4,812.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,443.75 |
| Max. Negotiated Rate |
$4,620.00 |
| Rate for Payer: Aetna Commercial |
$3,705.62
|
| Rate for Payer: Anthem Medicaid |
$1,655.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,753.75
|
| Rate for Payer: Cash Price |
$2,406.25
|
| Rate for Payer: Cigna Commercial |
$3,994.38
|
| Rate for Payer: First Health Commercial |
$4,571.88
|
| Rate for Payer: Humana Commercial |
$4,090.62
|
| Rate for Payer: Humana KY Medicaid |
$1,655.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,671.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,946.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,551.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,688.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,235.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,609.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,850.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,186.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,320.62
|
| Rate for Payer: PHCS Commercial |
$4,620.00
|
| Rate for Payer: United Healthcare All Payer |
$4,235.00
|
|
|
COBRA PZF 2.50*15
|
Facility
|
IP
|
$4,812.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,443.75 |
| Max. Negotiated Rate |
$4,620.00 |
| Rate for Payer: Aetna Commercial |
$3,705.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,753.75
|
| Rate for Payer: Cash Price |
$2,406.25
|
| Rate for Payer: Cigna Commercial |
$3,994.38
|
| Rate for Payer: First Health Commercial |
$4,571.88
|
| Rate for Payer: Humana Commercial |
$4,090.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,946.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,551.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,235.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,609.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,850.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,186.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,320.62
|
| Rate for Payer: PHCS Commercial |
$4,620.00
|
| Rate for Payer: United Healthcare All Payer |
$4,235.00
|
|
|
COBRA PZF 2.50*18
|
Facility
|
OP
|
$4,812.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,443.75 |
| Max. Negotiated Rate |
$4,620.00 |
| Rate for Payer: Aetna Commercial |
$3,705.62
|
| Rate for Payer: Anthem Medicaid |
$1,655.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,753.75
|
| Rate for Payer: Cash Price |
$2,406.25
|
| Rate for Payer: Cigna Commercial |
$3,994.38
|
| Rate for Payer: First Health Commercial |
$4,571.88
|
| Rate for Payer: Humana Commercial |
$4,090.62
|
| Rate for Payer: Humana KY Medicaid |
$1,655.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,671.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,946.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,551.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,688.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,235.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,609.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,850.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,186.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,320.62
|
| Rate for Payer: PHCS Commercial |
$4,620.00
|
| Rate for Payer: United Healthcare All Payer |
$4,235.00
|
|
|
COBRA PZF 2.50*18
|
Facility
|
IP
|
$4,812.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,443.75 |
| Max. Negotiated Rate |
$4,620.00 |
| Rate for Payer: Aetna Commercial |
$3,705.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,753.75
|
| Rate for Payer: Cash Price |
$2,406.25
|
| Rate for Payer: Cigna Commercial |
$3,994.38
|
| Rate for Payer: First Health Commercial |
$4,571.88
|
| Rate for Payer: Humana Commercial |
$4,090.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,946.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,551.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,235.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,609.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,850.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,186.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,320.62
|
| Rate for Payer: PHCS Commercial |
$4,620.00
|
| Rate for Payer: United Healthcare All Payer |
$4,235.00
|
|
|
COBRA PZF 2.50*24
|
Facility
|
OP
|
$4,812.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,443.75 |
| Max. Negotiated Rate |
$4,620.00 |
| Rate for Payer: Aetna Commercial |
$3,705.62
|
| Rate for Payer: Anthem Medicaid |
$1,655.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,753.75
|
| Rate for Payer: Cash Price |
$2,406.25
|
| Rate for Payer: Cigna Commercial |
$3,994.38
|
| Rate for Payer: First Health Commercial |
$4,571.88
|
| Rate for Payer: Humana Commercial |
$4,090.62
|
| Rate for Payer: Humana KY Medicaid |
$1,655.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,671.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,946.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,551.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,688.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,235.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,609.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,850.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,186.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,320.62
|
| Rate for Payer: PHCS Commercial |
$4,620.00
|
| Rate for Payer: United Healthcare All Payer |
$4,235.00
|
|
|
COBRA PZF 2.50*24
|
Facility
|
IP
|
$4,812.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,443.75 |
| Max. Negotiated Rate |
$4,620.00 |
| Rate for Payer: Aetna Commercial |
$3,705.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,753.75
|
| Rate for Payer: Cash Price |
$2,406.25
|
| Rate for Payer: Cigna Commercial |
$3,994.38
|
| Rate for Payer: First Health Commercial |
$4,571.88
|
| Rate for Payer: Humana Commercial |
$4,090.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,946.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,551.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,235.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,609.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,850.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,186.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,320.62
|
| Rate for Payer: PHCS Commercial |
$4,620.00
|
| Rate for Payer: United Healthcare All Payer |
$4,235.00
|
|
|
COBRA PZF 2.50*30
|
Facility
|
IP
|
$4,812.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,443.75 |
| Max. Negotiated Rate |
$4,620.00 |
| Rate for Payer: Aetna Commercial |
$3,705.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,753.75
|
| Rate for Payer: Cash Price |
$2,406.25
|
| Rate for Payer: Cigna Commercial |
$3,994.38
|
| Rate for Payer: First Health Commercial |
$4,571.88
|
| Rate for Payer: Humana Commercial |
$4,090.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,946.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,551.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,235.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,609.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,850.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,186.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,320.62
|
| Rate for Payer: PHCS Commercial |
$4,620.00
|
| Rate for Payer: United Healthcare All Payer |
$4,235.00
|
|
|
COBRA PZF 2.50*30
|
Facility
|
OP
|
$4,812.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,443.75 |
| Max. Negotiated Rate |
$4,620.00 |
| Rate for Payer: Aetna Commercial |
$3,705.62
|
| Rate for Payer: Anthem Medicaid |
$1,655.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,753.75
|
| Rate for Payer: Cash Price |
$2,406.25
|
| Rate for Payer: Cigna Commercial |
$3,994.38
|
| Rate for Payer: First Health Commercial |
$4,571.88
|
| Rate for Payer: Humana Commercial |
$4,090.62
|
| Rate for Payer: Humana KY Medicaid |
$1,655.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,671.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,946.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,551.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,688.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,235.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,609.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,850.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,186.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,320.62
|
| Rate for Payer: PHCS Commercial |
$4,620.00
|
| Rate for Payer: United Healthcare All Payer |
$4,235.00
|
|
|
COBRA PZF 2.50*8
|
Facility
|
OP
|
$4,812.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,443.75 |
| Max. Negotiated Rate |
$4,620.00 |
| Rate for Payer: Aetna Commercial |
$3,705.62
|
| Rate for Payer: Anthem Medicaid |
$1,655.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,753.75
|
| Rate for Payer: Cash Price |
$2,406.25
|
| Rate for Payer: Cigna Commercial |
$3,994.38
|
| Rate for Payer: First Health Commercial |
$4,571.88
|
| Rate for Payer: Humana Commercial |
$4,090.62
|
| Rate for Payer: Humana KY Medicaid |
$1,655.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,671.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,946.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,551.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,688.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,235.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,609.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,850.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,186.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,320.62
|
| Rate for Payer: PHCS Commercial |
$4,620.00
|
| Rate for Payer: United Healthcare All Payer |
$4,235.00
|
|
|
COBRA PZF 2.50*8
|
Facility
|
IP
|
$4,812.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,443.75 |
| Max. Negotiated Rate |
$4,620.00 |
| Rate for Payer: Aetna Commercial |
$3,705.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,753.75
|
| Rate for Payer: Cash Price |
$2,406.25
|
| Rate for Payer: Cigna Commercial |
$3,994.38
|
| Rate for Payer: First Health Commercial |
$4,571.88
|
| Rate for Payer: Humana Commercial |
$4,090.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,946.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,551.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,235.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,609.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,850.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,186.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,320.62
|
| Rate for Payer: PHCS Commercial |
$4,620.00
|
| Rate for Payer: United Healthcare All Payer |
$4,235.00
|
|
|
COBRA PZF 2.75*12
|
Facility
|
OP
|
$4,812.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,443.75 |
| Max. Negotiated Rate |
$4,620.00 |
| Rate for Payer: Aetna Commercial |
$3,705.62
|
| Rate for Payer: Anthem Medicaid |
$1,655.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,753.75
|
| Rate for Payer: Cash Price |
$2,406.25
|
| Rate for Payer: Cigna Commercial |
$3,994.38
|
| Rate for Payer: First Health Commercial |
$4,571.88
|
| Rate for Payer: Humana Commercial |
$4,090.62
|
| Rate for Payer: Humana KY Medicaid |
$1,655.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,671.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,946.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,551.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,688.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,235.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,609.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,850.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,186.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,320.62
|
| Rate for Payer: PHCS Commercial |
$4,620.00
|
| Rate for Payer: United Healthcare All Payer |
$4,235.00
|
|
|
COBRA PZF 2.75*12
|
Facility
|
IP
|
$4,812.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,443.75 |
| Max. Negotiated Rate |
$4,620.00 |
| Rate for Payer: Aetna Commercial |
$3,705.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,753.75
|
| Rate for Payer: Cash Price |
$2,406.25
|
| Rate for Payer: Cigna Commercial |
$3,994.38
|
| Rate for Payer: First Health Commercial |
$4,571.88
|
| Rate for Payer: Humana Commercial |
$4,090.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,946.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,551.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,235.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,609.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,850.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,186.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,320.62
|
| Rate for Payer: PHCS Commercial |
$4,620.00
|
| Rate for Payer: United Healthcare All Payer |
$4,235.00
|
|
|
COBRA PZF 2.75*15
|
Facility
|
IP
|
$4,812.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,443.75 |
| Max. Negotiated Rate |
$4,620.00 |
| Rate for Payer: Aetna Commercial |
$3,705.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,753.75
|
| Rate for Payer: Cash Price |
$2,406.25
|
| Rate for Payer: Cigna Commercial |
$3,994.38
|
| Rate for Payer: First Health Commercial |
$4,571.88
|
| Rate for Payer: Humana Commercial |
$4,090.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,946.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,551.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,235.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,609.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,850.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,186.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,320.62
|
| Rate for Payer: PHCS Commercial |
$4,620.00
|
| Rate for Payer: United Healthcare All Payer |
$4,235.00
|
|
