|
LCCK 0D SZ4 5MM 31*31 CPL
|
Facility
|
OP
|
$26,426.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,435.48 |
| Max. Negotiated Rate |
$25,369.73 |
| Rate for Payer: Aetna Commercial |
$20,348.64
|
| Rate for Payer: Anthem Medicaid |
$9,088.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,612.90
|
| Rate for Payer: Cash Price |
$13,213.40
|
| Rate for Payer: Cigna Commercial |
$21,934.24
|
| Rate for Payer: First Health Commercial |
$25,105.46
|
| Rate for Payer: Humana Commercial |
$22,462.78
|
| Rate for Payer: Humana KY Medicaid |
$9,088.18
|
| Rate for Payer: Kentucky WC Medicaid |
$9,180.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,669.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,502.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,928.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,270.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,255.58
|
| Rate for Payer: Ohio Health Group HMO |
$19,820.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,285.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,435.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,192.31
|
| Rate for Payer: PHCS Commercial |
$25,369.73
|
| Rate for Payer: United Healthcare All Payer |
$23,255.58
|
|
|
LCCK 0D SZ4 5MM 31*31 CPL
|
Facility
|
IP
|
$26,426.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,435.48 |
| Max. Negotiated Rate |
$25,369.73 |
| Rate for Payer: Aetna Commercial |
$20,348.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,612.90
|
| Rate for Payer: Cash Price |
$13,213.40
|
| Rate for Payer: Cigna Commercial |
$21,934.24
|
| Rate for Payer: First Health Commercial |
$25,105.46
|
| Rate for Payer: Humana Commercial |
$22,462.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,669.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,502.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,928.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,255.58
|
| Rate for Payer: Ohio Health Group HMO |
$19,820.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,285.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,435.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,192.31
|
| Rate for Payer: PHCS Commercial |
$25,369.73
|
| Rate for Payer: United Healthcare All Payer |
$23,255.58
|
|
|
LCCK 0D SZ4 5MM 36*31 CPL
|
Facility
|
IP
|
$26,426.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,435.48 |
| Max. Negotiated Rate |
$25,369.73 |
| Rate for Payer: Aetna Commercial |
$20,348.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,612.90
|
| Rate for Payer: Cash Price |
$13,213.40
|
| Rate for Payer: Cigna Commercial |
$21,934.24
|
| Rate for Payer: First Health Commercial |
$25,105.46
|
| Rate for Payer: Humana Commercial |
$22,462.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,669.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,502.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,928.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,255.58
|
| Rate for Payer: Ohio Health Group HMO |
$19,820.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,285.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,435.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,192.31
|
| Rate for Payer: PHCS Commercial |
$25,369.73
|
| Rate for Payer: United Healthcare All Payer |
$23,255.58
|
|
|
LCCK 0D SZ4 5MM 36*31 CPL
|
Facility
|
OP
|
$26,426.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,435.48 |
| Max. Negotiated Rate |
$25,369.73 |
| Rate for Payer: Aetna Commercial |
$20,348.64
|
| Rate for Payer: Anthem Medicaid |
$9,088.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,612.90
|
| Rate for Payer: Cash Price |
$13,213.40
|
| Rate for Payer: Cigna Commercial |
$21,934.24
|
| Rate for Payer: First Health Commercial |
$25,105.46
|
| Rate for Payer: Humana Commercial |
$22,462.78
|
| Rate for Payer: Humana KY Medicaid |
$9,088.18
|
| Rate for Payer: Kentucky WC Medicaid |
$9,180.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,669.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,502.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,928.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,270.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,255.58
|
| Rate for Payer: Ohio Health Group HMO |
$19,820.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,285.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,435.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,192.31
|
| Rate for Payer: PHCS Commercial |
$25,369.73
|
| Rate for Payer: United Healthcare All Payer |
$23,255.58
|
|
|
LCCK 0D SZ4 5MM 41*34 CPL
|
Facility
|
OP
|
$26,426.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,435.48 |
| Max. Negotiated Rate |
$25,369.73 |
| Rate for Payer: Aetna Commercial |
$20,348.64
|
| Rate for Payer: Anthem Medicaid |
$9,088.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,612.90
|
| Rate for Payer: Cash Price |
$13,213.40
|
| Rate for Payer: Cigna Commercial |
$21,934.24
|
| Rate for Payer: First Health Commercial |
$25,105.46
|
| Rate for Payer: Humana Commercial |
$22,462.78
|
| Rate for Payer: Humana KY Medicaid |
$9,088.18
|
| Rate for Payer: Kentucky WC Medicaid |
$9,180.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,669.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,502.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,928.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,270.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,255.58
|
| Rate for Payer: Ohio Health Group HMO |
$19,820.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,285.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,435.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,192.31
|
| Rate for Payer: PHCS Commercial |
$25,369.73
|
| Rate for Payer: United Healthcare All Payer |
$23,255.58
|
|
|
LCCK 0D SZ4 5MM 41*34 CPL
|
Facility
|
IP
|
$26,426.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,435.48 |
| Max. Negotiated Rate |
$25,369.73 |
| Rate for Payer: Aetna Commercial |
$20,348.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,612.90
|
| Rate for Payer: Cash Price |
$13,213.40
|
| Rate for Payer: Cigna Commercial |
$21,934.24
|
| Rate for Payer: First Health Commercial |
$25,105.46
|
| Rate for Payer: Humana Commercial |
$22,462.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,669.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,502.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,928.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,255.58
|
| Rate for Payer: Ohio Health Group HMO |
$19,820.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,285.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,435.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,192.31
|
| Rate for Payer: PHCS Commercial |
$25,369.73
|
| Rate for Payer: United Healthcare All Payer |
$23,255.58
|
|
|
LCCK 0D SZ4 5MM 46*34 CPL
|
Facility
|
IP
|
$26,426.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,435.48 |
| Max. Negotiated Rate |
$25,369.73 |
| Rate for Payer: Aetna Commercial |
$20,348.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,612.90
|
| Rate for Payer: Cash Price |
$13,213.40
|
| Rate for Payer: Cigna Commercial |
$21,934.24
|
| Rate for Payer: First Health Commercial |
$25,105.46
|
| Rate for Payer: Humana Commercial |
$22,462.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,669.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,502.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,928.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,255.58
|
| Rate for Payer: Ohio Health Group HMO |
$19,820.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,285.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,435.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,192.31
|
| Rate for Payer: PHCS Commercial |
$25,369.73
|
| Rate for Payer: United Healthcare All Payer |
$23,255.58
|
|
|
LCCK 0D SZ4 5MM 46*34 CPL
|
Facility
|
OP
|
$26,426.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,435.48 |
| Max. Negotiated Rate |
$25,369.73 |
| Rate for Payer: Aetna Commercial |
$20,348.64
|
| Rate for Payer: Anthem Medicaid |
$9,088.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,612.90
|
| Rate for Payer: Cash Price |
$13,213.40
|
| Rate for Payer: Cigna Commercial |
$21,934.24
|
| Rate for Payer: First Health Commercial |
$25,105.46
|
| Rate for Payer: Humana Commercial |
$22,462.78
|
| Rate for Payer: Humana KY Medicaid |
$9,088.18
|
| Rate for Payer: Kentucky WC Medicaid |
$9,180.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,669.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,502.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,928.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,270.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,255.58
|
| Rate for Payer: Ohio Health Group HMO |
$19,820.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,285.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,435.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,192.31
|
| Rate for Payer: PHCS Commercial |
$25,369.73
|
| Rate for Payer: United Healthcare All Payer |
$23,255.58
|
|
|
LCCK 0D SZ5 5MM 31*31 CPL
|
Facility
|
IP
|
$26,426.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,435.48 |
| Max. Negotiated Rate |
$25,369.73 |
| Rate for Payer: Aetna Commercial |
$20,348.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,612.90
|
| Rate for Payer: Cash Price |
$13,213.40
|
| Rate for Payer: Cigna Commercial |
$21,934.24
|
| Rate for Payer: First Health Commercial |
$25,105.46
|
| Rate for Payer: Humana Commercial |
$22,462.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,669.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,502.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,928.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,255.58
|
| Rate for Payer: Ohio Health Group HMO |
$19,820.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,285.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,435.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,192.31
|
| Rate for Payer: PHCS Commercial |
$25,369.73
|
| Rate for Payer: United Healthcare All Payer |
$23,255.58
|
|
|
LCCK 0D SZ5 5MM 31*31 CPL
|
Facility
|
OP
|
$26,426.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,435.48 |
| Max. Negotiated Rate |
$25,369.73 |
| Rate for Payer: Aetna Commercial |
$20,348.64
|
| Rate for Payer: Anthem Medicaid |
$9,088.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,612.90
|
| Rate for Payer: Cash Price |
$13,213.40
|
| Rate for Payer: Cigna Commercial |
$21,934.24
|
| Rate for Payer: First Health Commercial |
$25,105.46
|
| Rate for Payer: Humana Commercial |
$22,462.78
|
| Rate for Payer: Humana KY Medicaid |
$9,088.18
|
| Rate for Payer: Kentucky WC Medicaid |
$9,180.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,669.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,502.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,928.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,270.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,255.58
|
| Rate for Payer: Ohio Health Group HMO |
$19,820.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,285.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,435.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,192.31
|
| Rate for Payer: PHCS Commercial |
$25,369.73
|
| Rate for Payer: United Healthcare All Payer |
$23,255.58
|
|
|
LCCK 0D SZ5 5MM 36*31 CPL
|
Facility
|
OP
|
$26,426.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,435.48 |
| Max. Negotiated Rate |
$25,369.73 |
| Rate for Payer: Aetna Commercial |
$20,348.64
|
| Rate for Payer: Anthem Medicaid |
$9,088.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,612.90
|
| Rate for Payer: Cash Price |
$13,213.40
|
| Rate for Payer: Cigna Commercial |
$21,934.24
|
| Rate for Payer: First Health Commercial |
$25,105.46
|
| Rate for Payer: Humana Commercial |
$22,462.78
|
| Rate for Payer: Humana KY Medicaid |
$9,088.18
|
| Rate for Payer: Kentucky WC Medicaid |
$9,180.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,669.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,502.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,928.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,270.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,255.58
|
| Rate for Payer: Ohio Health Group HMO |
$19,820.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,285.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,435.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,192.31
|
| Rate for Payer: PHCS Commercial |
$25,369.73
|
| Rate for Payer: United Healthcare All Payer |
$23,255.58
|
|
|
LCCK 0D SZ5 5MM 36*31 CPL
|
Facility
|
IP
|
$26,426.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,435.48 |
| Max. Negotiated Rate |
$25,369.73 |
| Rate for Payer: Aetna Commercial |
$20,348.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,612.90
|
| Rate for Payer: Cash Price |
$13,213.40
|
| Rate for Payer: Cigna Commercial |
$21,934.24
|
| Rate for Payer: First Health Commercial |
$25,105.46
|
| Rate for Payer: Humana Commercial |
$22,462.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,669.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,502.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,928.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,255.58
|
| Rate for Payer: Ohio Health Group HMO |
$19,820.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,285.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,435.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,192.31
|
| Rate for Payer: PHCS Commercial |
$25,369.73
|
| Rate for Payer: United Healthcare All Payer |
$23,255.58
|
|
|
LCCK 0D SZ5 5MM 41*34 CPL
|
Facility
|
OP
|
$26,426.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,435.48 |
| Max. Negotiated Rate |
$25,369.73 |
| Rate for Payer: Aetna Commercial |
$20,348.64
|
| Rate for Payer: Anthem Medicaid |
$9,088.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,612.90
|
| Rate for Payer: Cash Price |
$13,213.40
|
| Rate for Payer: Cigna Commercial |
$21,934.24
|
| Rate for Payer: First Health Commercial |
$25,105.46
|
| Rate for Payer: Humana Commercial |
$22,462.78
|
| Rate for Payer: Humana KY Medicaid |
$9,088.18
|
| Rate for Payer: Kentucky WC Medicaid |
$9,180.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,669.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,502.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,928.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,270.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,255.58
|
| Rate for Payer: Ohio Health Group HMO |
$19,820.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,285.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,435.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,192.31
|
| Rate for Payer: PHCS Commercial |
$25,369.73
|
| Rate for Payer: United Healthcare All Payer |
$23,255.58
|
|
|
LCCK 0D SZ5 5MM 41*34 CPL
|
Facility
|
IP
|
$26,426.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,435.48 |
| Max. Negotiated Rate |
$25,369.73 |
| Rate for Payer: Aetna Commercial |
$20,348.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,612.90
|
| Rate for Payer: Cash Price |
$13,213.40
|
| Rate for Payer: Cigna Commercial |
$21,934.24
|
| Rate for Payer: First Health Commercial |
$25,105.46
|
| Rate for Payer: Humana Commercial |
$22,462.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,669.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,502.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,928.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,255.58
|
| Rate for Payer: Ohio Health Group HMO |
$19,820.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,285.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,435.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,192.31
|
| Rate for Payer: PHCS Commercial |
$25,369.73
|
| Rate for Payer: United Healthcare All Payer |
$23,255.58
|
|
|
LCCK 0D SZ5 5MM 46*34 CPL
|
Facility
|
OP
|
$26,426.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,435.48 |
| Max. Negotiated Rate |
$25,369.73 |
| Rate for Payer: Cigna Commercial |
$21,934.24
|
| Rate for Payer: Aetna Commercial |
$20,348.64
|
| Rate for Payer: Anthem Medicaid |
$9,088.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,612.90
|
| Rate for Payer: Cash Price |
$13,213.40
|
| Rate for Payer: First Health Commercial |
$25,105.46
|
| Rate for Payer: Humana Commercial |
$22,462.78
|
| Rate for Payer: Humana KY Medicaid |
$9,088.18
|
| Rate for Payer: Kentucky WC Medicaid |
$9,180.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,669.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,502.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,928.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,270.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,255.58
|
| Rate for Payer: Ohio Health Group HMO |
$19,820.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,285.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,435.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,192.31
|
| Rate for Payer: PHCS Commercial |
$25,369.73
|
| Rate for Payer: United Healthcare All Payer |
$23,255.58
|
|
|
LCCK 0D SZ5 5MM 46*34 CPL
|
Facility
|
IP
|
$26,426.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,435.48 |
| Max. Negotiated Rate |
$25,369.73 |
| Rate for Payer: Aetna Commercial |
$20,348.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,612.90
|
| Rate for Payer: Cash Price |
$13,213.40
|
| Rate for Payer: Cigna Commercial |
$21,934.24
|
| Rate for Payer: First Health Commercial |
$25,105.46
|
| Rate for Payer: Humana Commercial |
$22,462.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,669.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,502.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,928.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,255.58
|
| Rate for Payer: Ohio Health Group HMO |
$19,820.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,285.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,435.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,192.31
|
| Rate for Payer: PHCS Commercial |
$25,369.73
|
| Rate for Payer: United Healthcare All Payer |
$23,255.58
|
|
|
LCCK 0D SZ6 5MM 31*31 CPL
|
Facility
|
OP
|
$26,426.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,435.48 |
| Max. Negotiated Rate |
$25,369.73 |
| Rate for Payer: Aetna Commercial |
$20,348.64
|
| Rate for Payer: Anthem Medicaid |
$9,088.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,612.90
|
| Rate for Payer: Cash Price |
$13,213.40
|
| Rate for Payer: Cigna Commercial |
$21,934.24
|
| Rate for Payer: First Health Commercial |
$25,105.46
|
| Rate for Payer: Humana Commercial |
$22,462.78
|
| Rate for Payer: Humana KY Medicaid |
$9,088.18
|
| Rate for Payer: Kentucky WC Medicaid |
$9,180.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,669.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,502.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,928.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,270.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,255.58
|
| Rate for Payer: Ohio Health Group HMO |
$19,820.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,285.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,435.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,192.31
|
| Rate for Payer: PHCS Commercial |
$25,369.73
|
| Rate for Payer: United Healthcare All Payer |
$23,255.58
|
|
|
LCCK 0D SZ6 5MM 31*31 CPL
|
Facility
|
IP
|
$26,426.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,435.48 |
| Max. Negotiated Rate |
$25,369.73 |
| Rate for Payer: Aetna Commercial |
$20,348.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,612.90
|
| Rate for Payer: Cash Price |
$13,213.40
|
| Rate for Payer: Cigna Commercial |
$21,934.24
|
| Rate for Payer: First Health Commercial |
$25,105.46
|
| Rate for Payer: Humana Commercial |
$22,462.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,669.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,502.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,928.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,255.58
|
| Rate for Payer: Ohio Health Group HMO |
$19,820.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,285.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,435.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,192.31
|
| Rate for Payer: PHCS Commercial |
$25,369.73
|
| Rate for Payer: United Healthcare All Payer |
$23,255.58
|
|
|
LCCK 0D SZ6 5MM 36*31 CPL
|
Facility
|
OP
|
$26,426.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,435.48 |
| Max. Negotiated Rate |
$25,369.73 |
| Rate for Payer: Aetna Commercial |
$20,348.64
|
| Rate for Payer: Anthem Medicaid |
$9,088.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,612.90
|
| Rate for Payer: Cash Price |
$13,213.40
|
| Rate for Payer: Cigna Commercial |
$21,934.24
|
| Rate for Payer: First Health Commercial |
$25,105.46
|
| Rate for Payer: Humana Commercial |
$22,462.78
|
| Rate for Payer: Humana KY Medicaid |
$9,088.18
|
| Rate for Payer: Kentucky WC Medicaid |
$9,180.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,669.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,502.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,928.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,270.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,255.58
|
| Rate for Payer: Ohio Health Group HMO |
$19,820.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,285.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,435.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,192.31
|
| Rate for Payer: PHCS Commercial |
$25,369.73
|
| Rate for Payer: United Healthcare All Payer |
$23,255.58
|
|
|
LCCK 0D SZ6 5MM 36*31 CPL
|
Facility
|
IP
|
$26,426.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,435.48 |
| Max. Negotiated Rate |
$25,369.73 |
| Rate for Payer: Aetna Commercial |
$20,348.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,612.90
|
| Rate for Payer: Cash Price |
$13,213.40
|
| Rate for Payer: Cigna Commercial |
$21,934.24
|
| Rate for Payer: First Health Commercial |
$25,105.46
|
| Rate for Payer: Humana Commercial |
$22,462.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,669.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,502.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,928.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,255.58
|
| Rate for Payer: Ohio Health Group HMO |
$19,820.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,285.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,435.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,192.31
|
| Rate for Payer: PHCS Commercial |
$25,369.73
|
| Rate for Payer: United Healthcare All Payer |
$23,255.58
|
|
|
LCCK 0D SZ6 5MM 41*34 CPL
|
Facility
|
IP
|
$26,426.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,435.48 |
| Max. Negotiated Rate |
$25,369.73 |
| Rate for Payer: Aetna Commercial |
$20,348.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,612.90
|
| Rate for Payer: Cash Price |
$13,213.40
|
| Rate for Payer: Cigna Commercial |
$21,934.24
|
| Rate for Payer: First Health Commercial |
$25,105.46
|
| Rate for Payer: Humana Commercial |
$22,462.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,669.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,502.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,928.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,255.58
|
| Rate for Payer: Ohio Health Group HMO |
$19,820.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,285.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,435.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,192.31
|
| Rate for Payer: PHCS Commercial |
$25,369.73
|
| Rate for Payer: United Healthcare All Payer |
$23,255.58
|
|
|
LCCK 0D SZ6 5MM 41*34 CPL
|
Facility
|
OP
|
$26,426.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,435.48 |
| Max. Negotiated Rate |
$25,369.73 |
| Rate for Payer: Aetna Commercial |
$20,348.64
|
| Rate for Payer: Anthem Medicaid |
$9,088.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,612.90
|
| Rate for Payer: Cash Price |
$13,213.40
|
| Rate for Payer: Cigna Commercial |
$21,934.24
|
| Rate for Payer: First Health Commercial |
$25,105.46
|
| Rate for Payer: Humana Commercial |
$22,462.78
|
| Rate for Payer: Humana KY Medicaid |
$9,088.18
|
| Rate for Payer: Kentucky WC Medicaid |
$9,180.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,669.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,502.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,928.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,270.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,255.58
|
| Rate for Payer: Ohio Health Group HMO |
$19,820.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,285.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,435.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,192.31
|
| Rate for Payer: PHCS Commercial |
$25,369.73
|
| Rate for Payer: United Healthcare All Payer |
$23,255.58
|
|
|
LCCK 0D SZ6 5MM 46*34 CPL
|
Facility
|
IP
|
$26,426.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,435.48 |
| Max. Negotiated Rate |
$25,369.73 |
| Rate for Payer: Aetna Commercial |
$20,348.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,612.90
|
| Rate for Payer: Cash Price |
$13,213.40
|
| Rate for Payer: Cigna Commercial |
$21,934.24
|
| Rate for Payer: First Health Commercial |
$25,105.46
|
| Rate for Payer: Humana Commercial |
$22,462.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,669.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,502.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,928.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,255.58
|
| Rate for Payer: Ohio Health Group HMO |
$19,820.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,285.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,435.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,192.31
|
| Rate for Payer: PHCS Commercial |
$25,369.73
|
| Rate for Payer: United Healthcare All Payer |
$23,255.58
|
|
|
LCCK 0D SZ6 5MM 46*34 CPL
|
Facility
|
OP
|
$26,426.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,435.48 |
| Max. Negotiated Rate |
$25,369.73 |
| Rate for Payer: Aetna Commercial |
$20,348.64
|
| Rate for Payer: Anthem Medicaid |
$9,088.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,612.90
|
| Rate for Payer: Cash Price |
$13,213.40
|
| Rate for Payer: Cigna Commercial |
$21,934.24
|
| Rate for Payer: First Health Commercial |
$25,105.46
|
| Rate for Payer: Humana Commercial |
$22,462.78
|
| Rate for Payer: Humana KY Medicaid |
$9,088.18
|
| Rate for Payer: Kentucky WC Medicaid |
$9,180.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,669.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,502.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,928.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,270.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,255.58
|
| Rate for Payer: Ohio Health Group HMO |
$19,820.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,285.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,435.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,192.31
|
| Rate for Payer: PHCS Commercial |
$25,369.73
|
| Rate for Payer: United Healthcare All Payer |
$23,255.58
|
|
|
LCCK 0D SZ7 5MM 46*34 CPL
|
Facility
|
IP
|
$26,426.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,435.48 |
| Max. Negotiated Rate |
$25,369.73 |
| Rate for Payer: Aetna Commercial |
$20,348.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,612.90
|
| Rate for Payer: Cash Price |
$13,213.40
|
| Rate for Payer: Cigna Commercial |
$21,934.24
|
| Rate for Payer: First Health Commercial |
$25,105.46
|
| Rate for Payer: Humana Commercial |
$22,462.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,669.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,502.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,928.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,255.58
|
| Rate for Payer: Ohio Health Group HMO |
$19,820.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,285.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,435.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,192.31
|
| Rate for Payer: PHCS Commercial |
$25,369.73
|
| Rate for Payer: United Healthcare All Payer |
$23,255.58
|
|
