|
LCCK 7D SZ2 5MM 36*31 CPL
|
Facility
|
IP
|
$27,219.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,165.79 |
| Max. Negotiated Rate |
$26,130.54 |
| Rate for Payer: Aetna Commercial |
$20,958.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,231.06
|
| Rate for Payer: Cash Price |
$13,609.66
|
| Rate for Payer: Cigna Commercial |
$22,592.03
|
| Rate for Payer: First Health Commercial |
$25,858.34
|
| Rate for Payer: Humana Commercial |
$23,136.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,319.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,087.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,165.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,952.99
|
| Rate for Payer: Ohio Health Group HMO |
$20,414.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,775.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,680.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,781.32
|
| Rate for Payer: PHCS Commercial |
$26,130.54
|
| Rate for Payer: United Healthcare All Payer |
$23,952.99
|
|
|
LCCK 7D SZ3 5MM 31*31 CPL
|
Facility
|
OP
|
$27,219.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,165.79 |
| Max. Negotiated Rate |
$26,130.54 |
| Rate for Payer: Aetna Commercial |
$20,958.87
|
| Rate for Payer: Anthem Medicaid |
$9,360.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,231.06
|
| Rate for Payer: Cash Price |
$13,609.66
|
| Rate for Payer: Cigna Commercial |
$22,592.03
|
| Rate for Payer: First Health Commercial |
$25,858.34
|
| Rate for Payer: Humana Commercial |
$23,136.41
|
| Rate for Payer: Humana KY Medicaid |
$9,360.72
|
| Rate for Payer: Kentucky WC Medicaid |
$9,455.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,319.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,087.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,165.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,548.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,952.99
|
| Rate for Payer: Ohio Health Group HMO |
$20,414.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,775.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,680.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,781.32
|
| Rate for Payer: PHCS Commercial |
$26,130.54
|
| Rate for Payer: United Healthcare All Payer |
$23,952.99
|
|
|
LCCK 7D SZ3 5MM 31*31 CPL
|
Facility
|
IP
|
$27,219.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,165.79 |
| Max. Negotiated Rate |
$26,130.54 |
| Rate for Payer: Aetna Commercial |
$20,958.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,231.06
|
| Rate for Payer: Cash Price |
$13,609.66
|
| Rate for Payer: Cigna Commercial |
$22,592.03
|
| Rate for Payer: First Health Commercial |
$25,858.34
|
| Rate for Payer: Humana Commercial |
$23,136.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,319.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,087.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,165.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,952.99
|
| Rate for Payer: Ohio Health Group HMO |
$20,414.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,775.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,680.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,781.32
|
| Rate for Payer: PHCS Commercial |
$26,130.54
|
| Rate for Payer: United Healthcare All Payer |
$23,952.99
|
|
|
LCCK 7D SZ3 5MM 36*31 CPL
|
Facility
|
OP
|
$27,219.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,165.79 |
| Max. Negotiated Rate |
$26,130.54 |
| Rate for Payer: Aetna Commercial |
$20,958.87
|
| Rate for Payer: Anthem Medicaid |
$9,360.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,231.06
|
| Rate for Payer: Cash Price |
$13,609.66
|
| Rate for Payer: Cigna Commercial |
$22,592.03
|
| Rate for Payer: First Health Commercial |
$25,858.34
|
| Rate for Payer: Humana Commercial |
$23,136.41
|
| Rate for Payer: Humana KY Medicaid |
$9,360.72
|
| Rate for Payer: Kentucky WC Medicaid |
$9,455.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,319.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,087.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,165.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,548.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,952.99
|
| Rate for Payer: Ohio Health Group HMO |
$20,414.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,775.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,680.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,781.32
|
| Rate for Payer: PHCS Commercial |
$26,130.54
|
| Rate for Payer: United Healthcare All Payer |
$23,952.99
|
|
|
LCCK 7D SZ3 5MM 36*31 CPL
|
Facility
|
IP
|
$27,219.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,165.79 |
| Max. Negotiated Rate |
$26,130.54 |
| Rate for Payer: Aetna Commercial |
$20,958.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,231.06
|
| Rate for Payer: Cash Price |
$13,609.66
|
| Rate for Payer: Cigna Commercial |
$22,592.03
|
| Rate for Payer: First Health Commercial |
$25,858.34
|
| Rate for Payer: Humana Commercial |
$23,136.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,319.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,087.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,165.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,952.99
|
| Rate for Payer: Ohio Health Group HMO |
$20,414.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,775.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,680.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,781.32
|
| Rate for Payer: PHCS Commercial |
$26,130.54
|
| Rate for Payer: United Healthcare All Payer |
$23,952.99
|
|
|
LCCK 7D SZ4 5MM 31*31 CPL
|
Facility
|
IP
|
$27,219.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,165.79 |
| Max. Negotiated Rate |
$26,130.54 |
| Rate for Payer: Aetna Commercial |
$20,958.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,231.06
|
| Rate for Payer: Cash Price |
$13,609.66
|
| Rate for Payer: Cigna Commercial |
$22,592.03
|
| Rate for Payer: First Health Commercial |
$25,858.34
|
| Rate for Payer: Humana Commercial |
$23,136.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,319.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,087.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,165.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,952.99
|
| Rate for Payer: Ohio Health Group HMO |
$20,414.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,775.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,680.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,781.32
|
| Rate for Payer: PHCS Commercial |
$26,130.54
|
| Rate for Payer: United Healthcare All Payer |
$23,952.99
|
|
|
LCCK 7D SZ4 5MM 31*31 CPL
|
Facility
|
OP
|
$27,219.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,165.79 |
| Max. Negotiated Rate |
$26,130.54 |
| Rate for Payer: Aetna Commercial |
$20,958.87
|
| Rate for Payer: Anthem Medicaid |
$9,360.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,231.06
|
| Rate for Payer: Cash Price |
$13,609.66
|
| Rate for Payer: Cigna Commercial |
$22,592.03
|
| Rate for Payer: First Health Commercial |
$25,858.34
|
| Rate for Payer: Humana Commercial |
$23,136.41
|
| Rate for Payer: Humana KY Medicaid |
$9,360.72
|
| Rate for Payer: Kentucky WC Medicaid |
$9,455.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,319.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,087.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,165.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,548.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,952.99
|
| Rate for Payer: Ohio Health Group HMO |
$20,414.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,775.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,680.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,781.32
|
| Rate for Payer: PHCS Commercial |
$26,130.54
|
| Rate for Payer: United Healthcare All Payer |
$23,952.99
|
|
|
LCCK 7D SZ4 5MM 36*31 CPL
|
Facility
|
OP
|
$27,219.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,165.79 |
| Max. Negotiated Rate |
$26,130.54 |
| Rate for Payer: Aetna Commercial |
$20,958.87
|
| Rate for Payer: Anthem Medicaid |
$9,360.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,231.06
|
| Rate for Payer: Cash Price |
$13,609.66
|
| Rate for Payer: Cigna Commercial |
$22,592.03
|
| Rate for Payer: First Health Commercial |
$25,858.34
|
| Rate for Payer: Humana Commercial |
$23,136.41
|
| Rate for Payer: Humana KY Medicaid |
$9,360.72
|
| Rate for Payer: Kentucky WC Medicaid |
$9,455.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,319.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,087.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,165.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,548.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,952.99
|
| Rate for Payer: Ohio Health Group HMO |
$20,414.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,775.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,680.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,781.32
|
| Rate for Payer: PHCS Commercial |
$26,130.54
|
| Rate for Payer: United Healthcare All Payer |
$23,952.99
|
|
|
LCCK 7D SZ4 5MM 36*31 CPL
|
Facility
|
IP
|
$27,219.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,165.79 |
| Max. Negotiated Rate |
$26,130.54 |
| Rate for Payer: Aetna Commercial |
$20,958.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,231.06
|
| Rate for Payer: Cash Price |
$13,609.66
|
| Rate for Payer: Cigna Commercial |
$22,592.03
|
| Rate for Payer: First Health Commercial |
$25,858.34
|
| Rate for Payer: Humana Commercial |
$23,136.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,319.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,087.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,165.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,952.99
|
| Rate for Payer: Ohio Health Group HMO |
$20,414.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,775.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,680.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,781.32
|
| Rate for Payer: PHCS Commercial |
$26,130.54
|
| Rate for Payer: United Healthcare All Payer |
$23,952.99
|
|
|
LCCK 7D SZ4 5MM 41*34 CPL
|
Facility
|
OP
|
$27,219.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,165.79 |
| Max. Negotiated Rate |
$26,130.54 |
| Rate for Payer: Aetna Commercial |
$20,958.87
|
| Rate for Payer: Anthem Medicaid |
$9,360.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,231.06
|
| Rate for Payer: Cash Price |
$13,609.66
|
| Rate for Payer: Cigna Commercial |
$22,592.03
|
| Rate for Payer: First Health Commercial |
$25,858.34
|
| Rate for Payer: Humana Commercial |
$23,136.41
|
| Rate for Payer: Humana KY Medicaid |
$9,360.72
|
| Rate for Payer: Kentucky WC Medicaid |
$9,455.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,319.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,087.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,165.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,548.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,952.99
|
| Rate for Payer: Ohio Health Group HMO |
$20,414.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,775.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,680.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,781.32
|
| Rate for Payer: PHCS Commercial |
$26,130.54
|
| Rate for Payer: United Healthcare All Payer |
$23,952.99
|
|
|
LCCK 7D SZ4 5MM 41*34 CPL
|
Facility
|
IP
|
$27,219.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,165.79 |
| Max. Negotiated Rate |
$26,130.54 |
| Rate for Payer: Aetna Commercial |
$20,958.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,231.06
|
| Rate for Payer: Cash Price |
$13,609.66
|
| Rate for Payer: Cigna Commercial |
$22,592.03
|
| Rate for Payer: First Health Commercial |
$25,858.34
|
| Rate for Payer: Humana Commercial |
$23,136.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,319.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,087.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,165.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,952.99
|
| Rate for Payer: Ohio Health Group HMO |
$20,414.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,775.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,680.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,781.32
|
| Rate for Payer: PHCS Commercial |
$26,130.54
|
| Rate for Payer: United Healthcare All Payer |
$23,952.99
|
|
|
LCCK 7D SZ4 5MM 46*34 CPL
|
Facility
|
OP
|
$27,219.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,165.79 |
| Max. Negotiated Rate |
$26,130.54 |
| Rate for Payer: Aetna Commercial |
$20,958.87
|
| Rate for Payer: Anthem Medicaid |
$9,360.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,231.06
|
| Rate for Payer: Cash Price |
$13,609.66
|
| Rate for Payer: Cigna Commercial |
$22,592.03
|
| Rate for Payer: First Health Commercial |
$25,858.34
|
| Rate for Payer: Humana Commercial |
$23,136.41
|
| Rate for Payer: Humana KY Medicaid |
$9,360.72
|
| Rate for Payer: Kentucky WC Medicaid |
$9,455.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,319.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,087.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,165.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,548.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,952.99
|
| Rate for Payer: Ohio Health Group HMO |
$20,414.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,775.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,680.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,781.32
|
| Rate for Payer: PHCS Commercial |
$26,130.54
|
| Rate for Payer: United Healthcare All Payer |
$23,952.99
|
|
|
LCCK 7D SZ4 5MM 46*34 CPL
|
Facility
|
IP
|
$27,219.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,165.79 |
| Max. Negotiated Rate |
$26,130.54 |
| Rate for Payer: Aetna Commercial |
$20,958.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,231.06
|
| Rate for Payer: Cash Price |
$13,609.66
|
| Rate for Payer: Cigna Commercial |
$22,592.03
|
| Rate for Payer: First Health Commercial |
$25,858.34
|
| Rate for Payer: Humana Commercial |
$23,136.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,319.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,087.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,165.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,952.99
|
| Rate for Payer: Ohio Health Group HMO |
$20,414.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,775.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,680.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,781.32
|
| Rate for Payer: PHCS Commercial |
$26,130.54
|
| Rate for Payer: United Healthcare All Payer |
$23,952.99
|
|
|
LCCK 7D SZ5 5MM 31*31 CPL
|
Facility
|
OP
|
$27,219.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,165.79 |
| Max. Negotiated Rate |
$26,130.54 |
| Rate for Payer: Aetna Commercial |
$20,958.87
|
| Rate for Payer: Anthem Medicaid |
$9,360.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,231.06
|
| Rate for Payer: Cash Price |
$13,609.66
|
| Rate for Payer: Cigna Commercial |
$22,592.03
|
| Rate for Payer: First Health Commercial |
$25,858.34
|
| Rate for Payer: Humana Commercial |
$23,136.41
|
| Rate for Payer: Humana KY Medicaid |
$9,360.72
|
| Rate for Payer: Kentucky WC Medicaid |
$9,455.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,319.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,087.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,165.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,548.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,952.99
|
| Rate for Payer: Ohio Health Group HMO |
$20,414.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,775.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,680.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,781.32
|
| Rate for Payer: PHCS Commercial |
$26,130.54
|
| Rate for Payer: United Healthcare All Payer |
$23,952.99
|
|
|
LCCK 7D SZ5 5MM 31*31 CPL
|
Facility
|
IP
|
$27,219.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,165.79 |
| Max. Negotiated Rate |
$26,130.54 |
| Rate for Payer: Aetna Commercial |
$20,958.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,231.06
|
| Rate for Payer: Cash Price |
$13,609.66
|
| Rate for Payer: Cigna Commercial |
$22,592.03
|
| Rate for Payer: First Health Commercial |
$25,858.34
|
| Rate for Payer: Humana Commercial |
$23,136.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,319.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,087.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,165.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,952.99
|
| Rate for Payer: Ohio Health Group HMO |
$20,414.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,775.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,680.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,781.32
|
| Rate for Payer: PHCS Commercial |
$26,130.54
|
| Rate for Payer: United Healthcare All Payer |
$23,952.99
|
|
|
LCCK 7D SZ5 5MM 36*31 CPL
|
Facility
|
IP
|
$27,219.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,165.79 |
| Max. Negotiated Rate |
$26,130.54 |
| Rate for Payer: Aetna Commercial |
$20,958.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,231.06
|
| Rate for Payer: Cash Price |
$13,609.66
|
| Rate for Payer: Cigna Commercial |
$22,592.03
|
| Rate for Payer: First Health Commercial |
$25,858.34
|
| Rate for Payer: Humana Commercial |
$23,136.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,319.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,087.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,165.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,952.99
|
| Rate for Payer: Ohio Health Group HMO |
$20,414.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,775.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,680.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,781.32
|
| Rate for Payer: PHCS Commercial |
$26,130.54
|
| Rate for Payer: United Healthcare All Payer |
$23,952.99
|
|
|
LCCK 7D SZ5 5MM 36*31 CPL
|
Facility
|
OP
|
$27,219.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,165.79 |
| Max. Negotiated Rate |
$26,130.54 |
| Rate for Payer: Aetna Commercial |
$20,958.87
|
| Rate for Payer: Anthem Medicaid |
$9,360.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,231.06
|
| Rate for Payer: Cash Price |
$13,609.66
|
| Rate for Payer: Cigna Commercial |
$22,592.03
|
| Rate for Payer: First Health Commercial |
$25,858.34
|
| Rate for Payer: Humana Commercial |
$23,136.41
|
| Rate for Payer: Humana KY Medicaid |
$9,360.72
|
| Rate for Payer: Kentucky WC Medicaid |
$9,455.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,319.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,087.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,165.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,548.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,952.99
|
| Rate for Payer: Ohio Health Group HMO |
$20,414.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,775.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,680.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,781.32
|
| Rate for Payer: PHCS Commercial |
$26,130.54
|
| Rate for Payer: United Healthcare All Payer |
$23,952.99
|
|
|
LCCK 7D SZ5 5MM 41*34 CPL
|
Facility
|
OP
|
$27,219.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,165.79 |
| Max. Negotiated Rate |
$26,130.54 |
| Rate for Payer: Aetna Commercial |
$20,958.87
|
| Rate for Payer: Anthem Medicaid |
$9,360.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,231.06
|
| Rate for Payer: Cash Price |
$13,609.66
|
| Rate for Payer: Cigna Commercial |
$22,592.03
|
| Rate for Payer: First Health Commercial |
$25,858.34
|
| Rate for Payer: Humana Commercial |
$23,136.41
|
| Rate for Payer: Humana KY Medicaid |
$9,360.72
|
| Rate for Payer: Kentucky WC Medicaid |
$9,455.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,319.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,087.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,165.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,548.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,952.99
|
| Rate for Payer: Ohio Health Group HMO |
$20,414.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,775.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,680.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,781.32
|
| Rate for Payer: PHCS Commercial |
$26,130.54
|
| Rate for Payer: United Healthcare All Payer |
$23,952.99
|
|
|
LCCK 7D SZ5 5MM 41*34 CPL
|
Facility
|
IP
|
$27,219.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,165.79 |
| Max. Negotiated Rate |
$26,130.54 |
| Rate for Payer: Aetna Commercial |
$20,958.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,231.06
|
| Rate for Payer: Cash Price |
$13,609.66
|
| Rate for Payer: Cigna Commercial |
$22,592.03
|
| Rate for Payer: First Health Commercial |
$25,858.34
|
| Rate for Payer: Humana Commercial |
$23,136.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,319.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,087.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,165.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,952.99
|
| Rate for Payer: Ohio Health Group HMO |
$20,414.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,775.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,680.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,781.32
|
| Rate for Payer: PHCS Commercial |
$26,130.54
|
| Rate for Payer: United Healthcare All Payer |
$23,952.99
|
|
|
LCCK 7D SZ5 5MM 46*34 CPL
|
Facility
|
IP
|
$27,219.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,165.79 |
| Max. Negotiated Rate |
$26,130.54 |
| Rate for Payer: Aetna Commercial |
$20,958.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,231.06
|
| Rate for Payer: Cash Price |
$13,609.66
|
| Rate for Payer: Cigna Commercial |
$22,592.03
|
| Rate for Payer: First Health Commercial |
$25,858.34
|
| Rate for Payer: Humana Commercial |
$23,136.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,319.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,087.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,165.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,952.99
|
| Rate for Payer: Ohio Health Group HMO |
$20,414.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,775.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,680.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,781.32
|
| Rate for Payer: PHCS Commercial |
$26,130.54
|
| Rate for Payer: United Healthcare All Payer |
$23,952.99
|
|
|
LCCK 7D SZ5 5MM 46*34 CPL
|
Facility
|
OP
|
$27,219.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,165.79 |
| Max. Negotiated Rate |
$26,130.54 |
| Rate for Payer: Aetna Commercial |
$20,958.87
|
| Rate for Payer: Anthem Medicaid |
$9,360.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,231.06
|
| Rate for Payer: Cash Price |
$13,609.66
|
| Rate for Payer: Cigna Commercial |
$22,592.03
|
| Rate for Payer: First Health Commercial |
$25,858.34
|
| Rate for Payer: Humana Commercial |
$23,136.41
|
| Rate for Payer: Humana KY Medicaid |
$9,360.72
|
| Rate for Payer: Kentucky WC Medicaid |
$9,455.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,319.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,087.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,165.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,548.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,952.99
|
| Rate for Payer: Ohio Health Group HMO |
$20,414.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,775.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,680.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,781.32
|
| Rate for Payer: PHCS Commercial |
$26,130.54
|
| Rate for Payer: United Healthcare All Payer |
$23,952.99
|
|
|
LCCK 7D SZ6 5MM 31*31 CPL
|
Facility
|
OP
|
$27,219.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,165.79 |
| Max. Negotiated Rate |
$26,130.54 |
| Rate for Payer: Aetna Commercial |
$20,958.87
|
| Rate for Payer: Anthem Medicaid |
$9,360.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,231.06
|
| Rate for Payer: Cash Price |
$13,609.66
|
| Rate for Payer: Cigna Commercial |
$22,592.03
|
| Rate for Payer: First Health Commercial |
$25,858.34
|
| Rate for Payer: Humana Commercial |
$23,136.41
|
| Rate for Payer: Humana KY Medicaid |
$9,360.72
|
| Rate for Payer: Kentucky WC Medicaid |
$9,455.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,319.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,087.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,165.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,548.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,952.99
|
| Rate for Payer: Ohio Health Group HMO |
$20,414.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,775.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,680.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,781.32
|
| Rate for Payer: PHCS Commercial |
$26,130.54
|
| Rate for Payer: United Healthcare All Payer |
$23,952.99
|
|
|
LCCK 7D SZ6 5MM 31*31 CPL
|
Facility
|
IP
|
$27,219.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,165.79 |
| Max. Negotiated Rate |
$26,130.54 |
| Rate for Payer: Aetna Commercial |
$20,958.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,231.06
|
| Rate for Payer: Cash Price |
$13,609.66
|
| Rate for Payer: Cigna Commercial |
$22,592.03
|
| Rate for Payer: First Health Commercial |
$25,858.34
|
| Rate for Payer: Humana Commercial |
$23,136.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,319.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,087.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,165.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,952.99
|
| Rate for Payer: Ohio Health Group HMO |
$20,414.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,775.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,680.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,781.32
|
| Rate for Payer: PHCS Commercial |
$26,130.54
|
| Rate for Payer: United Healthcare All Payer |
$23,952.99
|
|
|
LCCK 7D SZ6 5MM 36*31 CPL
|
Facility
|
IP
|
$27,219.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,165.79 |
| Max. Negotiated Rate |
$26,130.54 |
| Rate for Payer: Aetna Commercial |
$20,958.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,231.06
|
| Rate for Payer: Cash Price |
$13,609.66
|
| Rate for Payer: Cigna Commercial |
$22,592.03
|
| Rate for Payer: First Health Commercial |
$25,858.34
|
| Rate for Payer: Humana Commercial |
$23,136.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,319.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,087.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,165.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,952.99
|
| Rate for Payer: Ohio Health Group HMO |
$20,414.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,775.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,680.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,781.32
|
| Rate for Payer: PHCS Commercial |
$26,130.54
|
| Rate for Payer: United Healthcare All Payer |
$23,952.99
|
|
|
LCCK 7D SZ6 5MM 36*31 CPL
|
Facility
|
OP
|
$27,219.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,165.79 |
| Max. Negotiated Rate |
$26,130.54 |
| Rate for Payer: Aetna Commercial |
$20,958.87
|
| Rate for Payer: Anthem Medicaid |
$9,360.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,231.06
|
| Rate for Payer: Cash Price |
$13,609.66
|
| Rate for Payer: Cigna Commercial |
$22,592.03
|
| Rate for Payer: First Health Commercial |
$25,858.34
|
| Rate for Payer: Humana Commercial |
$23,136.41
|
| Rate for Payer: Humana KY Medicaid |
$9,360.72
|
| Rate for Payer: Kentucky WC Medicaid |
$9,455.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,319.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,087.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,165.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,548.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,952.99
|
| Rate for Payer: Ohio Health Group HMO |
$20,414.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,775.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,680.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,781.32
|
| Rate for Payer: PHCS Commercial |
$26,130.54
|
| Rate for Payer: United Healthcare All Payer |
$23,952.99
|
|
