|
LINER DISP TRL 0+4 28ID 52OD
|
Facility
|
OP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem Medicaid |
$705.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Humana KY Medicaid |
$705.01
|
| Rate for Payer: Kentucky WC Medicaid |
$712.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
|
LINER DISP TRL 0+4 28ID 52OD
|
Facility
|
IP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
|
LINER DISP TRL 0+4 28ID 54OD
|
Facility
|
OP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem Medicaid |
$705.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Humana KY Medicaid |
$705.01
|
| Rate for Payer: Kentucky WC Medicaid |
$712.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
|
LINER DISP TRL 0+4 28ID 54OD
|
Facility
|
IP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
|
LINER DISP TRL 0+4 28ID 56OD
|
Facility
|
OP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem Medicaid |
$705.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Humana KY Medicaid |
$705.01
|
| Rate for Payer: Kentucky WC Medicaid |
$712.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
|
LINER DISP TRL 0+4 28ID 56OD
|
Facility
|
IP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
|
LINER DISP TRL 0+4 28ID 58OD
|
Facility
|
IP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
|
LINER DISP TRL 0+4 28ID 58OD
|
Facility
|
OP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem Medicaid |
$705.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Humana KY Medicaid |
$705.01
|
| Rate for Payer: Kentucky WC Medicaid |
$712.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
|
LINER DISP TRL 0+4 28ID 60OD
|
Facility
|
IP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
|
LINER DISP TRL 0+4 28ID 60OD
|
Facility
|
OP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem Medicaid |
$705.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Humana KY Medicaid |
$705.01
|
| Rate for Payer: Kentucky WC Medicaid |
$712.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
|
LINER DISP TRL 0+4 32ID 48OD
|
Facility
|
IP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
|
LINER DISP TRL 0+4 32ID 48OD
|
Facility
|
OP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem Medicaid |
$705.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Humana KY Medicaid |
$705.01
|
| Rate for Payer: Kentucky WC Medicaid |
$712.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
|
LINER DISP TRL 0+4 32ID 50OD
|
Facility
|
IP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
|
LINER DISP TRL 0+4 32ID 50OD
|
Facility
|
OP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem Medicaid |
$705.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Humana KY Medicaid |
$705.01
|
| Rate for Payer: Kentucky WC Medicaid |
$712.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
|
LINER DISP TRL 0+4 32ID 52OD
|
Facility
|
IP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
|
LINER DISP TRL 0+4 32ID 52OD
|
Facility
|
OP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem Medicaid |
$705.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Humana KY Medicaid |
$705.01
|
| Rate for Payer: Kentucky WC Medicaid |
$712.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
|
LINER DISP TRL 0+4 32ID 54OD
|
Facility
|
OP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem Medicaid |
$705.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Humana KY Medicaid |
$705.01
|
| Rate for Payer: Kentucky WC Medicaid |
$712.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
|
LINER DISP TRL 0+4 32ID 54OD
|
Facility
|
IP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
|
LINER DISP TRL 0+4 32ID 56OD
|
Facility
|
OP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem Medicaid |
$705.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Humana KY Medicaid |
$705.01
|
| Rate for Payer: Kentucky WC Medicaid |
$712.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
|
LINER DISP TRL 0+4 32ID 56OD
|
Facility
|
IP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
|
LINER DISP TRL 0+4 32ID 58OD
|
Facility
|
OP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem Medicaid |
$705.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Humana KY Medicaid |
$705.01
|
| Rate for Payer: Kentucky WC Medicaid |
$712.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
|
LINER DISP TRL 0+4 32ID 58OD
|
Facility
|
IP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
|
LINER DISP TRL 0+4 32ID 60OD
|
Facility
|
OP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem Medicaid |
$705.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Humana KY Medicaid |
$705.01
|
| Rate for Payer: Kentucky WC Medicaid |
$712.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
|
LINER DISP TRL 0+4 32ID 60OD
|
Facility
|
IP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
|
LINER DISP TRL 0+4 32ID 62OD
|
Facility
|
OP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem Medicaid |
$705.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Humana KY Medicaid |
$705.01
|
| Rate for Payer: Kentucky WC Medicaid |
$712.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
