|
LINER CRMC DISP TRL 36ID 60OD
|
Facility
|
OP
|
$2,060.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.01 |
| Max. Negotiated Rate |
$1,977.64 |
| Rate for Payer: Aetna Commercial |
$1,586.23
|
| Rate for Payer: Anthem Medicaid |
$708.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.83
|
| Rate for Payer: Cash Price |
$1,030.02
|
| Rate for Payer: Cigna Commercial |
$1,709.83
|
| Rate for Payer: First Health Commercial |
$1,957.04
|
| Rate for Payer: Humana Commercial |
$1,751.03
|
| Rate for Payer: Humana KY Medicaid |
$708.45
|
| Rate for Payer: Kentucky WC Medicaid |
$715.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.43
|
| Rate for Payer: PHCS Commercial |
$1,977.64
|
| Rate for Payer: United Healthcare All Payer |
$1,812.84
|
|
|
LINER CRMC DISP TRL 36ID 62OD
|
Facility
|
OP
|
$2,060.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.01 |
| Max. Negotiated Rate |
$1,977.64 |
| Rate for Payer: Aetna Commercial |
$1,586.23
|
| Rate for Payer: Anthem Medicaid |
$708.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.83
|
| Rate for Payer: Cash Price |
$1,030.02
|
| Rate for Payer: Cigna Commercial |
$1,709.83
|
| Rate for Payer: First Health Commercial |
$1,957.04
|
| Rate for Payer: Humana Commercial |
$1,751.03
|
| Rate for Payer: Humana KY Medicaid |
$708.45
|
| Rate for Payer: Kentucky WC Medicaid |
$715.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.43
|
| Rate for Payer: PHCS Commercial |
$1,977.64
|
| Rate for Payer: United Healthcare All Payer |
$1,812.84
|
|
|
LINER CRMC DISP TRL 36ID 62OD
|
Facility
|
IP
|
$2,060.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.01 |
| Max. Negotiated Rate |
$1,977.64 |
| Rate for Payer: Aetna Commercial |
$1,586.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.83
|
| Rate for Payer: Cash Price |
$1,030.02
|
| Rate for Payer: Cigna Commercial |
$1,709.83
|
| Rate for Payer: First Health Commercial |
$1,957.04
|
| Rate for Payer: Humana Commercial |
$1,751.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.43
|
| Rate for Payer: PHCS Commercial |
$1,977.64
|
| Rate for Payer: United Healthcare All Payer |
$1,812.84
|
|
|
LINER CRMC DISP TRL 36ID 64OD
|
Facility
|
OP
|
$2,060.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.01 |
| Max. Negotiated Rate |
$1,977.64 |
| Rate for Payer: Aetna Commercial |
$1,586.23
|
| Rate for Payer: Anthem Medicaid |
$708.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.83
|
| Rate for Payer: Cash Price |
$1,030.02
|
| Rate for Payer: Cigna Commercial |
$1,709.83
|
| Rate for Payer: First Health Commercial |
$1,957.04
|
| Rate for Payer: Humana Commercial |
$1,751.03
|
| Rate for Payer: Humana KY Medicaid |
$708.45
|
| Rate for Payer: Kentucky WC Medicaid |
$715.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.43
|
| Rate for Payer: PHCS Commercial |
$1,977.64
|
| Rate for Payer: United Healthcare All Payer |
$1,812.84
|
|
|
LINER CRMC DISP TRL 36ID 64OD
|
Facility
|
IP
|
$2,060.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.01 |
| Max. Negotiated Rate |
$1,977.64 |
| Rate for Payer: Aetna Commercial |
$1,586.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.83
|
| Rate for Payer: Cash Price |
$1,030.02
|
| Rate for Payer: Cigna Commercial |
$1,709.83
|
| Rate for Payer: First Health Commercial |
$1,957.04
|
| Rate for Payer: Humana Commercial |
$1,751.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.43
|
| Rate for Payer: PHCS Commercial |
$1,977.64
|
| Rate for Payer: United Healthcare All Payer |
$1,812.84
|
|
|
LINER DE ANT 36 20 +6 54-56 F
|
Facility
|
OP
|
$8,919.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,675.82 |
| Max. Negotiated Rate |
$8,562.61 |
| Rate for Payer: Aetna Commercial |
$6,867.93
|
| Rate for Payer: Anthem Medicaid |
$3,067.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,957.12
|
| Rate for Payer: Cash Price |
$4,459.69
|
| Rate for Payer: Cigna Commercial |
$7,403.09
|
| Rate for Payer: First Health Commercial |
$8,473.42
|
| Rate for Payer: Humana Commercial |
$7,581.48
|
| Rate for Payer: Humana KY Medicaid |
$3,067.38
|
| Rate for Payer: Kentucky WC Medicaid |
$3,098.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,313.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,582.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,675.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,128.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,849.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,689.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,135.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,759.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,154.38
|
| Rate for Payer: PHCS Commercial |
$8,562.61
|
| Rate for Payer: United Healthcare All Payer |
$7,849.06
|
|
|
LINER DE ANT 36 20 +6 54-56 F
|
Facility
|
IP
|
$8,919.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,675.82 |
| Max. Negotiated Rate |
$8,562.61 |
| Rate for Payer: Aetna Commercial |
$6,867.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,957.12
|
| Rate for Payer: Cash Price |
$4,459.69
|
| Rate for Payer: Cigna Commercial |
$7,403.09
|
| Rate for Payer: First Health Commercial |
$8,473.42
|
| Rate for Payer: Humana Commercial |
$7,581.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,313.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,582.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,675.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,849.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,689.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,135.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,759.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,154.38
|
| Rate for Payer: PHCS Commercial |
$8,562.61
|
| Rate for Payer: United Healthcare All Payer |
$7,849.06
|
|
|
LINER DE ANT 36 20 +6 58-60 F
|
Facility
|
OP
|
$8,919.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,675.82 |
| Max. Negotiated Rate |
$8,562.61 |
| Rate for Payer: Aetna Commercial |
$6,867.93
|
| Rate for Payer: Anthem Medicaid |
$3,067.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,957.12
|
| Rate for Payer: Cash Price |
$4,459.69
|
| Rate for Payer: Cigna Commercial |
$7,403.09
|
| Rate for Payer: First Health Commercial |
$8,473.42
|
| Rate for Payer: Humana Commercial |
$7,581.48
|
| Rate for Payer: Humana KY Medicaid |
$3,067.38
|
| Rate for Payer: Kentucky WC Medicaid |
$3,098.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,313.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,582.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,675.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,128.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,849.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,689.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,135.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,759.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,154.38
|
| Rate for Payer: PHCS Commercial |
$8,562.61
|
| Rate for Payer: United Healthcare All Payer |
$7,849.06
|
|
|
LINER DE ANT 36 20 +6 58-60 F
|
Facility
|
IP
|
$8,919.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,675.82 |
| Max. Negotiated Rate |
$8,562.61 |
| Rate for Payer: Aetna Commercial |
$6,867.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,957.12
|
| Rate for Payer: Cash Price |
$4,459.69
|
| Rate for Payer: Cigna Commercial |
$7,403.09
|
| Rate for Payer: First Health Commercial |
$8,473.42
|
| Rate for Payer: Humana Commercial |
$7,581.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,313.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,582.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,675.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,849.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,689.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,135.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,759.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,154.38
|
| Rate for Payer: PHCS Commercial |
$8,562.61
|
| Rate for Payer: United Healthcare All Payer |
$7,849.06
|
|
|
LINER DE ANT 36 20 +6 62-64 G
|
Facility
|
IP
|
$8,919.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,675.82 |
| Max. Negotiated Rate |
$8,562.61 |
| Rate for Payer: Aetna Commercial |
$6,867.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,957.12
|
| Rate for Payer: Cash Price |
$4,459.69
|
| Rate for Payer: Cigna Commercial |
$7,403.09
|
| Rate for Payer: First Health Commercial |
$8,473.42
|
| Rate for Payer: Humana Commercial |
$7,581.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,313.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,582.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,675.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,849.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,689.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,135.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,759.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,154.38
|
| Rate for Payer: PHCS Commercial |
$8,562.61
|
| Rate for Payer: United Healthcare All Payer |
$7,849.06
|
|
|
LINER DE ANT 36 20 +6 62-64 G
|
Facility
|
OP
|
$8,919.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,675.82 |
| Max. Negotiated Rate |
$8,562.61 |
| Rate for Payer: Aetna Commercial |
$6,867.93
|
| Rate for Payer: Anthem Medicaid |
$3,067.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,957.12
|
| Rate for Payer: Cash Price |
$4,459.69
|
| Rate for Payer: Cigna Commercial |
$7,403.09
|
| Rate for Payer: First Health Commercial |
$8,473.42
|
| Rate for Payer: Humana Commercial |
$7,581.48
|
| Rate for Payer: Humana KY Medicaid |
$3,067.38
|
| Rate for Payer: Kentucky WC Medicaid |
$3,098.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,313.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,582.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,675.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,128.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,849.06
|
| Rate for Payer: Ohio Health Group HMO |
$6,689.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,135.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,759.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,154.38
|
| Rate for Payer: PHCS Commercial |
$8,562.61
|
| Rate for Payer: United Healthcare All Payer |
$7,849.06
|
|
|
LINER DISP TRL 0+4 28ID 46OD
|
Facility
|
IP
|
$2,060.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.01 |
| Max. Negotiated Rate |
$1,977.64 |
| Rate for Payer: Aetna Commercial |
$1,586.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.83
|
| Rate for Payer: Cash Price |
$1,030.02
|
| Rate for Payer: Cigna Commercial |
$1,709.83
|
| Rate for Payer: First Health Commercial |
$1,957.04
|
| Rate for Payer: Humana Commercial |
$1,751.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.43
|
| Rate for Payer: PHCS Commercial |
$1,977.64
|
| Rate for Payer: United Healthcare All Payer |
$1,812.84
|
|
|
LINER DISP TRL 0+4 28ID 46OD
|
Facility
|
OP
|
$2,060.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.01 |
| Max. Negotiated Rate |
$1,977.64 |
| Rate for Payer: Aetna Commercial |
$1,586.23
|
| Rate for Payer: Anthem Medicaid |
$708.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.83
|
| Rate for Payer: Cash Price |
$1,030.02
|
| Rate for Payer: Cigna Commercial |
$1,709.83
|
| Rate for Payer: First Health Commercial |
$1,957.04
|
| Rate for Payer: Humana Commercial |
$1,751.03
|
| Rate for Payer: Humana KY Medicaid |
$708.45
|
| Rate for Payer: Kentucky WC Medicaid |
$715.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.43
|
| Rate for Payer: PHCS Commercial |
$1,977.64
|
| Rate for Payer: United Healthcare All Payer |
$1,812.84
|
|
|
LINER DISP TRL 0+4 28ID 48OD
|
Facility
|
OP
|
$2,060.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.01 |
| Max. Negotiated Rate |
$1,977.64 |
| Rate for Payer: Aetna Commercial |
$1,586.23
|
| Rate for Payer: Anthem Medicaid |
$708.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.83
|
| Rate for Payer: Cash Price |
$1,030.02
|
| Rate for Payer: Cigna Commercial |
$1,709.83
|
| Rate for Payer: First Health Commercial |
$1,957.04
|
| Rate for Payer: Humana Commercial |
$1,751.03
|
| Rate for Payer: Humana KY Medicaid |
$708.45
|
| Rate for Payer: Kentucky WC Medicaid |
$715.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.43
|
| Rate for Payer: PHCS Commercial |
$1,977.64
|
| Rate for Payer: United Healthcare All Payer |
$1,812.84
|
|
|
LINER DISP TRL 0+4 28ID 48OD
|
Facility
|
IP
|
$2,060.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.01 |
| Max. Negotiated Rate |
$1,977.64 |
| Rate for Payer: Aetna Commercial |
$1,586.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.83
|
| Rate for Payer: Cash Price |
$1,030.02
|
| Rate for Payer: Cigna Commercial |
$1,709.83
|
| Rate for Payer: First Health Commercial |
$1,957.04
|
| Rate for Payer: Humana Commercial |
$1,751.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.43
|
| Rate for Payer: PHCS Commercial |
$1,977.64
|
| Rate for Payer: United Healthcare All Payer |
$1,812.84
|
|
|
LINER DISP TRL 0+4 28ID 50OD
|
Facility
|
IP
|
$2,060.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.01 |
| Max. Negotiated Rate |
$1,977.64 |
| Rate for Payer: Aetna Commercial |
$1,586.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.83
|
| Rate for Payer: Cash Price |
$1,030.02
|
| Rate for Payer: Cigna Commercial |
$1,709.83
|
| Rate for Payer: First Health Commercial |
$1,957.04
|
| Rate for Payer: Humana Commercial |
$1,751.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.43
|
| Rate for Payer: PHCS Commercial |
$1,977.64
|
| Rate for Payer: United Healthcare All Payer |
$1,812.84
|
|
|
LINER DISP TRL 0+4 28ID 50OD
|
Facility
|
OP
|
$2,060.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.01 |
| Max. Negotiated Rate |
$1,977.64 |
| Rate for Payer: Aetna Commercial |
$1,586.23
|
| Rate for Payer: Anthem Medicaid |
$708.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.83
|
| Rate for Payer: Cash Price |
$1,030.02
|
| Rate for Payer: Cigna Commercial |
$1,709.83
|
| Rate for Payer: First Health Commercial |
$1,957.04
|
| Rate for Payer: Humana Commercial |
$1,751.03
|
| Rate for Payer: Humana KY Medicaid |
$708.45
|
| Rate for Payer: Kentucky WC Medicaid |
$715.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.43
|
| Rate for Payer: PHCS Commercial |
$1,977.64
|
| Rate for Payer: United Healthcare All Payer |
$1,812.84
|
|
|
LINER DISP TRL 0+4 28ID 52OD
|
Facility
|
IP
|
$2,060.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.01 |
| Max. Negotiated Rate |
$1,977.64 |
| Rate for Payer: Aetna Commercial |
$1,586.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.83
|
| Rate for Payer: Cash Price |
$1,030.02
|
| Rate for Payer: Cigna Commercial |
$1,709.83
|
| Rate for Payer: First Health Commercial |
$1,957.04
|
| Rate for Payer: Humana Commercial |
$1,751.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.43
|
| Rate for Payer: PHCS Commercial |
$1,977.64
|
| Rate for Payer: United Healthcare All Payer |
$1,812.84
|
|
|
LINER DISP TRL 0+4 28ID 52OD
|
Facility
|
OP
|
$2,060.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.01 |
| Max. Negotiated Rate |
$1,977.64 |
| Rate for Payer: Aetna Commercial |
$1,586.23
|
| Rate for Payer: Anthem Medicaid |
$708.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.83
|
| Rate for Payer: Cash Price |
$1,030.02
|
| Rate for Payer: Cigna Commercial |
$1,709.83
|
| Rate for Payer: First Health Commercial |
$1,957.04
|
| Rate for Payer: Humana Commercial |
$1,751.03
|
| Rate for Payer: Humana KY Medicaid |
$708.45
|
| Rate for Payer: Kentucky WC Medicaid |
$715.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.43
|
| Rate for Payer: PHCS Commercial |
$1,977.64
|
| Rate for Payer: United Healthcare All Payer |
$1,812.84
|
|
|
LINER DISP TRL 0+4 28ID 54OD
|
Facility
|
IP
|
$2,060.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.01 |
| Max. Negotiated Rate |
$1,977.64 |
| Rate for Payer: Aetna Commercial |
$1,586.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.83
|
| Rate for Payer: Cash Price |
$1,030.02
|
| Rate for Payer: Cigna Commercial |
$1,709.83
|
| Rate for Payer: First Health Commercial |
$1,957.04
|
| Rate for Payer: Humana Commercial |
$1,751.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.43
|
| Rate for Payer: PHCS Commercial |
$1,977.64
|
| Rate for Payer: United Healthcare All Payer |
$1,812.84
|
|
|
LINER DISP TRL 0+4 28ID 54OD
|
Facility
|
OP
|
$2,060.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.01 |
| Max. Negotiated Rate |
$1,977.64 |
| Rate for Payer: Aetna Commercial |
$1,586.23
|
| Rate for Payer: Anthem Medicaid |
$708.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.83
|
| Rate for Payer: Cash Price |
$1,030.02
|
| Rate for Payer: Cigna Commercial |
$1,709.83
|
| Rate for Payer: First Health Commercial |
$1,957.04
|
| Rate for Payer: Humana Commercial |
$1,751.03
|
| Rate for Payer: Humana KY Medicaid |
$708.45
|
| Rate for Payer: Kentucky WC Medicaid |
$715.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.43
|
| Rate for Payer: PHCS Commercial |
$1,977.64
|
| Rate for Payer: United Healthcare All Payer |
$1,812.84
|
|
|
LINER DISP TRL 0+4 28ID 56OD
|
Facility
|
OP
|
$2,060.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.01 |
| Max. Negotiated Rate |
$1,977.64 |
| Rate for Payer: Aetna Commercial |
$1,586.23
|
| Rate for Payer: Anthem Medicaid |
$708.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.83
|
| Rate for Payer: Cash Price |
$1,030.02
|
| Rate for Payer: Cigna Commercial |
$1,709.83
|
| Rate for Payer: First Health Commercial |
$1,957.04
|
| Rate for Payer: Humana Commercial |
$1,751.03
|
| Rate for Payer: Humana KY Medicaid |
$708.45
|
| Rate for Payer: Kentucky WC Medicaid |
$715.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.43
|
| Rate for Payer: PHCS Commercial |
$1,977.64
|
| Rate for Payer: United Healthcare All Payer |
$1,812.84
|
|
|
LINER DISP TRL 0+4 28ID 56OD
|
Facility
|
IP
|
$2,060.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.01 |
| Max. Negotiated Rate |
$1,977.64 |
| Rate for Payer: Aetna Commercial |
$1,586.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.83
|
| Rate for Payer: Cash Price |
$1,030.02
|
| Rate for Payer: Cigna Commercial |
$1,709.83
|
| Rate for Payer: First Health Commercial |
$1,957.04
|
| Rate for Payer: Humana Commercial |
$1,751.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.43
|
| Rate for Payer: PHCS Commercial |
$1,977.64
|
| Rate for Payer: United Healthcare All Payer |
$1,812.84
|
|
|
LINER DISP TRL 0+4 28ID 58OD
|
Facility
|
OP
|
$2,060.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.01 |
| Max. Negotiated Rate |
$1,977.64 |
| Rate for Payer: Aetna Commercial |
$1,586.23
|
| Rate for Payer: Anthem Medicaid |
$708.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.83
|
| Rate for Payer: Cash Price |
$1,030.02
|
| Rate for Payer: Cigna Commercial |
$1,709.83
|
| Rate for Payer: First Health Commercial |
$1,957.04
|
| Rate for Payer: Humana Commercial |
$1,751.03
|
| Rate for Payer: Humana KY Medicaid |
$708.45
|
| Rate for Payer: Kentucky WC Medicaid |
$715.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.43
|
| Rate for Payer: PHCS Commercial |
$1,977.64
|
| Rate for Payer: United Healthcare All Payer |
$1,812.84
|
|
|
LINER DISP TRL 0+4 28ID 58OD
|
Facility
|
IP
|
$2,060.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.01 |
| Max. Negotiated Rate |
$1,977.64 |
| Rate for Payer: Aetna Commercial |
$1,586.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.83
|
| Rate for Payer: Cash Price |
$1,030.02
|
| Rate for Payer: Cigna Commercial |
$1,709.83
|
| Rate for Payer: First Health Commercial |
$1,957.04
|
| Rate for Payer: Humana Commercial |
$1,751.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.43
|
| Rate for Payer: PHCS Commercial |
$1,977.64
|
| Rate for Payer: United Healthcare All Payer |
$1,812.84
|
|
