|
LINER DISP TRL 0+4 36ID 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 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 DISP TRL 0+4 36ID 60OD
|
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 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 DISP TRL 0+4 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 DISP TRL 0+4 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 DISP TRL 0+4 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 DISP TRL 0 DEG 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 DEG 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 DEG 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 DEG 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 DEG 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 DEG 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 DEG 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 DEG 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 DEG 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 DEG 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 DEG 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 DEG 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 DEG 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 DEG 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
|
|
|
LINER DISP TRL 0 DEG 28ID 60OD
|
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 DEG 28ID 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 DISP TRL 0 DEG 32ID 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 DEG 32ID 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
|
|
