|
LPS SEGMENTAL COMP 30MM
|
Facility
|
IP
|
$12,402.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.36 |
| Max. Negotiated Rate |
$11,906.63 |
| Rate for Payer: Aetna Commercial |
$9,550.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,674.14
|
| Rate for Payer: Cash Price |
$6,201.37
|
| Rate for Payer: Cigna Commercial |
$10,294.27
|
| Rate for Payer: First Health Commercial |
$11,782.60
|
| Rate for Payer: Humana Commercial |
$10,542.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,170.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,153.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,720.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,914.41
|
| Rate for Payer: Ohio Health Group HMO |
$9,302.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,480.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,612.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,844.85
|
| Rate for Payer: PHCS Commercial |
$11,906.63
|
| Rate for Payer: United Healthcare All Payer |
$10,914.41
|
|
|
LPS SEGMENTAL COMP 35MM
|
Facility
|
OP
|
$12,402.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.36 |
| Max. Negotiated Rate |
$11,906.63 |
| Rate for Payer: Aetna Commercial |
$9,550.11
|
| Rate for Payer: Anthem Medicaid |
$4,265.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,674.14
|
| Rate for Payer: Cash Price |
$6,201.37
|
| Rate for Payer: Cigna Commercial |
$10,294.27
|
| Rate for Payer: First Health Commercial |
$11,782.60
|
| Rate for Payer: Humana Commercial |
$10,542.33
|
| Rate for Payer: Humana KY Medicaid |
$4,265.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,308.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,170.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,153.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,720.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,350.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,914.41
|
| Rate for Payer: Ohio Health Group HMO |
$9,302.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,480.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,612.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,844.85
|
| Rate for Payer: PHCS Commercial |
$11,906.63
|
| Rate for Payer: United Healthcare All Payer |
$10,914.41
|
|
|
LPS SEGMENTAL COMP 35MM
|
Facility
|
IP
|
$12,402.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.36 |
| Max. Negotiated Rate |
$11,906.63 |
| Rate for Payer: Aetna Commercial |
$9,550.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,674.14
|
| Rate for Payer: Cash Price |
$6,201.37
|
| Rate for Payer: Cigna Commercial |
$10,294.27
|
| Rate for Payer: First Health Commercial |
$11,782.60
|
| Rate for Payer: Humana Commercial |
$10,542.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,170.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,153.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,720.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,914.41
|
| Rate for Payer: Ohio Health Group HMO |
$9,302.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,480.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,612.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,844.85
|
| Rate for Payer: PHCS Commercial |
$11,906.63
|
| Rate for Payer: United Healthcare All Payer |
$10,914.41
|
|
|
LPS SEGMENTAL COMP 40MM
|
Facility
|
IP
|
$16,922.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,199.91 |
| Max. Negotiated Rate |
$16,245.50 |
| Rate for Payer: Aetna Commercial |
$13,030.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,199.47
|
| Rate for Payer: Cash Price |
$8,461.20
|
| Rate for Payer: Cigna Commercial |
$14,045.59
|
| Rate for Payer: First Health Commercial |
$16,076.28
|
| Rate for Payer: Humana Commercial |
$14,384.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,876.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,488.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,076.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,891.71
|
| Rate for Payer: Ohio Health Group HMO |
$12,691.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,384.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,199.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,245.94
|
| Rate for Payer: PHCS Commercial |
$16,245.50
|
| Rate for Payer: United Healthcare All Payer |
$14,891.71
|
|
|
LPS SEGMENTAL COMP 40MM
|
Facility
|
OP
|
$16,922.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,199.91 |
| Max. Negotiated Rate |
$16,245.50 |
| Rate for Payer: Aetna Commercial |
$13,030.25
|
| Rate for Payer: Anthem Medicaid |
$5,819.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,199.47
|
| Rate for Payer: Cash Price |
$8,461.20
|
| Rate for Payer: Cigna Commercial |
$14,045.59
|
| Rate for Payer: First Health Commercial |
$16,076.28
|
| Rate for Payer: Humana Commercial |
$14,384.04
|
| Rate for Payer: Humana KY Medicaid |
$5,819.61
|
| Rate for Payer: Kentucky WC Medicaid |
$5,878.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,876.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,488.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,076.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,936.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,891.71
|
| Rate for Payer: Ohio Health Group HMO |
$12,691.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,384.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,199.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,245.94
|
| Rate for Payer: PHCS Commercial |
$16,245.50
|
| Rate for Payer: United Healthcare All Payer |
$14,891.71
|
|
|
LPS SEGMENTAL COMP 45MM
|
Facility
|
OP
|
$10,923.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,420.10 |
| Max. Negotiated Rate |
$10,486.88 |
| Rate for Payer: Aetna Commercial |
$8,411.35
|
| Rate for Payer: Anthem Medicaid |
$3,756.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,520.59
|
| Rate for Payer: Cash Price |
$5,461.91
|
| Rate for Payer: Cigna Commercial |
$9,066.78
|
| Rate for Payer: First Health Commercial |
$10,377.64
|
| Rate for Payer: Humana Commercial |
$9,285.26
|
| Rate for Payer: Humana KY Medicaid |
$3,756.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,794.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,957.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,061.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,277.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,832.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,612.97
|
| Rate for Payer: Ohio Health Group HMO |
$8,192.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,184.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,420.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,386.39
|
| Rate for Payer: PHCS Commercial |
$10,486.88
|
| Rate for Payer: United Healthcare All Payer |
$9,612.97
|
|
|
LPS SEGMENTAL COMP 45MM
|
Facility
|
IP
|
$10,923.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,420.10 |
| Max. Negotiated Rate |
$10,486.88 |
| Rate for Payer: Aetna Commercial |
$8,411.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,520.59
|
| Rate for Payer: Cash Price |
$5,461.91
|
| Rate for Payer: Cigna Commercial |
$9,066.78
|
| Rate for Payer: First Health Commercial |
$10,377.64
|
| Rate for Payer: Humana Commercial |
$9,285.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,957.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,061.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,277.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,612.97
|
| Rate for Payer: Ohio Health Group HMO |
$8,192.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,184.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,420.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,386.39
|
| Rate for Payer: PHCS Commercial |
$10,486.88
|
| Rate for Payer: United Healthcare All Payer |
$9,612.97
|
|
|
LPS SEGMENTAL COMP 65MM
|
Facility
|
OP
|
$12,402.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.36 |
| Max. Negotiated Rate |
$11,906.63 |
| Rate for Payer: Aetna Commercial |
$9,550.11
|
| Rate for Payer: Anthem Medicaid |
$4,265.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,674.14
|
| Rate for Payer: Cash Price |
$6,201.37
|
| Rate for Payer: Cigna Commercial |
$10,294.27
|
| Rate for Payer: First Health Commercial |
$11,782.60
|
| Rate for Payer: Humana Commercial |
$10,542.33
|
| Rate for Payer: Humana KY Medicaid |
$4,265.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,308.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,170.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,153.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,720.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,350.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,914.41
|
| Rate for Payer: Ohio Health Group HMO |
$9,302.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,480.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,612.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,844.85
|
| Rate for Payer: PHCS Commercial |
$11,906.63
|
| Rate for Payer: United Healthcare All Payer |
$10,914.41
|
|
|
LPS SEGMENTAL COMP 65MM
|
Facility
|
IP
|
$12,402.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.36 |
| Max. Negotiated Rate |
$11,906.63 |
| Rate for Payer: Aetna Commercial |
$9,550.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,674.14
|
| Rate for Payer: Cash Price |
$6,201.37
|
| Rate for Payer: Cigna Commercial |
$10,294.27
|
| Rate for Payer: First Health Commercial |
$11,782.60
|
| Rate for Payer: Humana Commercial |
$10,542.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,170.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,153.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,720.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,914.41
|
| Rate for Payer: Ohio Health Group HMO |
$9,302.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,480.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,612.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,844.85
|
| Rate for Payer: PHCS Commercial |
$11,906.63
|
| Rate for Payer: United Healthcare All Payer |
$10,914.41
|
|
|
LPS SEGMENTAL COMP 85MM
|
Facility
|
IP
|
$12,402.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.36 |
| Max. Negotiated Rate |
$11,906.63 |
| Rate for Payer: Aetna Commercial |
$9,550.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,674.14
|
| Rate for Payer: Cash Price |
$6,201.37
|
| Rate for Payer: Cigna Commercial |
$10,294.27
|
| Rate for Payer: First Health Commercial |
$11,782.60
|
| Rate for Payer: Humana Commercial |
$10,542.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,170.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,153.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,720.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,914.41
|
| Rate for Payer: Ohio Health Group HMO |
$9,302.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,480.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,612.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,844.85
|
| Rate for Payer: PHCS Commercial |
$11,906.63
|
| Rate for Payer: United Healthcare All Payer |
$10,914.41
|
|
|
LPS SEGMENTAL COMP 85MM
|
Facility
|
OP
|
$12,402.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.36 |
| Max. Negotiated Rate |
$11,906.63 |
| Rate for Payer: Aetna Commercial |
$9,550.11
|
| Rate for Payer: Anthem Medicaid |
$4,265.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,674.14
|
| Rate for Payer: Cash Price |
$6,201.37
|
| Rate for Payer: Cigna Commercial |
$10,294.27
|
| Rate for Payer: First Health Commercial |
$11,782.60
|
| Rate for Payer: Humana Commercial |
$10,542.33
|
| Rate for Payer: Humana KY Medicaid |
$4,265.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,308.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,170.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,153.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,720.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,350.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,914.41
|
| Rate for Payer: Ohio Health Group HMO |
$9,302.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,480.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,612.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,844.85
|
| Rate for Payer: PHCS Commercial |
$11,906.63
|
| Rate for Payer: United Healthcare All Payer |
$10,914.41
|
|
|
LPS TOTAL FEM SEG COMP 55MM
|
Facility
|
IP
|
$11,601.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,508.24 |
| Max. Negotiated Rate |
$11,137.78 |
| Rate for Payer: Aetna Commercial |
$8,933.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,049.44
|
| Rate for Payer: Cash Price |
$5,800.93
|
| Rate for Payer: Cigna Commercial |
$9,629.54
|
| Rate for Payer: First Health Commercial |
$11,021.76
|
| Rate for Payer: Humana Commercial |
$9,861.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,513.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,562.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,480.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,209.63
|
| Rate for Payer: Ohio Health Group HMO |
$8,701.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,320.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,508.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,596.57
|
| Rate for Payer: PHCS Commercial |
$11,137.78
|
| Rate for Payer: United Healthcare All Payer |
$10,209.63
|
|
|
LPS TOTAL FEM SEG COMP 55MM
|
Facility
|
OP
|
$11,601.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,508.24 |
| Max. Negotiated Rate |
$11,137.78 |
| Rate for Payer: Aetna Commercial |
$8,933.42
|
| Rate for Payer: Anthem Medicaid |
$3,989.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,049.44
|
| Rate for Payer: Cash Price |
$5,800.93
|
| Rate for Payer: Cigna Commercial |
$9,629.54
|
| Rate for Payer: First Health Commercial |
$11,021.76
|
| Rate for Payer: Humana Commercial |
$9,861.57
|
| Rate for Payer: Humana KY Medicaid |
$3,989.88
|
| Rate for Payer: Kentucky WC Medicaid |
$4,030.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,513.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,562.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,480.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,069.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,209.63
|
| Rate for Payer: Ohio Health Group HMO |
$8,701.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,320.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,508.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,596.57
|
| Rate for Payer: PHCS Commercial |
$11,137.78
|
| Rate for Payer: United Healthcare All Payer |
$10,209.63
|
|
|
LPS UNIV TIB HIN INS MED 14MM
|
Facility
|
IP
|
$12,370.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.13 |
| Max. Negotiated Rate |
$11,875.44 |
| Rate for Payer: Aetna Commercial |
$9,525.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,648.80
|
| Rate for Payer: Cash Price |
$6,185.12
|
| Rate for Payer: Cigna Commercial |
$10,267.31
|
| Rate for Payer: First Health Commercial |
$11,751.74
|
| Rate for Payer: Humana Commercial |
$10,514.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,143.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,129.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,711.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,885.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,277.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,474.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,608.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,834.78
|
| Rate for Payer: PHCS Commercial |
$11,875.44
|
| Rate for Payer: United Healthcare All Payer |
$10,885.82
|
|
|
LPS UNIV TIB HIN INS MED 14MM
|
Facility
|
OP
|
$12,370.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.13 |
| Max. Negotiated Rate |
$11,875.44 |
| Rate for Payer: Aetna Commercial |
$9,525.09
|
| Rate for Payer: Anthem Medicaid |
$4,254.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,648.80
|
| Rate for Payer: Cash Price |
$6,185.12
|
| Rate for Payer: Cigna Commercial |
$10,267.31
|
| Rate for Payer: First Health Commercial |
$11,751.74
|
| Rate for Payer: Humana Commercial |
$10,514.71
|
| Rate for Payer: Humana KY Medicaid |
$4,254.13
|
| Rate for Payer: Kentucky WC Medicaid |
$4,297.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,143.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,129.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,711.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,339.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,885.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,277.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,474.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,608.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,834.78
|
| Rate for Payer: PHCS Commercial |
$11,875.44
|
| Rate for Payer: United Healthcare All Payer |
$10,885.82
|
|
|
LPS UNIV TIB HIN INS MED 18MM
|
Facility
|
IP
|
$22,728.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,954.74 |
| Max. Negotiated Rate |
$21,819.65 |
| Rate for Payer: Aetna Commercial |
$17,501.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,728.46
|
| Rate for Payer: Cash Price |
$11,364.40
|
| Rate for Payer: Cigna Commercial |
$18,864.90
|
| Rate for Payer: First Health Commercial |
$21,592.36
|
| Rate for Payer: Humana Commercial |
$19,319.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,637.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,773.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,818.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,001.34
|
| Rate for Payer: Ohio Health Group HMO |
$17,046.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,545.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,954.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,045.93
|
| Rate for Payer: PHCS Commercial |
$21,819.65
|
| Rate for Payer: United Healthcare All Payer |
$20,001.34
|
|
|
LPS UNIV TIB HIN INS MED 18MM
|
Facility
|
OP
|
$22,728.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,954.74 |
| Max. Negotiated Rate |
$21,819.65 |
| Rate for Payer: Aetna Commercial |
$17,501.18
|
| Rate for Payer: Anthem Medicaid |
$7,816.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,728.46
|
| Rate for Payer: Cash Price |
$11,364.40
|
| Rate for Payer: Cigna Commercial |
$18,864.90
|
| Rate for Payer: First Health Commercial |
$21,592.36
|
| Rate for Payer: Humana Commercial |
$19,319.48
|
| Rate for Payer: Humana KY Medicaid |
$7,816.43
|
| Rate for Payer: Kentucky WC Medicaid |
$7,895.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,637.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,773.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,818.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,973.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,001.34
|
| Rate for Payer: Ohio Health Group HMO |
$17,046.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,545.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,954.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,045.93
|
| Rate for Payer: PHCS Commercial |
$21,819.65
|
| Rate for Payer: United Healthcare All Payer |
$20,001.34
|
|
|
LPS UNIV TIB HIN INS MED 21MM
|
Facility
|
OP
|
$20,967.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,725.73 |
| Max. Negotiated Rate |
$20,128.44 |
| Rate for Payer: Aetna Commercial |
$16,144.69
|
| Rate for Payer: Anthem Medicaid |
$7,210.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,354.36
|
| Rate for Payer: Cash Price |
$10,483.56
|
| Rate for Payer: Cigna Commercial |
$17,402.72
|
| Rate for Payer: First Health Commercial |
$19,918.77
|
| Rate for Payer: Humana Commercial |
$17,822.06
|
| Rate for Payer: Humana KY Medicaid |
$7,210.60
|
| Rate for Payer: Kentucky WC Medicaid |
$7,283.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,193.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,473.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,290.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,355.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,451.07
|
| Rate for Payer: Ohio Health Group HMO |
$15,725.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,193.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,725.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,499.81
|
| Rate for Payer: PHCS Commercial |
$20,128.44
|
| Rate for Payer: United Healthcare All Payer |
$18,451.07
|
|
|
LPS UNIV TIB HIN INS MED 21MM
|
Facility
|
IP
|
$20,967.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,725.73 |
| Max. Negotiated Rate |
$20,128.44 |
| Rate for Payer: Aetna Commercial |
$16,144.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,354.36
|
| Rate for Payer: Cash Price |
$10,483.56
|
| Rate for Payer: Cigna Commercial |
$17,402.72
|
| Rate for Payer: First Health Commercial |
$19,918.77
|
| Rate for Payer: Humana Commercial |
$17,822.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,193.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,473.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,290.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,451.07
|
| Rate for Payer: Ohio Health Group HMO |
$15,725.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,193.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,725.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,499.81
|
| Rate for Payer: PHCS Commercial |
$20,128.44
|
| Rate for Payer: United Healthcare All Payer |
$18,451.07
|
|
|
LPS UNIV TIB HIN INS SM 12MM
|
Facility
|
IP
|
$20,967.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,725.73 |
| Max. Negotiated Rate |
$20,128.44 |
| Rate for Payer: Aetna Commercial |
$16,144.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,354.36
|
| Rate for Payer: Cash Price |
$10,483.56
|
| Rate for Payer: Cigna Commercial |
$17,402.72
|
| Rate for Payer: First Health Commercial |
$19,918.77
|
| Rate for Payer: Humana Commercial |
$17,822.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,193.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,473.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,290.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,451.07
|
| Rate for Payer: Ohio Health Group HMO |
$15,725.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,193.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,725.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,499.81
|
| Rate for Payer: PHCS Commercial |
$20,128.44
|
| Rate for Payer: United Healthcare All Payer |
$18,451.07
|
|
|
LPS UNIV TIB HIN INS SM 12MM
|
Facility
|
OP
|
$20,967.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,725.73 |
| Max. Negotiated Rate |
$20,128.44 |
| Rate for Payer: Aetna Commercial |
$16,144.69
|
| Rate for Payer: Anthem Medicaid |
$7,210.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,354.36
|
| Rate for Payer: Cash Price |
$10,483.56
|
| Rate for Payer: Cigna Commercial |
$17,402.72
|
| Rate for Payer: First Health Commercial |
$19,918.77
|
| Rate for Payer: Humana Commercial |
$17,822.06
|
| Rate for Payer: Humana KY Medicaid |
$7,210.60
|
| Rate for Payer: Kentucky WC Medicaid |
$7,283.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,193.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,473.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,290.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,355.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,451.07
|
| Rate for Payer: Ohio Health Group HMO |
$15,725.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,193.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,725.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,499.81
|
| Rate for Payer: PHCS Commercial |
$20,128.44
|
| Rate for Payer: United Healthcare All Payer |
$18,451.07
|
|
|
LPS UNIV TIB HIN INS SM 14MM
|
Facility
|
IP
|
$23,820.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,096.62 |
| Max. Negotiated Rate |
$22,867.34 |
| Rate for Payer: Aetna Commercial |
$18,341.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,579.72
|
| Rate for Payer: Cash Price |
$11,910.08
|
| Rate for Payer: Cigna Commercial |
$19,770.72
|
| Rate for Payer: First Health Commercial |
$22,629.14
|
| Rate for Payer: Humana Commercial |
$20,247.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,532.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,579.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,146.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,961.73
|
| Rate for Payer: Ohio Health Group HMO |
$17,865.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,764.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,096.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,384.25
|
| Rate for Payer: PHCS Commercial |
$22,867.34
|
| Rate for Payer: United Healthcare All Payer |
$20,961.73
|
|
|
LPS UNIV TIB HIN INS SM 14MM
|
Facility
|
OP
|
$23,820.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,096.62 |
| Max. Negotiated Rate |
$22,867.34 |
| Rate for Payer: Aetna Commercial |
$18,341.52
|
| Rate for Payer: Anthem Medicaid |
$8,191.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,579.72
|
| Rate for Payer: Cash Price |
$11,910.08
|
| Rate for Payer: Cigna Commercial |
$19,770.72
|
| Rate for Payer: First Health Commercial |
$22,629.14
|
| Rate for Payer: Humana Commercial |
$20,247.13
|
| Rate for Payer: Humana KY Medicaid |
$8,191.75
|
| Rate for Payer: Kentucky WC Medicaid |
$8,275.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,532.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,579.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,146.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,356.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,961.73
|
| Rate for Payer: Ohio Health Group HMO |
$17,865.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,764.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,096.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,384.25
|
| Rate for Payer: PHCS Commercial |
$22,867.34
|
| Rate for Payer: United Healthcare All Payer |
$20,961.73
|
|
|
LPS UNIV TIB HIN INS SM 16MM
|
Facility
|
IP
|
$22,728.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,954.74 |
| Max. Negotiated Rate |
$21,819.65 |
| Rate for Payer: Aetna Commercial |
$17,501.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,728.46
|
| Rate for Payer: Cash Price |
$11,364.40
|
| Rate for Payer: Cigna Commercial |
$18,864.90
|
| Rate for Payer: First Health Commercial |
$21,592.36
|
| Rate for Payer: Humana Commercial |
$19,319.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,637.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,773.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,818.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,001.34
|
| Rate for Payer: Ohio Health Group HMO |
$17,046.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,545.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,954.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,045.93
|
| Rate for Payer: PHCS Commercial |
$21,819.65
|
| Rate for Payer: United Healthcare All Payer |
$20,001.34
|
|
|
LPS UNIV TIB HIN INS SM 16MM
|
Facility
|
OP
|
$22,728.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,954.74 |
| Max. Negotiated Rate |
$21,819.65 |
| Rate for Payer: Aetna Commercial |
$17,501.18
|
| Rate for Payer: Anthem Medicaid |
$7,816.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,728.46
|
| Rate for Payer: Cash Price |
$11,364.40
|
| Rate for Payer: Cigna Commercial |
$18,864.90
|
| Rate for Payer: First Health Commercial |
$21,592.36
|
| Rate for Payer: Humana Commercial |
$19,319.48
|
| Rate for Payer: Humana KY Medicaid |
$7,816.43
|
| Rate for Payer: Kentucky WC Medicaid |
$7,895.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,637.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,773.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,818.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,973.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,001.34
|
| Rate for Payer: Ohio Health Group HMO |
$17,046.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,545.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,954.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,045.93
|
| Rate for Payer: PHCS Commercial |
$21,819.65
|
| Rate for Payer: United Healthcare All Payer |
$20,001.34
|
|
