LPS UNIV TIB HIN INS SM 21MM
|
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 SM 21MM
|
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 XSM 12MM
|
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 XSM 12MM
|
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 XSM 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 XSM 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 XSM 16MM
|
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 XSM 16MM
|
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 XSM 18MM
|
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 XSM 18MM
|
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 XSM 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 XSM 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 XXSM 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 XXSM 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 XXSM 14MM
|
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 XXSM 14MM
|
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 XXSM 16MM
|
Facility
|
OP
|
$20,286.95
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,637.30 |
Max. Negotiated Rate |
$19,475.47 |
Rate for Payer: Aetna Commercial |
$15,620.95
|
Rate for Payer: Anthem Medicaid |
$6,976.68
|
Rate for Payer: Anthem POS/PPO/Traditional |
$15,823.82
|
Rate for Payer: Cash Price |
$10,143.48
|
Rate for Payer: Cigna Commercial |
$16,838.17
|
Rate for Payer: First Health Commercial |
$19,272.60
|
Rate for Payer: Humana Commercial |
$17,243.91
|
Rate for Payer: Humana KY Medicaid |
$6,976.68
|
Rate for Payer: Kentucky WC Medicaid |
$7,047.69
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$16,635.30
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,971.77
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6,086.08
|
Rate for Payer: Molina Healthcare Medicaid |
$7,116.66
|
Rate for Payer: Ohio Health Choice Commercial |
$17,852.52
|
Rate for Payer: Ohio Health Group HMO |
$15,215.21
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,057.39
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2,637.30
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,288.95
|
Rate for Payer: PHCS Commercial |
$19,475.47
|
Rate for Payer: United Healthcare All Payer |
$17,852.52
|
|
LPS UNIV TIB HIN INS XXSM 16MM
|
Facility
|
IP
|
$20,286.95
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$2,637.30 |
Max. Negotiated Rate |
$19,475.47 |
Rate for Payer: Aetna Commercial |
$15,620.95
|
Rate for Payer: Anthem POS/PPO/Traditional |
$15,823.82
|
Rate for Payer: Cash Price |
$10,143.48
|
Rate for Payer: Cigna Commercial |
$16,838.17
|
Rate for Payer: First Health Commercial |
$19,272.60
|
Rate for Payer: Humana Commercial |
$17,243.91
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$16,635.30
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,971.77
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6,086.08
|
Rate for Payer: Ohio Health Choice Commercial |
$17,852.52
|
Rate for Payer: Ohio Health Group HMO |
$15,215.21
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,057.39
|
Rate for Payer: Ohio Health Group PPO No Differential |
$2,637.30
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,288.95
|
Rate for Payer: PHCS Commercial |
$19,475.47
|
Rate for Payer: United Healthcare All Payer |
$17,852.52
|
|
LPS UNIV TIB HIN INS XXSM 18MM
|
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 XXSM 18MM
|
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 XXSM 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 XXSM 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
|
|
LPT GREAT TOE KIT W/O SIZERS
|
Facility
|
OP
|
$8,731.25
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,135.06 |
Max. Negotiated Rate |
$8,382.00 |
Rate for Payer: Aetna Commercial |
$6,723.06
|
Rate for Payer: Anthem Medicaid |
$3,002.68
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,810.38
|
Rate for Payer: Cash Price |
$4,365.62
|
Rate for Payer: Cigna Commercial |
$7,246.94
|
Rate for Payer: First Health Commercial |
$8,294.69
|
Rate for Payer: Humana Commercial |
$7,421.56
|
Rate for Payer: Humana KY Medicaid |
$3,002.68
|
Rate for Payer: Kentucky WC Medicaid |
$3,033.24
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,159.62
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,443.66
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,619.38
|
Rate for Payer: Molina Healthcare Medicaid |
$3,062.92
|
Rate for Payer: Ohio Health Choice Commercial |
$7,683.50
|
Rate for Payer: Ohio Health Group HMO |
$6,548.44
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,746.25
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,135.06
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,706.69
|
Rate for Payer: PHCS Commercial |
$8,382.00
|
Rate for Payer: United Healthcare All Payer |
$7,683.50
|
|
LPT GREAT TOE KIT W/O SIZERS
|
Facility
|
IP
|
$8,731.25
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,135.06 |
Max. Negotiated Rate |
$8,382.00 |
Rate for Payer: Aetna Commercial |
$6,723.06
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,810.38
|
Rate for Payer: Cash Price |
$4,365.62
|
Rate for Payer: Cigna Commercial |
$7,246.94
|
Rate for Payer: First Health Commercial |
$8,294.69
|
Rate for Payer: Humana Commercial |
$7,421.56
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,159.62
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,443.66
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,619.38
|
Rate for Payer: Ohio Health Choice Commercial |
$7,683.50
|
Rate for Payer: Ohio Health Group HMO |
$6,548.44
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,746.25
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,135.06
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,706.69
|
Rate for Payer: PHCS Commercial |
$8,382.00
|
Rate for Payer: United Healthcare All Payer |
$7,683.50
|
|
LPT GREAT TOE KIT W/SIZERS
|
Facility
|
IP
|
$11,238.75
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,461.04 |
Max. Negotiated Rate |
$10,789.20 |
Rate for Payer: Aetna Commercial |
$8,653.84
|
Rate for Payer: Anthem POS/PPO/Traditional |
$8,766.22
|
Rate for Payer: Cash Price |
$5,619.38
|
Rate for Payer: Cigna Commercial |
$9,328.16
|
Rate for Payer: First Health Commercial |
$10,676.81
|
Rate for Payer: Humana Commercial |
$9,552.94
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$9,215.78
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,294.20
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,371.62
|
Rate for Payer: Ohio Health Choice Commercial |
$9,890.10
|
Rate for Payer: Ohio Health Group HMO |
$8,429.06
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,247.75
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,461.04
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,484.01
|
Rate for Payer: PHCS Commercial |
$10,789.20
|
Rate for Payer: United Healthcare All Payer |
$9,890.10
|
|