|
LOXITANE (LOXAPINE) 10MG/1CAP
|
Facility
|
IP
|
$4.92
|
|
|
Service Code
|
NDC 378701001
|
| Hospital Charge Code |
25000918
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$4.72 |
| Rate for Payer: Aetna Commercial |
$3.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.84
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cigna Commercial |
$4.08
|
| Rate for Payer: First Health Commercial |
$4.67
|
| Rate for Payer: Humana Commercial |
$4.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.33
|
| Rate for Payer: Ohio Health Group HMO |
$3.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.39
|
| Rate for Payer: PHCS Commercial |
$4.72
|
| Rate for Payer: United Healthcare All Payer |
$4.33
|
|
|
LOXITANE (LOXAPINE) 10MG/1CAP
|
Facility
|
OP
|
$4.92
|
|
|
Service Code
|
NDC 378701001
|
| Hospital Charge Code |
25000918
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$4.72 |
| Rate for Payer: Aetna Commercial |
$3.79
|
| Rate for Payer: Anthem Medicaid |
$1.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.84
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cigna Commercial |
$4.08
|
| Rate for Payer: First Health Commercial |
$4.67
|
| Rate for Payer: Humana Commercial |
$4.18
|
| Rate for Payer: Humana KY Medicaid |
$1.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.33
|
| Rate for Payer: Ohio Health Group HMO |
$3.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.39
|
| Rate for Payer: PHCS Commercial |
$4.72
|
| Rate for Payer: United Healthcare All Payer |
$4.33
|
|
|
LOZOL (INDAPAMIDE) 2.5MG/1TAB
|
Facility
|
OP
|
$4.49
|
|
|
Service Code
|
NDC 43975030410
|
| Hospital Charge Code |
25000921
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$4.31 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem Medicaid |
$1.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.50
|
| Rate for Payer: Cash Price |
$2.24
|
| Rate for Payer: Cigna Commercial |
$3.73
|
| Rate for Payer: First Health Commercial |
$4.27
|
| Rate for Payer: Humana Commercial |
$3.82
|
| Rate for Payer: Humana KY Medicaid |
$1.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.95
|
| Rate for Payer: Ohio Health Group HMO |
$3.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.10
|
| Rate for Payer: PHCS Commercial |
$4.31
|
| Rate for Payer: United Healthcare All Payer |
$3.95
|
|
|
LOZOL (INDAPAMIDE) 2.5MG/1TAB
|
Facility
|
IP
|
$4.49
|
|
|
Service Code
|
NDC 43975030410
|
| Hospital Charge Code |
25000921
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$4.31 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.50
|
| Rate for Payer: Cash Price |
$2.24
|
| Rate for Payer: Cigna Commercial |
$3.73
|
| Rate for Payer: First Health Commercial |
$4.27
|
| Rate for Payer: Humana Commercial |
$3.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.95
|
| Rate for Payer: Ohio Health Group HMO |
$3.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.10
|
| Rate for Payer: PHCS Commercial |
$4.31
|
| Rate for Payer: United Healthcare All Payer |
$3.95
|
|
|
LPS DISTAL FEM COMP XSM LT
|
Facility
|
IP
|
$78,512.02
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,553.61 |
| Max. Negotiated Rate |
$75,371.54 |
| Rate for Payer: Aetna Commercial |
$60,454.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,239.38
|
| Rate for Payer: Cash Price |
$39,256.01
|
| Rate for Payer: Cigna Commercial |
$65,164.98
|
| Rate for Payer: First Health Commercial |
$74,586.42
|
| Rate for Payer: Humana Commercial |
$66,735.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,379.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,941.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,553.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,090.58
|
| Rate for Payer: Ohio Health Group HMO |
$58,884.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62,809.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,305.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54,173.29
|
| Rate for Payer: PHCS Commercial |
$75,371.54
|
| Rate for Payer: United Healthcare All Payer |
$69,090.58
|
|
|
LPS DISTAL FEM COMP XSM LT
|
Facility
|
OP
|
$78,512.02
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,553.61 |
| Max. Negotiated Rate |
$75,371.54 |
| Rate for Payer: Aetna Commercial |
$60,454.26
|
| Rate for Payer: Anthem Medicaid |
$27,000.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,239.38
|
| Rate for Payer: Cash Price |
$39,256.01
|
| Rate for Payer: Cigna Commercial |
$65,164.98
|
| Rate for Payer: First Health Commercial |
$74,586.42
|
| Rate for Payer: Humana Commercial |
$66,735.22
|
| Rate for Payer: Humana KY Medicaid |
$27,000.28
|
| Rate for Payer: Kentucky WC Medicaid |
$27,275.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,379.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,941.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,553.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,542.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,090.58
|
| Rate for Payer: Ohio Health Group HMO |
$58,884.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62,809.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,305.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54,173.29
|
| Rate for Payer: PHCS Commercial |
$75,371.54
|
| Rate for Payer: United Healthcare All Payer |
$69,090.58
|
|
|
LPS DISTAL FEM COMP XSM RT
|
Facility
|
IP
|
$78,512.02
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,553.61 |
| Max. Negotiated Rate |
$75,371.54 |
| Rate for Payer: Aetna Commercial |
$60,454.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,239.38
|
| Rate for Payer: Cash Price |
$39,256.01
|
| Rate for Payer: Cigna Commercial |
$65,164.98
|
| Rate for Payer: First Health Commercial |
$74,586.42
|
| Rate for Payer: Humana Commercial |
$66,735.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,379.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,941.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,553.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,090.58
|
| Rate for Payer: Ohio Health Group HMO |
$58,884.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62,809.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,305.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54,173.29
|
| Rate for Payer: PHCS Commercial |
$75,371.54
|
| Rate for Payer: United Healthcare All Payer |
$69,090.58
|
|
|
LPS DISTAL FEM COMP XSM RT
|
Facility
|
OP
|
$78,512.02
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,553.61 |
| Max. Negotiated Rate |
$75,371.54 |
| Rate for Payer: Aetna Commercial |
$60,454.26
|
| Rate for Payer: Anthem Medicaid |
$27,000.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,239.38
|
| Rate for Payer: Cash Price |
$39,256.01
|
| Rate for Payer: Cigna Commercial |
$65,164.98
|
| Rate for Payer: First Health Commercial |
$74,586.42
|
| Rate for Payer: Humana Commercial |
$66,735.22
|
| Rate for Payer: Humana KY Medicaid |
$27,000.28
|
| Rate for Payer: Kentucky WC Medicaid |
$27,275.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,379.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,941.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,553.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,542.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,090.58
|
| Rate for Payer: Ohio Health Group HMO |
$58,884.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62,809.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,305.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54,173.29
|
| Rate for Payer: PHCS Commercial |
$75,371.54
|
| Rate for Payer: United Healthcare All Payer |
$69,090.58
|
|
|
LPS DISTAL FEM COMP XXSM L
|
Facility
|
IP
|
$78,512.02
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,553.61 |
| Max. Negotiated Rate |
$75,371.54 |
| Rate for Payer: Aetna Commercial |
$60,454.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,239.38
|
| Rate for Payer: Cash Price |
$39,256.01
|
| Rate for Payer: Cigna Commercial |
$65,164.98
|
| Rate for Payer: First Health Commercial |
$74,586.42
|
| Rate for Payer: Humana Commercial |
$66,735.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,379.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,941.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,553.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,090.58
|
| Rate for Payer: Ohio Health Group HMO |
$58,884.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62,809.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,305.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54,173.29
|
| Rate for Payer: PHCS Commercial |
$75,371.54
|
| Rate for Payer: United Healthcare All Payer |
$69,090.58
|
|
|
LPS DISTAL FEM COMP XXSM L
|
Facility
|
OP
|
$78,512.02
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,553.61 |
| Max. Negotiated Rate |
$75,371.54 |
| Rate for Payer: Aetna Commercial |
$60,454.26
|
| Rate for Payer: Anthem Medicaid |
$27,000.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,239.38
|
| Rate for Payer: Cash Price |
$39,256.01
|
| Rate for Payer: Cigna Commercial |
$65,164.98
|
| Rate for Payer: First Health Commercial |
$74,586.42
|
| Rate for Payer: Humana Commercial |
$66,735.22
|
| Rate for Payer: Humana KY Medicaid |
$27,000.28
|
| Rate for Payer: Kentucky WC Medicaid |
$27,275.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,379.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,941.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,553.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,542.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,090.58
|
| Rate for Payer: Ohio Health Group HMO |
$58,884.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62,809.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,305.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54,173.29
|
| Rate for Payer: PHCS Commercial |
$75,371.54
|
| Rate for Payer: United Healthcare All Payer |
$69,090.58
|
|
|
LPS DISTAL FEM COMP XXSM RT
|
Facility
|
OP
|
$78,512.02
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,553.61 |
| Max. Negotiated Rate |
$75,371.54 |
| Rate for Payer: Aetna Commercial |
$60,454.26
|
| Rate for Payer: Anthem Medicaid |
$27,000.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,239.38
|
| Rate for Payer: Cash Price |
$39,256.01
|
| Rate for Payer: Cigna Commercial |
$65,164.98
|
| Rate for Payer: First Health Commercial |
$74,586.42
|
| Rate for Payer: Humana Commercial |
$66,735.22
|
| Rate for Payer: Humana KY Medicaid |
$27,000.28
|
| Rate for Payer: Kentucky WC Medicaid |
$27,275.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,379.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,941.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,553.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,542.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,090.58
|
| Rate for Payer: Ohio Health Group HMO |
$58,884.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62,809.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,305.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54,173.29
|
| Rate for Payer: PHCS Commercial |
$75,371.54
|
| Rate for Payer: United Healthcare All Payer |
$69,090.58
|
|
|
LPS DISTAL FEM COMP XXSM RT
|
Facility
|
IP
|
$78,512.02
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,553.61 |
| Max. Negotiated Rate |
$75,371.54 |
| Rate for Payer: Aetna Commercial |
$60,454.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,239.38
|
| Rate for Payer: Cash Price |
$39,256.01
|
| Rate for Payer: Cigna Commercial |
$65,164.98
|
| Rate for Payer: First Health Commercial |
$74,586.42
|
| Rate for Payer: Humana Commercial |
$66,735.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,379.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57,941.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,553.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,090.58
|
| Rate for Payer: Ohio Health Group HMO |
$58,884.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62,809.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,305.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54,173.29
|
| Rate for Payer: PHCS Commercial |
$75,371.54
|
| Rate for Payer: United Healthcare All Payer |
$69,090.58
|
|
|
LPS-FLEX GSF OPTION FEM C LT
|
Facility
|
OP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem Medicaid |
$5,743.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Humana KY Medicaid |
$5,743.99
|
| Rate for Payer: Kentucky WC Medicaid |
$5,802.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,859.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
LPS-FLEX GSF OPTION FEM C LT
|
Facility
|
IP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
LPS-FLEX GSF OPTION FEM C RT
|
Facility
|
IP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
LPS-FLEX GSF OPTION FEM C RT
|
Facility
|
OP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem Medicaid |
$5,743.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Humana KY Medicaid |
$5,743.99
|
| Rate for Payer: Kentucky WC Medicaid |
$5,802.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,859.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
LPS-FLEX GSF OPTION FEM D LT
|
Facility
|
IP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
LPS-FLEX GSF OPTION FEM D LT
|
Facility
|
OP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem Medicaid |
$5,743.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Humana KY Medicaid |
$5,743.99
|
| Rate for Payer: Kentucky WC Medicaid |
$5,802.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,859.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
LPS-FLEX GSF OPTION FEM D RT
|
Facility
|
IP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
LPS-FLEX GSF OPTION FEM D RT
|
Facility
|
OP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem Medicaid |
$5,743.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Humana KY Medicaid |
$5,743.99
|
| Rate for Payer: Kentucky WC Medicaid |
$5,802.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,859.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
LPS-FLEX GSF OPTION FEM E LT
|
Facility
|
IP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
LPS-FLEX GSF OPTION FEM E LT
|
Facility
|
OP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem Medicaid |
$5,743.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Humana KY Medicaid |
$5,743.99
|
| Rate for Payer: Kentucky WC Medicaid |
$5,802.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,859.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
LPS-FLEX GSF OPTION FEM E RT
|
Facility
|
OP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem Medicaid |
$5,743.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Humana KY Medicaid |
$5,743.99
|
| Rate for Payer: Kentucky WC Medicaid |
$5,802.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,859.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
LPS-FLEX GSF OPTION FEM E RT
|
Facility
|
IP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
|
LPS-FLEX GSF OPTION FEM F LT
|
Facility
|
OP
|
$16,702.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,010.75 |
| Max. Negotiated Rate |
$16,034.40 |
| Rate for Payer: Aetna Commercial |
$12,860.92
|
| Rate for Payer: Anthem Medicaid |
$5,743.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,027.95
|
| Rate for Payer: Cash Price |
$8,351.25
|
| Rate for Payer: Cigna Commercial |
$13,863.08
|
| Rate for Payer: First Health Commercial |
$15,867.38
|
| Rate for Payer: Humana Commercial |
$14,197.12
|
| Rate for Payer: Humana KY Medicaid |
$5,743.99
|
| Rate for Payer: Kentucky WC Medicaid |
$5,802.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,696.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,326.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,010.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,859.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,698.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,526.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,362.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,531.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,524.73
|
| Rate for Payer: PHCS Commercial |
$16,034.40
|
| Rate for Payer: United Healthcare All Payer |
$14,698.20
|
|
