|
LPS-FLEX GSF POROUS FEM G RT
|
Facility
|
IP
|
$22,812.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,843.75 |
| Max. Negotiated Rate |
$21,900.00 |
| Rate for Payer: Aetna Commercial |
$17,565.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,793.75
|
| Rate for Payer: Cash Price |
$11,406.25
|
| Rate for Payer: Cigna Commercial |
$18,934.38
|
| Rate for Payer: First Health Commercial |
$21,671.88
|
| Rate for Payer: Humana Commercial |
$19,390.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,706.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,835.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,843.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,075.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,109.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,250.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,846.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,740.62
|
| Rate for Payer: PHCS Commercial |
$21,900.00
|
| Rate for Payer: United Healthcare All Payer |
$20,075.00
|
|
|
LPS-FLEX GSF POROUS FEM G RT
|
Facility
|
OP
|
$22,812.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,843.75 |
| Max. Negotiated Rate |
$21,900.00 |
| Rate for Payer: Aetna Commercial |
$17,565.62
|
| Rate for Payer: Anthem Medicaid |
$7,845.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,793.75
|
| Rate for Payer: Cash Price |
$11,406.25
|
| Rate for Payer: Cigna Commercial |
$18,934.38
|
| Rate for Payer: First Health Commercial |
$21,671.88
|
| Rate for Payer: Humana Commercial |
$19,390.62
|
| Rate for Payer: Humana KY Medicaid |
$7,845.22
|
| Rate for Payer: Kentucky WC Medicaid |
$7,925.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,706.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,835.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,843.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,002.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,075.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,109.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,250.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,846.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,740.62
|
| Rate for Payer: PHCS Commercial |
$21,900.00
|
| Rate for Payer: United Healthcare All Payer |
$20,075.00
|
|
|
LPS PROX FEM STD BODY 15^ LT
|
Facility
|
OP
|
$28,534.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,560.36 |
| Max. Negotiated Rate |
$27,393.17 |
| Rate for Payer: Aetna Commercial |
$21,971.60
|
| Rate for Payer: Anthem Medicaid |
$9,813.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,256.95
|
| Rate for Payer: Cash Price |
$14,267.27
|
| Rate for Payer: Cigna Commercial |
$23,683.68
|
| Rate for Payer: First Health Commercial |
$27,107.82
|
| Rate for Payer: Humana Commercial |
$24,254.37
|
| Rate for Payer: Humana KY Medicaid |
$9,813.03
|
| Rate for Payer: Kentucky WC Medicaid |
$9,912.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,398.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,058.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,560.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,009.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,110.40
|
| Rate for Payer: Ohio Health Group HMO |
$21,400.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,827.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,825.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,688.84
|
| Rate for Payer: PHCS Commercial |
$27,393.17
|
| Rate for Payer: United Healthcare All Payer |
$25,110.40
|
|
|
LPS PROX FEM STD BODY 15^ LT
|
Facility
|
IP
|
$28,534.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,560.36 |
| Max. Negotiated Rate |
$27,393.17 |
| Rate for Payer: Aetna Commercial |
$21,971.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,256.95
|
| Rate for Payer: Cash Price |
$14,267.27
|
| Rate for Payer: Cigna Commercial |
$23,683.68
|
| Rate for Payer: First Health Commercial |
$27,107.82
|
| Rate for Payer: Humana Commercial |
$24,254.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,398.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,058.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,560.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,110.40
|
| Rate for Payer: Ohio Health Group HMO |
$21,400.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,827.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,825.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,688.84
|
| Rate for Payer: PHCS Commercial |
$27,393.17
|
| Rate for Payer: United Healthcare All Payer |
$25,110.40
|
|
|
LPS PROX FEM STD BODY 15^ RT
|
Facility
|
OP
|
$28,534.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,560.36 |
| Max. Negotiated Rate |
$27,393.17 |
| Rate for Payer: Aetna Commercial |
$21,971.60
|
| Rate for Payer: Anthem Medicaid |
$9,813.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,256.95
|
| Rate for Payer: Cash Price |
$14,267.27
|
| Rate for Payer: Cigna Commercial |
$23,683.68
|
| Rate for Payer: First Health Commercial |
$27,107.82
|
| Rate for Payer: Humana Commercial |
$24,254.37
|
| Rate for Payer: Humana KY Medicaid |
$9,813.03
|
| Rate for Payer: Kentucky WC Medicaid |
$9,912.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,398.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,058.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,560.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,009.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,110.40
|
| Rate for Payer: Ohio Health Group HMO |
$21,400.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,827.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,825.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,688.84
|
| Rate for Payer: PHCS Commercial |
$27,393.17
|
| Rate for Payer: United Healthcare All Payer |
$25,110.40
|
|
|
LPS PROX FEM STD BODY 15^ RT
|
Facility
|
IP
|
$28,534.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,560.36 |
| Max. Negotiated Rate |
$27,393.17 |
| Rate for Payer: Aetna Commercial |
$21,971.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,256.95
|
| Rate for Payer: Cash Price |
$14,267.27
|
| Rate for Payer: Cigna Commercial |
$23,683.68
|
| Rate for Payer: First Health Commercial |
$27,107.82
|
| Rate for Payer: Humana Commercial |
$24,254.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,398.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,058.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,560.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,110.40
|
| Rate for Payer: Ohio Health Group HMO |
$21,400.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,827.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,825.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,688.84
|
| Rate for Payer: PHCS Commercial |
$27,393.17
|
| Rate for Payer: United Healthcare All Payer |
$25,110.40
|
|
|
LPS PROX FEM STD BODY NEUTRAL
|
Facility
|
OP
|
$69,859.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,957.94 |
| Max. Negotiated Rate |
$67,065.41 |
| Rate for Payer: Aetna Commercial |
$53,792.05
|
| Rate for Payer: Anthem Medicaid |
$24,024.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54,490.64
|
| Rate for Payer: Cash Price |
$34,929.90
|
| Rate for Payer: Cigna Commercial |
$57,983.63
|
| Rate for Payer: First Health Commercial |
$66,366.81
|
| Rate for Payer: Humana Commercial |
$59,380.83
|
| Rate for Payer: Humana KY Medicaid |
$24,024.79
|
| Rate for Payer: Kentucky WC Medicaid |
$24,269.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,285.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51,556.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,957.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,506.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$61,476.62
|
| Rate for Payer: Ohio Health Group HMO |
$52,394.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55,887.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60,778.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,203.26
|
| Rate for Payer: PHCS Commercial |
$67,065.41
|
| Rate for Payer: United Healthcare All Payer |
$61,476.62
|
|
|
LPS PROX FEM STD BODY NEUTRAL
|
Facility
|
IP
|
$69,859.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,957.94 |
| Max. Negotiated Rate |
$67,065.41 |
| Rate for Payer: Aetna Commercial |
$53,792.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54,490.64
|
| Rate for Payer: Cash Price |
$34,929.90
|
| Rate for Payer: Cigna Commercial |
$57,983.63
|
| Rate for Payer: First Health Commercial |
$66,366.81
|
| Rate for Payer: Humana Commercial |
$59,380.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,285.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51,556.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,957.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$61,476.62
|
| Rate for Payer: Ohio Health Group HMO |
$52,394.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55,887.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60,778.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,203.26
|
| Rate for Payer: PHCS Commercial |
$67,065.41
|
| Rate for Payer: United Healthcare All Payer |
$61,476.62
|
|
|
LPS PROX FEM TROC BODY 15^ LT
|
Facility
|
IP
|
$28,534.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,560.27 |
| Max. Negotiated Rate |
$27,392.88 |
| Rate for Payer: Aetna Commercial |
$21,971.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,256.72
|
| Rate for Payer: Cash Price |
$14,267.12
|
| Rate for Payer: Cigna Commercial |
$23,683.43
|
| Rate for Payer: First Health Commercial |
$27,107.54
|
| Rate for Payer: Humana Commercial |
$24,254.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,398.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,058.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,560.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,110.14
|
| Rate for Payer: Ohio Health Group HMO |
$21,400.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,827.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,824.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,688.63
|
| Rate for Payer: PHCS Commercial |
$27,392.88
|
| Rate for Payer: United Healthcare All Payer |
$25,110.14
|
|
|
LPS PROX FEM TROC BODY 15^ LT
|
Facility
|
OP
|
$28,534.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,560.27 |
| Max. Negotiated Rate |
$27,392.88 |
| Rate for Payer: Aetna Commercial |
$21,971.37
|
| Rate for Payer: Anthem Medicaid |
$9,812.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,256.72
|
| Rate for Payer: Cash Price |
$14,267.12
|
| Rate for Payer: Cigna Commercial |
$23,683.43
|
| Rate for Payer: First Health Commercial |
$27,107.54
|
| Rate for Payer: Humana Commercial |
$24,254.11
|
| Rate for Payer: Humana KY Medicaid |
$9,812.93
|
| Rate for Payer: Kentucky WC Medicaid |
$9,912.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,398.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,058.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,560.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,009.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,110.14
|
| Rate for Payer: Ohio Health Group HMO |
$21,400.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,827.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,824.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,688.63
|
| Rate for Payer: PHCS Commercial |
$27,392.88
|
| Rate for Payer: United Healthcare All Payer |
$25,110.14
|
|
|
LPS PROX FEM TROC BODY 15^ RT
|
Facility
|
IP
|
$30,417.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,125.25 |
| Max. Negotiated Rate |
$29,200.80 |
| Rate for Payer: Aetna Commercial |
$23,421.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,725.65
|
| Rate for Payer: Cash Price |
$15,208.75
|
| Rate for Payer: Cigna Commercial |
$25,246.53
|
| Rate for Payer: First Health Commercial |
$28,896.62
|
| Rate for Payer: Humana Commercial |
$25,854.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,942.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,448.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,125.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,767.40
|
| Rate for Payer: Ohio Health Group HMO |
$22,813.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,334.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,463.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,988.08
|
| Rate for Payer: PHCS Commercial |
$29,200.80
|
| Rate for Payer: United Healthcare All Payer |
$26,767.40
|
|
|
LPS PROX FEM TROC BODY 15^ RT
|
Facility
|
OP
|
$30,417.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,125.25 |
| Max. Negotiated Rate |
$29,200.80 |
| Rate for Payer: Aetna Commercial |
$23,421.47
|
| Rate for Payer: Anthem Medicaid |
$10,460.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,725.65
|
| Rate for Payer: Cash Price |
$15,208.75
|
| Rate for Payer: Cigna Commercial |
$25,246.53
|
| Rate for Payer: First Health Commercial |
$28,896.62
|
| Rate for Payer: Humana Commercial |
$25,854.88
|
| Rate for Payer: Humana KY Medicaid |
$10,460.58
|
| Rate for Payer: Kentucky WC Medicaid |
$10,567.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,942.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,448.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,125.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,670.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,767.40
|
| Rate for Payer: Ohio Health Group HMO |
$22,813.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,334.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,463.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,988.08
|
| Rate for Payer: PHCS Commercial |
$29,200.80
|
| Rate for Payer: United Healthcare All Payer |
$26,767.40
|
|
|
LPS PROX FEM TROC BODY NEUTRAL
|
Facility
|
OP
|
$28,534.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,560.36 |
| Max. Negotiated Rate |
$27,393.17 |
| Rate for Payer: Aetna Commercial |
$21,971.60
|
| Rate for Payer: Anthem Medicaid |
$9,813.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,256.95
|
| Rate for Payer: Cash Price |
$14,267.27
|
| Rate for Payer: Cigna Commercial |
$23,683.68
|
| Rate for Payer: First Health Commercial |
$27,107.82
|
| Rate for Payer: Humana Commercial |
$24,254.37
|
| Rate for Payer: Humana KY Medicaid |
$9,813.03
|
| Rate for Payer: Kentucky WC Medicaid |
$9,912.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,398.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,058.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,560.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,009.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,110.40
|
| Rate for Payer: Ohio Health Group HMO |
$21,400.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,827.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,825.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,688.84
|
| Rate for Payer: PHCS Commercial |
$27,393.17
|
| Rate for Payer: United Healthcare All Payer |
$25,110.40
|
|
|
LPS PROX FEM TROC BODY NEUTRAL
|
Facility
|
IP
|
$28,534.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,560.36 |
| Max. Negotiated Rate |
$27,393.17 |
| Rate for Payer: Aetna Commercial |
$21,971.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,256.95
|
| Rate for Payer: Cash Price |
$14,267.27
|
| Rate for Payer: Cigna Commercial |
$23,683.68
|
| Rate for Payer: First Health Commercial |
$27,107.82
|
| Rate for Payer: Humana Commercial |
$24,254.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,398.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,058.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,560.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,110.40
|
| Rate for Payer: Ohio Health Group HMO |
$21,400.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,827.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,825.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,688.84
|
| Rate for Payer: PHCS Commercial |
$27,393.17
|
| Rate for Payer: United Healthcare All Payer |
$25,110.40
|
|
|
LPS SEGMENTAL COMP 105MM
|
Facility
|
OP
|
$11,779.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,533.86 |
| Max. Negotiated Rate |
$11,308.34 |
| Rate for Payer: Aetna Commercial |
$9,070.23
|
| Rate for Payer: Anthem Medicaid |
$4,050.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,188.03
|
| Rate for Payer: Cash Price |
$5,889.76
|
| Rate for Payer: Cigna Commercial |
$9,777.00
|
| Rate for Payer: First Health Commercial |
$11,190.54
|
| Rate for Payer: Humana Commercial |
$10,012.59
|
| Rate for Payer: Humana KY Medicaid |
$4,050.98
|
| Rate for Payer: Kentucky WC Medicaid |
$4,092.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,659.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,693.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,533.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,132.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,365.98
|
| Rate for Payer: Ohio Health Group HMO |
$8,834.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,423.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,248.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,127.87
|
| Rate for Payer: PHCS Commercial |
$11,308.34
|
| Rate for Payer: United Healthcare All Payer |
$10,365.98
|
|
|
LPS SEGMENTAL COMP 105MM
|
Facility
|
IP
|
$11,779.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,533.86 |
| Max. Negotiated Rate |
$11,308.34 |
| Rate for Payer: Aetna Commercial |
$9,070.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,188.03
|
| Rate for Payer: Cash Price |
$5,889.76
|
| Rate for Payer: Cigna Commercial |
$9,777.00
|
| Rate for Payer: First Health Commercial |
$11,190.54
|
| Rate for Payer: Humana Commercial |
$10,012.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,659.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,693.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,533.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,365.98
|
| Rate for Payer: Ohio Health Group HMO |
$8,834.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,423.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,248.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,127.87
|
| Rate for Payer: PHCS Commercial |
$11,308.34
|
| Rate for Payer: United Healthcare All Payer |
$10,365.98
|
|
|
LPS SEGMENTAL COMP 125MM
|
Facility
|
IP
|
$12,627.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,788.19 |
| Max. Negotiated Rate |
$12,122.20 |
| Rate for Payer: Aetna Commercial |
$9,723.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,849.29
|
| Rate for Payer: Cash Price |
$6,313.65
|
| Rate for Payer: Cigna Commercial |
$10,480.65
|
| Rate for Payer: First Health Commercial |
$11,995.93
|
| Rate for Payer: Humana Commercial |
$10,733.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,354.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,318.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,788.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,112.02
|
| Rate for Payer: Ohio Health Group HMO |
$9,470.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,101.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,985.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,712.83
|
| Rate for Payer: PHCS Commercial |
$12,122.20
|
| Rate for Payer: United Healthcare All Payer |
$11,112.02
|
|
|
LPS SEGMENTAL COMP 125MM
|
Facility
|
OP
|
$12,627.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,788.19 |
| Max. Negotiated Rate |
$12,122.20 |
| Rate for Payer: Aetna Commercial |
$9,723.01
|
| Rate for Payer: Anthem Medicaid |
$4,342.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,849.29
|
| Rate for Payer: Cash Price |
$6,313.65
|
| Rate for Payer: Cigna Commercial |
$10,480.65
|
| Rate for Payer: First Health Commercial |
$11,995.93
|
| Rate for Payer: Humana Commercial |
$10,733.20
|
| Rate for Payer: Humana KY Medicaid |
$4,342.53
|
| Rate for Payer: Kentucky WC Medicaid |
$4,386.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,354.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,318.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,788.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,429.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,112.02
|
| Rate for Payer: Ohio Health Group HMO |
$9,470.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,101.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,985.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,712.83
|
| Rate for Payer: PHCS Commercial |
$12,122.20
|
| Rate for Payer: United Healthcare All Payer |
$11,112.02
|
|
|
LPS SEGMENTAL COMP 25MM
|
Facility
|
OP
|
$12,652.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,795.78 |
| Max. Negotiated Rate |
$12,146.51 |
| Rate for Payer: Aetna Commercial |
$9,742.51
|
| Rate for Payer: Anthem Medicaid |
$4,351.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,869.04
|
| Rate for Payer: Cash Price |
$6,326.31
|
| Rate for Payer: Cigna Commercial |
$10,501.67
|
| Rate for Payer: First Health Commercial |
$12,019.98
|
| Rate for Payer: Humana Commercial |
$10,754.72
|
| Rate for Payer: Humana KY Medicaid |
$4,351.23
|
| Rate for Payer: Kentucky WC Medicaid |
$4,395.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,375.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,337.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,795.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,438.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,134.30
|
| Rate for Payer: Ohio Health Group HMO |
$9,489.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,122.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,007.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,730.30
|
| Rate for Payer: PHCS Commercial |
$12,146.51
|
| Rate for Payer: United Healthcare All Payer |
$11,134.30
|
|
|
LPS SEGMENTAL COMP 25MM
|
Facility
|
IP
|
$12,652.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,795.78 |
| Max. Negotiated Rate |
$12,146.51 |
| Rate for Payer: Aetna Commercial |
$9,742.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,869.04
|
| Rate for Payer: Cash Price |
$6,326.31
|
| Rate for Payer: Cigna Commercial |
$10,501.67
|
| Rate for Payer: First Health Commercial |
$12,019.98
|
| Rate for Payer: Humana Commercial |
$10,754.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,375.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,337.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,795.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,134.30
|
| Rate for Payer: Ohio Health Group HMO |
$9,489.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,122.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,007.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,730.30
|
| Rate for Payer: PHCS Commercial |
$12,146.51
|
| Rate for Payer: United Healthcare All Payer |
$11,134.30
|
|
|
LPS SEGMENTAL COMP 30MM
|
Facility
|
IP
|
$12,652.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,795.78 |
| Max. Negotiated Rate |
$12,146.51 |
| Rate for Payer: Aetna Commercial |
$9,742.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,869.04
|
| Rate for Payer: Cash Price |
$6,326.31
|
| Rate for Payer: Cigna Commercial |
$10,501.67
|
| Rate for Payer: First Health Commercial |
$12,019.98
|
| Rate for Payer: Humana Commercial |
$10,754.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,375.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,337.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,795.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,134.30
|
| Rate for Payer: Ohio Health Group HMO |
$9,489.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,122.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,007.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,730.30
|
| Rate for Payer: PHCS Commercial |
$12,146.51
|
| Rate for Payer: United Healthcare All Payer |
$11,134.30
|
|
|
LPS SEGMENTAL COMP 30MM
|
Facility
|
OP
|
$12,652.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,795.78 |
| Max. Negotiated Rate |
$12,146.51 |
| Rate for Payer: Aetna Commercial |
$9,742.51
|
| Rate for Payer: Anthem Medicaid |
$4,351.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,869.04
|
| Rate for Payer: Cash Price |
$6,326.31
|
| Rate for Payer: Cigna Commercial |
$10,501.67
|
| Rate for Payer: First Health Commercial |
$12,019.98
|
| Rate for Payer: Humana Commercial |
$10,754.72
|
| Rate for Payer: Humana KY Medicaid |
$4,351.23
|
| Rate for Payer: Kentucky WC Medicaid |
$4,395.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,375.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,337.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,795.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,438.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,134.30
|
| Rate for Payer: Ohio Health Group HMO |
$9,489.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,122.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,007.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,730.30
|
| Rate for Payer: PHCS Commercial |
$12,146.51
|
| Rate for Payer: United Healthcare All Payer |
$11,134.30
|
|
|
LPS SEGMENTAL COMP 35MM
|
Facility
|
IP
|
$12,652.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,795.78 |
| Max. Negotiated Rate |
$12,146.51 |
| Rate for Payer: Aetna Commercial |
$9,742.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,869.04
|
| Rate for Payer: Cash Price |
$6,326.31
|
| Rate for Payer: Cigna Commercial |
$10,501.67
|
| Rate for Payer: First Health Commercial |
$12,019.98
|
| Rate for Payer: Humana Commercial |
$10,754.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,375.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,337.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,795.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,134.30
|
| Rate for Payer: Ohio Health Group HMO |
$9,489.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,122.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,007.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,730.30
|
| Rate for Payer: PHCS Commercial |
$12,146.51
|
| Rate for Payer: United Healthcare All Payer |
$11,134.30
|
|
|
LPS SEGMENTAL COMP 35MM
|
Facility
|
OP
|
$12,652.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,795.78 |
| Max. Negotiated Rate |
$12,146.51 |
| Rate for Payer: Aetna Commercial |
$9,742.51
|
| Rate for Payer: Anthem Medicaid |
$4,351.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,869.04
|
| Rate for Payer: Cash Price |
$6,326.31
|
| Rate for Payer: Cigna Commercial |
$10,501.67
|
| Rate for Payer: First Health Commercial |
$12,019.98
|
| Rate for Payer: Humana Commercial |
$10,754.72
|
| Rate for Payer: Humana KY Medicaid |
$4,351.23
|
| Rate for Payer: Kentucky WC Medicaid |
$4,395.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,375.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,337.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,795.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,438.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,134.30
|
| Rate for Payer: Ohio Health Group HMO |
$9,489.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,122.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,007.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,730.30
|
| Rate for Payer: PHCS Commercial |
$12,146.51
|
| Rate for Payer: United Healthcare All Payer |
$11,134.30
|
|
|
LPS SEGMENTAL COMP 40MM
|
Facility
|
OP
|
$17,475.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,242.74 |
| Max. Negotiated Rate |
$16,776.77 |
| Rate for Payer: Aetna Commercial |
$13,456.37
|
| Rate for Payer: Anthem Medicaid |
$6,009.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,631.12
|
| Rate for Payer: Cash Price |
$8,737.90
|
| Rate for Payer: Cigna Commercial |
$14,504.91
|
| Rate for Payer: First Health Commercial |
$16,602.01
|
| Rate for Payer: Humana Commercial |
$14,854.43
|
| Rate for Payer: Humana KY Medicaid |
$6,009.93
|
| Rate for Payer: Kentucky WC Medicaid |
$6,071.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,330.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,897.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,242.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,130.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,378.70
|
| Rate for Payer: Ohio Health Group HMO |
$13,106.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,980.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,203.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,058.30
|
| Rate for Payer: PHCS Commercial |
$16,776.77
|
| Rate for Payer: United Healthcare All Payer |
$15,378.70
|
|
