|
LPS SEGMENTAL COMP 40MM
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
LPS SEGMENTAL COMP 45MM
|
Facility
|
IP
|
$11,165.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,349.68 |
| Max. Negotiated Rate |
$10,718.98 |
| Rate for Payer: Aetna Commercial |
$8,597.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,709.17
|
| Rate for Payer: Cash Price |
$5,582.80
|
| Rate for Payer: Cigna Commercial |
$9,267.45
|
| Rate for Payer: First Health Commercial |
$10,607.32
|
| Rate for Payer: Humana Commercial |
$9,490.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,155.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,240.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,349.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,825.73
|
| Rate for Payer: Ohio Health Group HMO |
$8,374.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,932.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,714.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,704.26
|
| Rate for Payer: PHCS Commercial |
$10,718.98
|
| Rate for Payer: United Healthcare All Payer |
$9,825.73
|
|
|
LPS SEGMENTAL COMP 45MM
|
Facility
|
OP
|
$11,165.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,349.68 |
| Max. Negotiated Rate |
$10,718.98 |
| Rate for Payer: Aetna Commercial |
$8,597.51
|
| Rate for Payer: Anthem Medicaid |
$3,839.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,709.17
|
| Rate for Payer: Cash Price |
$5,582.80
|
| Rate for Payer: Cigna Commercial |
$9,267.45
|
| Rate for Payer: First Health Commercial |
$10,607.32
|
| Rate for Payer: Humana Commercial |
$9,490.76
|
| Rate for Payer: Humana KY Medicaid |
$3,839.85
|
| Rate for Payer: Kentucky WC Medicaid |
$3,878.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,155.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,240.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,349.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,916.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,825.73
|
| Rate for Payer: Ohio Health Group HMO |
$8,374.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,932.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,714.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,704.26
|
| Rate for Payer: PHCS Commercial |
$10,718.98
|
| Rate for Payer: United Healthcare All Payer |
$9,825.73
|
|
|
LPS SEGMENTAL COMP 65MM
|
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 65MM
|
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 85MM
|
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 85MM
|
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 TOTAL FEM SEG COMP 55MM
|
Facility
|
OP
|
$11,847.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,554.20 |
| Max. Negotiated Rate |
$11,373.45 |
| Rate for Payer: Aetna Commercial |
$9,122.45
|
| Rate for Payer: Anthem Medicaid |
$4,074.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,240.93
|
| Rate for Payer: Cash Price |
$5,923.67
|
| Rate for Payer: Cigna Commercial |
$9,833.29
|
| Rate for Payer: First Health Commercial |
$11,254.97
|
| Rate for Payer: Humana Commercial |
$10,070.24
|
| Rate for Payer: Humana KY Medicaid |
$4,074.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,115.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,714.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,743.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,554.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,156.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,425.66
|
| Rate for Payer: Ohio Health Group HMO |
$8,885.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,477.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,307.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,174.66
|
| Rate for Payer: PHCS Commercial |
$11,373.45
|
| Rate for Payer: United Healthcare All Payer |
$10,425.66
|
|
|
LPS TOTAL FEM SEG COMP 55MM
|
Facility
|
IP
|
$11,847.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,554.20 |
| Max. Negotiated Rate |
$11,373.45 |
| Rate for Payer: Aetna Commercial |
$9,122.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,240.93
|
| Rate for Payer: Cash Price |
$5,923.67
|
| Rate for Payer: Cigna Commercial |
$9,833.29
|
| Rate for Payer: First Health Commercial |
$11,254.97
|
| Rate for Payer: Humana Commercial |
$10,070.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,714.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,743.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,554.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,425.66
|
| Rate for Payer: Ohio Health Group HMO |
$8,885.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,477.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,307.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,174.66
|
| Rate for Payer: PHCS Commercial |
$11,373.45
|
| Rate for Payer: United Healthcare All Payer |
$10,425.66
|
|
|
LPS UNIV TIB HIN INS MED 14MM
|
Facility
|
IP
|
$12,619.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,785.99 |
| Max. Negotiated Rate |
$12,115.15 |
| Rate for Payer: Aetna Commercial |
$9,717.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,843.56
|
| Rate for Payer: Cash Price |
$6,309.98
|
| Rate for Payer: Cigna Commercial |
$10,474.56
|
| Rate for Payer: First Health Commercial |
$11,988.95
|
| Rate for Payer: Humana Commercial |
$10,726.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,348.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,313.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,785.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,105.56
|
| Rate for Payer: Ohio Health Group HMO |
$9,464.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,095.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,979.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,707.77
|
| Rate for Payer: PHCS Commercial |
$12,115.15
|
| Rate for Payer: United Healthcare All Payer |
$11,105.56
|
|
|
LPS UNIV TIB HIN INS MED 14MM
|
Facility
|
OP
|
$12,619.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,785.99 |
| Max. Negotiated Rate |
$12,115.15 |
| Rate for Payer: Aetna Commercial |
$9,717.36
|
| Rate for Payer: Anthem Medicaid |
$4,340.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,843.56
|
| Rate for Payer: Cash Price |
$6,309.98
|
| Rate for Payer: Cigna Commercial |
$10,474.56
|
| Rate for Payer: First Health Commercial |
$11,988.95
|
| Rate for Payer: Humana Commercial |
$10,726.96
|
| Rate for Payer: Humana KY Medicaid |
$4,340.00
|
| Rate for Payer: Kentucky WC Medicaid |
$4,384.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,348.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,313.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,785.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,427.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,105.56
|
| Rate for Payer: Ohio Health Group HMO |
$9,464.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,095.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,979.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,707.77
|
| Rate for Payer: PHCS Commercial |
$12,115.15
|
| Rate for Payer: United Healthcare All Payer |
$11,105.56
|
|
|
LPS UNIV TIB HIN INS MED 18MM
|
Facility
|
IP
|
$23,420.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,026.00 |
| Max. Negotiated Rate |
$22,483.20 |
| Rate for Payer: Aetna Commercial |
$18,033.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,267.60
|
| Rate for Payer: Cash Price |
$11,710.00
|
| Rate for Payer: Cigna Commercial |
$19,438.60
|
| Rate for Payer: First Health Commercial |
$22,249.00
|
| Rate for Payer: Humana Commercial |
$19,907.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,204.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,283.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,026.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,609.60
|
| Rate for Payer: Ohio Health Group HMO |
$17,565.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,736.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,375.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,159.80
|
| Rate for Payer: PHCS Commercial |
$22,483.20
|
| Rate for Payer: United Healthcare All Payer |
$20,609.60
|
|
|
LPS UNIV TIB HIN INS MED 18MM
|
Facility
|
OP
|
$23,420.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,026.00 |
| Max. Negotiated Rate |
$22,483.20 |
| Rate for Payer: Aetna Commercial |
$18,033.40
|
| Rate for Payer: Anthem Medicaid |
$8,054.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,267.60
|
| Rate for Payer: Cash Price |
$11,710.00
|
| Rate for Payer: Cigna Commercial |
$19,438.60
|
| Rate for Payer: First Health Commercial |
$22,249.00
|
| Rate for Payer: Humana Commercial |
$19,907.00
|
| Rate for Payer: Humana KY Medicaid |
$8,054.14
|
| Rate for Payer: Kentucky WC Medicaid |
$8,136.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,204.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,283.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,026.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,215.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,609.60
|
| Rate for Payer: Ohio Health Group HMO |
$17,565.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,736.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,375.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,159.80
|
| Rate for Payer: PHCS Commercial |
$22,483.20
|
| Rate for Payer: United Healthcare All Payer |
$20,609.60
|
|
|
LPS UNIV TIB HIN INS MED 21MM
|
Facility
|
OP
|
$21,610.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,483.02 |
| Max. Negotiated Rate |
$20,745.66 |
| Rate for Payer: Aetna Commercial |
$16,639.75
|
| Rate for Payer: Anthem Medicaid |
$7,431.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,855.85
|
| Rate for Payer: Cash Price |
$10,805.03
|
| Rate for Payer: Cigna Commercial |
$17,936.35
|
| Rate for Payer: First Health Commercial |
$20,529.56
|
| Rate for Payer: Humana Commercial |
$18,368.55
|
| Rate for Payer: Humana KY Medicaid |
$7,431.70
|
| Rate for Payer: Kentucky WC Medicaid |
$7,507.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,720.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,948.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,483.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,580.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,016.85
|
| Rate for Payer: Ohio Health Group HMO |
$16,207.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,288.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,800.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,910.94
|
| Rate for Payer: PHCS Commercial |
$20,745.66
|
| Rate for Payer: United Healthcare All Payer |
$19,016.85
|
|
|
LPS UNIV TIB HIN INS MED 21MM
|
Facility
|
IP
|
$21,610.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,483.02 |
| Max. Negotiated Rate |
$20,745.66 |
| Rate for Payer: Aetna Commercial |
$16,639.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,855.85
|
| Rate for Payer: Cash Price |
$10,805.03
|
| Rate for Payer: Cigna Commercial |
$17,936.35
|
| Rate for Payer: First Health Commercial |
$20,529.56
|
| Rate for Payer: Humana Commercial |
$18,368.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,720.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,948.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,483.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,016.85
|
| Rate for Payer: Ohio Health Group HMO |
$16,207.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,288.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,800.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,910.94
|
| Rate for Payer: PHCS Commercial |
$20,745.66
|
| Rate for Payer: United Healthcare All Payer |
$19,016.85
|
|
|
LPS UNIV TIB HIN INS SM 12MM
|
Facility
|
OP
|
$21,610.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,483.02 |
| Max. Negotiated Rate |
$20,745.66 |
| Rate for Payer: Aetna Commercial |
$16,639.75
|
| Rate for Payer: Anthem Medicaid |
$7,431.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,855.85
|
| Rate for Payer: Cash Price |
$10,805.03
|
| Rate for Payer: Cigna Commercial |
$17,936.35
|
| Rate for Payer: First Health Commercial |
$20,529.56
|
| Rate for Payer: Humana Commercial |
$18,368.55
|
| Rate for Payer: Humana KY Medicaid |
$7,431.70
|
| Rate for Payer: Kentucky WC Medicaid |
$7,507.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,720.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,948.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,483.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,580.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,016.85
|
| Rate for Payer: Ohio Health Group HMO |
$16,207.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,288.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,800.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,910.94
|
| Rate for Payer: PHCS Commercial |
$20,745.66
|
| Rate for Payer: United Healthcare All Payer |
$19,016.85
|
|
|
LPS UNIV TIB HIN INS SM 12MM
|
Facility
|
IP
|
$21,610.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,483.02 |
| Max. Negotiated Rate |
$20,745.66 |
| Rate for Payer: Aetna Commercial |
$16,639.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,855.85
|
| Rate for Payer: Cash Price |
$10,805.03
|
| Rate for Payer: Cigna Commercial |
$17,936.35
|
| Rate for Payer: First Health Commercial |
$20,529.56
|
| Rate for Payer: Humana Commercial |
$18,368.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,720.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,948.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,483.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,016.85
|
| Rate for Payer: Ohio Health Group HMO |
$16,207.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,288.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,800.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,910.94
|
| Rate for Payer: PHCS Commercial |
$20,745.66
|
| Rate for Payer: United Healthcare All Payer |
$19,016.85
|
|
|
LPS UNIV TIB HIN INS SM 14MM
|
Facility
|
OP
|
$24,541.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,362.38 |
| Max. Negotiated Rate |
$23,559.60 |
| Rate for Payer: Aetna Commercial |
$18,896.76
|
| Rate for Payer: Anthem Medicaid |
$8,439.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,142.17
|
| Rate for Payer: Cash Price |
$12,270.62
|
| Rate for Payer: Cigna Commercial |
$20,369.24
|
| Rate for Payer: First Health Commercial |
$23,314.19
|
| Rate for Payer: Humana Commercial |
$20,860.06
|
| Rate for Payer: Humana KY Medicaid |
$8,439.74
|
| Rate for Payer: Kentucky WC Medicaid |
$8,525.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,123.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,111.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,362.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,609.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,596.30
|
| Rate for Payer: Ohio Health Group HMO |
$18,405.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,633.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,350.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,933.46
|
| Rate for Payer: PHCS Commercial |
$23,559.60
|
| Rate for Payer: United Healthcare All Payer |
$21,596.30
|
|
|
LPS UNIV TIB HIN INS SM 14MM
|
Facility
|
IP
|
$24,541.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,362.38 |
| Max. Negotiated Rate |
$23,559.60 |
| Rate for Payer: Aetna Commercial |
$18,896.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,142.17
|
| Rate for Payer: Cash Price |
$12,270.62
|
| Rate for Payer: Cigna Commercial |
$20,369.24
|
| Rate for Payer: First Health Commercial |
$23,314.19
|
| Rate for Payer: Humana Commercial |
$20,860.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,123.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,111.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,362.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,596.30
|
| Rate for Payer: Ohio Health Group HMO |
$18,405.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,633.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,350.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,933.46
|
| Rate for Payer: PHCS Commercial |
$23,559.60
|
| Rate for Payer: United Healthcare All Payer |
$21,596.30
|
|
|
LPS UNIV TIB HIN INS SM 16MM
|
Facility
|
IP
|
$23,420.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,026.00 |
| Max. Negotiated Rate |
$22,483.20 |
| Rate for Payer: Aetna Commercial |
$18,033.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,267.60
|
| Rate for Payer: Cash Price |
$11,710.00
|
| Rate for Payer: Cigna Commercial |
$19,438.60
|
| Rate for Payer: First Health Commercial |
$22,249.00
|
| Rate for Payer: Humana Commercial |
$19,907.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,204.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,283.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,026.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,609.60
|
| Rate for Payer: Ohio Health Group HMO |
$17,565.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,736.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,375.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,159.80
|
| Rate for Payer: PHCS Commercial |
$22,483.20
|
| Rate for Payer: United Healthcare All Payer |
$20,609.60
|
|
|
LPS UNIV TIB HIN INS SM 16MM
|
Facility
|
OP
|
$23,420.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,026.00 |
| Max. Negotiated Rate |
$22,483.20 |
| Rate for Payer: Aetna Commercial |
$18,033.40
|
| Rate for Payer: Anthem Medicaid |
$8,054.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,267.60
|
| Rate for Payer: Cash Price |
$11,710.00
|
| Rate for Payer: Cigna Commercial |
$19,438.60
|
| Rate for Payer: First Health Commercial |
$22,249.00
|
| Rate for Payer: Humana Commercial |
$19,907.00
|
| Rate for Payer: Humana KY Medicaid |
$8,054.14
|
| Rate for Payer: Kentucky WC Medicaid |
$8,136.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,204.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,283.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,026.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,215.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,609.60
|
| Rate for Payer: Ohio Health Group HMO |
$17,565.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,736.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,375.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,159.80
|
| Rate for Payer: PHCS Commercial |
$22,483.20
|
| Rate for Payer: United Healthcare All Payer |
$20,609.60
|
|
|
LPS UNIV TIB HIN INS SM 21MM
|
Facility
|
OP
|
$23,420.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,026.00 |
| Max. Negotiated Rate |
$22,483.20 |
| Rate for Payer: Aetna Commercial |
$18,033.40
|
| Rate for Payer: Anthem Medicaid |
$8,054.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,267.60
|
| Rate for Payer: Cash Price |
$11,710.00
|
| Rate for Payer: Cigna Commercial |
$19,438.60
|
| Rate for Payer: First Health Commercial |
$22,249.00
|
| Rate for Payer: Humana Commercial |
$19,907.00
|
| Rate for Payer: Humana KY Medicaid |
$8,054.14
|
| Rate for Payer: Kentucky WC Medicaid |
$8,136.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,204.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,283.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,026.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,215.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,609.60
|
| Rate for Payer: Ohio Health Group HMO |
$17,565.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,736.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,375.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,159.80
|
| Rate for Payer: PHCS Commercial |
$22,483.20
|
| Rate for Payer: United Healthcare All Payer |
$20,609.60
|
|
|
LPS UNIV TIB HIN INS SM 21MM
|
Facility
|
IP
|
$23,420.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,026.00 |
| Max. Negotiated Rate |
$22,483.20 |
| Rate for Payer: Aetna Commercial |
$18,033.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,267.60
|
| Rate for Payer: Cash Price |
$11,710.00
|
| Rate for Payer: Cigna Commercial |
$19,438.60
|
| Rate for Payer: First Health Commercial |
$22,249.00
|
| Rate for Payer: Humana Commercial |
$19,907.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,204.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,283.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,026.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,609.60
|
| Rate for Payer: Ohio Health Group HMO |
$17,565.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,736.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,375.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,159.80
|
| Rate for Payer: PHCS Commercial |
$22,483.20
|
| Rate for Payer: United Healthcare All Payer |
$20,609.60
|
|
|
LPS UNIV TIB HIN INS XSM 12MM
|
Facility
|
IP
|
$24,541.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,362.38 |
| Max. Negotiated Rate |
$23,559.60 |
| Rate for Payer: Aetna Commercial |
$18,896.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,142.17
|
| Rate for Payer: Cash Price |
$12,270.62
|
| Rate for Payer: Cigna Commercial |
$20,369.24
|
| Rate for Payer: First Health Commercial |
$23,314.19
|
| Rate for Payer: Humana Commercial |
$20,860.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,123.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,111.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,362.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,596.30
|
| Rate for Payer: Ohio Health Group HMO |
$18,405.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,633.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,350.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,933.46
|
| Rate for Payer: PHCS Commercial |
$23,559.60
|
| Rate for Payer: United Healthcare All Payer |
$21,596.30
|
|
|
LPS UNIV TIB HIN INS XSM 12MM
|
Facility
|
OP
|
$24,541.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,362.38 |
| Max. Negotiated Rate |
$23,559.60 |
| Rate for Payer: Aetna Commercial |
$18,896.76
|
| Rate for Payer: Anthem Medicaid |
$8,439.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,142.17
|
| Rate for Payer: Cash Price |
$12,270.62
|
| Rate for Payer: Cigna Commercial |
$20,369.24
|
| Rate for Payer: First Health Commercial |
$23,314.19
|
| Rate for Payer: Humana Commercial |
$20,860.06
|
| Rate for Payer: Humana KY Medicaid |
$8,439.74
|
| Rate for Payer: Kentucky WC Medicaid |
$8,525.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,123.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,111.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,362.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,609.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,596.30
|
| Rate for Payer: Ohio Health Group HMO |
$18,405.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,633.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,350.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,933.46
|
| Rate for Payer: PHCS Commercial |
$23,559.60
|
| Rate for Payer: United Healthcare All Payer |
$21,596.30
|
|
