|
LPS UNIV TIB HIN INS XSM 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 XSM 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 XSM 16MM
|
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 XSM 16MM
|
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 XSM 18MM
|
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 XSM 18MM
|
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 XSM 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 XSM 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 XXSM 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 XXSM 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 XXSM 14MM
|
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 XXSM 14MM
|
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 XXSM 16MM
|
Facility
|
IP
|
$20,911.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,273.38 |
| Max. Negotiated Rate |
$20,074.80 |
| Rate for Payer: Aetna Commercial |
$16,101.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,310.77
|
| Rate for Payer: Cash Price |
$10,455.62
|
| Rate for Payer: Cigna Commercial |
$17,356.34
|
| Rate for Payer: First Health Commercial |
$19,865.69
|
| Rate for Payer: Humana Commercial |
$17,774.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,147.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,432.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,273.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,401.90
|
| Rate for Payer: Ohio Health Group HMO |
$15,683.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,729.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,192.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,428.76
|
| Rate for Payer: PHCS Commercial |
$20,074.80
|
| Rate for Payer: United Healthcare All Payer |
$18,401.90
|
|
|
LPS UNIV TIB HIN INS XXSM 16MM
|
Facility
|
OP
|
$20,911.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,273.38 |
| Max. Negotiated Rate |
$20,074.80 |
| Rate for Payer: Aetna Commercial |
$16,101.66
|
| Rate for Payer: Anthem Medicaid |
$7,191.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,310.77
|
| Rate for Payer: Cash Price |
$10,455.62
|
| Rate for Payer: Cigna Commercial |
$17,356.34
|
| Rate for Payer: First Health Commercial |
$19,865.69
|
| Rate for Payer: Humana Commercial |
$17,774.56
|
| Rate for Payer: Humana KY Medicaid |
$7,191.38
|
| Rate for Payer: Kentucky WC Medicaid |
$7,264.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,147.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,432.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,273.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,335.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,401.90
|
| Rate for Payer: Ohio Health Group HMO |
$15,683.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,729.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,192.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,428.76
|
| Rate for Payer: PHCS Commercial |
$20,074.80
|
| Rate for Payer: United Healthcare All Payer |
$18,401.90
|
|
|
LPS UNIV TIB HIN INS XXSM 18MM
|
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 XXSM 18MM
|
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 XXSM 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 XXSM 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
|
|
|
LPT GREAT TOE KIT W/O SIZERS
|
Facility
|
OP
|
$8,931.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,679.38 |
| Max. Negotiated Rate |
$8,574.00 |
| Rate for Payer: Aetna Commercial |
$6,877.06
|
| Rate for Payer: Anthem Medicaid |
$3,071.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.38
|
| Rate for Payer: Cash Price |
$4,465.62
|
| Rate for Payer: Cigna Commercial |
$7,412.94
|
| Rate for Payer: First Health Commercial |
$8,484.69
|
| Rate for Payer: Humana Commercial |
$7,591.56
|
| Rate for Payer: Humana KY Medicaid |
$3,071.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,102.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,323.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,133.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,859.50
|
| Rate for Payer: Ohio Health Group HMO |
$6,698.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,145.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,770.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,162.56
|
| Rate for Payer: PHCS Commercial |
$8,574.00
|
| Rate for Payer: United Healthcare All Payer |
$7,859.50
|
|
|
LPT GREAT TOE KIT W/O SIZERS
|
Facility
|
IP
|
$8,931.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,679.38 |
| Max. Negotiated Rate |
$8,574.00 |
| Rate for Payer: Aetna Commercial |
$6,877.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.38
|
| Rate for Payer: Cash Price |
$4,465.62
|
| Rate for Payer: Cigna Commercial |
$7,412.94
|
| Rate for Payer: First Health Commercial |
$8,484.69
|
| Rate for Payer: Humana Commercial |
$7,591.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,323.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,859.50
|
| Rate for Payer: Ohio Health Group HMO |
$6,698.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,145.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,770.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,162.56
|
| Rate for Payer: PHCS Commercial |
$8,574.00
|
| Rate for Payer: United Healthcare All Payer |
$7,859.50
|
|
|
LPT GREAT TOE KIT W/SIZERS
|
Facility
|
IP
|
$11,482.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,444.68 |
| Max. Negotiated Rate |
$11,022.96 |
| Rate for Payer: Aetna Commercial |
$8,841.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,956.16
|
| Rate for Payer: Cash Price |
$5,741.12
|
| Rate for Payer: Cigna Commercial |
$9,530.27
|
| Rate for Payer: First Health Commercial |
$10,908.14
|
| Rate for Payer: Humana Commercial |
$9,759.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,415.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,473.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,444.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,104.38
|
| Rate for Payer: Ohio Health Group HMO |
$8,611.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,185.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,989.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,922.75
|
| Rate for Payer: PHCS Commercial |
$11,022.96
|
| Rate for Payer: United Healthcare All Payer |
$10,104.38
|
|
|
LPT GREAT TOE KIT W/SIZERS
|
Facility
|
OP
|
$11,482.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,444.68 |
| Max. Negotiated Rate |
$11,022.96 |
| Rate for Payer: Aetna Commercial |
$8,841.33
|
| Rate for Payer: Anthem Medicaid |
$3,948.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,956.16
|
| Rate for Payer: Cash Price |
$5,741.12
|
| Rate for Payer: Cigna Commercial |
$9,530.27
|
| Rate for Payer: First Health Commercial |
$10,908.14
|
| Rate for Payer: Humana Commercial |
$9,759.91
|
| Rate for Payer: Humana KY Medicaid |
$3,948.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3,988.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,415.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,473.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,444.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,027.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,104.38
|
| Rate for Payer: Ohio Health Group HMO |
$8,611.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,185.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,989.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,922.75
|
| Rate for Payer: PHCS Commercial |
$11,022.96
|
| Rate for Payer: United Healthcare All Payer |
$10,104.38
|
|
|
LPT GREAT TOE SZ 0 STRAIGHT
|
Facility
|
IP
|
$8,931.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,679.38 |
| Max. Negotiated Rate |
$8,574.00 |
| Rate for Payer: Aetna Commercial |
$6,877.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.38
|
| Rate for Payer: Cash Price |
$4,465.62
|
| Rate for Payer: Cigna Commercial |
$7,412.94
|
| Rate for Payer: First Health Commercial |
$8,484.69
|
| Rate for Payer: Humana Commercial |
$7,591.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,323.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,859.50
|
| Rate for Payer: Ohio Health Group HMO |
$6,698.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,145.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,770.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,162.56
|
| Rate for Payer: PHCS Commercial |
$8,574.00
|
| Rate for Payer: United Healthcare All Payer |
$7,859.50
|
|
|
LPT GREAT TOE SZ 0 STRAIGHT
|
Facility
|
OP
|
$8,931.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,679.38 |
| Max. Negotiated Rate |
$8,574.00 |
| Rate for Payer: Aetna Commercial |
$6,877.06
|
| Rate for Payer: Anthem Medicaid |
$3,071.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.38
|
| Rate for Payer: Cash Price |
$4,465.62
|
| Rate for Payer: Cigna Commercial |
$7,412.94
|
| Rate for Payer: First Health Commercial |
$8,484.69
|
| Rate for Payer: Humana Commercial |
$7,591.56
|
| Rate for Payer: Humana KY Medicaid |
$3,071.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,102.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,323.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,133.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,859.50
|
| Rate for Payer: Ohio Health Group HMO |
$6,698.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,145.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,770.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,162.56
|
| Rate for Payer: PHCS Commercial |
$8,574.00
|
| Rate for Payer: United Healthcare All Payer |
$7,859.50
|
|
|
LPT GREAT TOE SZ 1 STRAIGHT
|
Facility
|
OP
|
$8,931.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,679.38 |
| Max. Negotiated Rate |
$8,574.00 |
| Rate for Payer: Aetna Commercial |
$6,877.06
|
| Rate for Payer: Anthem Medicaid |
$3,071.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.38
|
| Rate for Payer: Cash Price |
$4,465.62
|
| Rate for Payer: Cigna Commercial |
$7,412.94
|
| Rate for Payer: First Health Commercial |
$8,484.69
|
| Rate for Payer: Humana Commercial |
$7,591.56
|
| Rate for Payer: Humana KY Medicaid |
$3,071.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,102.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,323.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,133.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,859.50
|
| Rate for Payer: Ohio Health Group HMO |
$6,698.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,145.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,770.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,162.56
|
| Rate for Payer: PHCS Commercial |
$8,574.00
|
| Rate for Payer: United Healthcare All Payer |
$7,859.50
|
|
