|
PINN MAR LIP LNR 28ID*48OD+4
|
Facility
|
IP
|
$10,760.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,398.88 |
| Max. Negotiated Rate |
$10,330.18 |
| Rate for Payer: Aetna Commercial |
$8,285.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,393.27
|
| Rate for Payer: Cash Price |
$5,380.30
|
| Rate for Payer: Cigna Commercial |
$8,931.30
|
| Rate for Payer: First Health Commercial |
$10,222.57
|
| Rate for Payer: Humana Commercial |
$9,146.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,823.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,941.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,228.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,469.33
|
| Rate for Payer: Ohio Health Group HMO |
$8,070.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,152.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,398.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,335.79
|
| Rate for Payer: PHCS Commercial |
$10,330.18
|
| Rate for Payer: United Healthcare All Payer |
$9,469.33
|
|
|
PINN MAR LIP LNR 28ID*48OD+4
|
Facility
|
OP
|
$10,760.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,398.88 |
| Max. Negotiated Rate |
$10,330.18 |
| Rate for Payer: Aetna Commercial |
$8,285.66
|
| Rate for Payer: Anthem Medicaid |
$3,700.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,393.27
|
| Rate for Payer: Cash Price |
$5,380.30
|
| Rate for Payer: Cigna Commercial |
$8,931.30
|
| Rate for Payer: First Health Commercial |
$10,222.57
|
| Rate for Payer: Humana Commercial |
$9,146.51
|
| Rate for Payer: Humana KY Medicaid |
$3,700.57
|
| Rate for Payer: Kentucky WC Medicaid |
$3,738.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,823.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,941.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,228.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,774.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,469.33
|
| Rate for Payer: Ohio Health Group HMO |
$8,070.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,152.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,398.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,335.79
|
| Rate for Payer: PHCS Commercial |
$10,330.18
|
| Rate for Payer: United Healthcare All Payer |
$9,469.33
|
|
|
PINN MAR LIP LNR 28ID*52OD
|
Facility
|
OP
|
$6,919.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$899.52 |
| Max. Negotiated Rate |
$6,642.61 |
| Rate for Payer: Aetna Commercial |
$5,327.93
|
| Rate for Payer: Anthem Medicaid |
$2,379.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,397.12
|
| Rate for Payer: Cash Price |
$3,459.70
|
| Rate for Payer: Cigna Commercial |
$5,743.09
|
| Rate for Payer: First Health Commercial |
$6,573.42
|
| Rate for Payer: Humana Commercial |
$5,881.48
|
| Rate for Payer: Humana KY Medicaid |
$2,379.58
|
| Rate for Payer: Kentucky WC Medicaid |
$2,403.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,673.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,106.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,075.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,427.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,089.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,189.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,383.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$899.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,145.01
|
| Rate for Payer: PHCS Commercial |
$6,642.61
|
| Rate for Payer: United Healthcare All Payer |
$6,089.06
|
|
|
PINN MAR LIP LNR 28ID*52OD
|
Facility
|
IP
|
$6,919.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$899.52 |
| Max. Negotiated Rate |
$6,642.61 |
| Rate for Payer: Aetna Commercial |
$5,327.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,397.12
|
| Rate for Payer: Cash Price |
$3,459.70
|
| Rate for Payer: Cigna Commercial |
$5,743.09
|
| Rate for Payer: First Health Commercial |
$6,573.42
|
| Rate for Payer: Humana Commercial |
$5,881.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,673.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,106.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,075.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,089.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,189.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,383.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$899.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,145.01
|
| Rate for Payer: PHCS Commercial |
$6,642.61
|
| Rate for Payer: United Healthcare All Payer |
$6,089.06
|
|
|
PINN MAR LIP LNR 32ID*52OD
|
Facility
|
OP
|
$6,971.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$906.35 |
| Max. Negotiated Rate |
$6,693.07 |
| Rate for Payer: Aetna Commercial |
$5,368.40
|
| Rate for Payer: Anthem Medicaid |
$2,397.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,438.12
|
| Rate for Payer: Cash Price |
$3,485.98
|
| Rate for Payer: Cigna Commercial |
$5,786.72
|
| Rate for Payer: First Health Commercial |
$6,623.35
|
| Rate for Payer: Humana Commercial |
$5,926.16
|
| Rate for Payer: Humana KY Medicaid |
$2,397.65
|
| Rate for Payer: Kentucky WC Medicaid |
$2,422.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,717.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,145.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,091.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,445.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,135.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,228.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,394.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$906.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,161.30
|
| Rate for Payer: PHCS Commercial |
$6,693.07
|
| Rate for Payer: United Healthcare All Payer |
$6,135.32
|
|
|
PINN MAR LIP LNR 32ID*52OD
|
Facility
|
IP
|
$6,971.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$906.35 |
| Max. Negotiated Rate |
$6,693.07 |
| Rate for Payer: Aetna Commercial |
$5,368.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,438.12
|
| Rate for Payer: Cash Price |
$3,485.98
|
| Rate for Payer: Cigna Commercial |
$5,786.72
|
| Rate for Payer: First Health Commercial |
$6,623.35
|
| Rate for Payer: Humana Commercial |
$5,926.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,717.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,145.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,091.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,135.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,228.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,394.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$906.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,161.30
|
| Rate for Payer: PHCS Commercial |
$6,693.07
|
| Rate for Payer: United Healthcare All Payer |
$6,135.32
|
|
|
PINN MAR LIP LNR 32ID*54OD
|
Facility
|
IP
|
$6,971.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$906.35 |
| Max. Negotiated Rate |
$6,693.07 |
| Rate for Payer: Aetna Commercial |
$5,368.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,438.12
|
| Rate for Payer: Cash Price |
$3,485.98
|
| Rate for Payer: Cigna Commercial |
$5,786.72
|
| Rate for Payer: First Health Commercial |
$6,623.35
|
| Rate for Payer: Humana Commercial |
$5,926.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,717.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,145.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,091.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,135.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,228.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,394.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$906.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,161.30
|
| Rate for Payer: PHCS Commercial |
$6,693.07
|
| Rate for Payer: United Healthcare All Payer |
$6,135.32
|
|
|
PINN MAR LIP LNR 32ID*54OD
|
Facility
|
OP
|
$6,971.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$906.35 |
| Max. Negotiated Rate |
$6,693.07 |
| Rate for Payer: Aetna Commercial |
$5,368.40
|
| Rate for Payer: Anthem Medicaid |
$2,397.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,438.12
|
| Rate for Payer: Cash Price |
$3,485.98
|
| Rate for Payer: Cigna Commercial |
$5,786.72
|
| Rate for Payer: First Health Commercial |
$6,623.35
|
| Rate for Payer: Humana Commercial |
$5,926.16
|
| Rate for Payer: Humana KY Medicaid |
$2,397.65
|
| Rate for Payer: Kentucky WC Medicaid |
$2,422.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,717.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,145.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,091.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,445.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,135.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,228.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,394.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$906.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,161.30
|
| Rate for Payer: PHCS Commercial |
$6,693.07
|
| Rate for Payer: United Healthcare All Payer |
$6,135.32
|
|
|
PINN MAR LIP LNR 32ID*56OD
|
Facility
|
OP
|
$6,971.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$906.35 |
| Max. Negotiated Rate |
$6,693.07 |
| Rate for Payer: Aetna Commercial |
$5,368.40
|
| Rate for Payer: Anthem Medicaid |
$2,397.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,438.12
|
| Rate for Payer: Cash Price |
$3,485.98
|
| Rate for Payer: Cigna Commercial |
$5,786.72
|
| Rate for Payer: First Health Commercial |
$6,623.35
|
| Rate for Payer: Humana Commercial |
$5,926.16
|
| Rate for Payer: Humana KY Medicaid |
$2,397.65
|
| Rate for Payer: Kentucky WC Medicaid |
$2,422.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,717.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,145.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,091.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,445.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,135.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,228.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,394.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$906.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,161.30
|
| Rate for Payer: PHCS Commercial |
$6,693.07
|
| Rate for Payer: United Healthcare All Payer |
$6,135.32
|
|
|
PINN MAR LIP LNR 32ID*56OD
|
Facility
|
IP
|
$6,971.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$906.35 |
| Max. Negotiated Rate |
$6,693.07 |
| Rate for Payer: Aetna Commercial |
$5,368.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,438.12
|
| Rate for Payer: Cash Price |
$3,485.98
|
| Rate for Payer: Cigna Commercial |
$5,786.72
|
| Rate for Payer: First Health Commercial |
$6,623.35
|
| Rate for Payer: Humana Commercial |
$5,926.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,717.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,145.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,091.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,135.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,228.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,394.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$906.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,161.30
|
| Rate for Payer: PHCS Commercial |
$6,693.07
|
| Rate for Payer: United Healthcare All Payer |
$6,135.32
|
|
|
PINN MAR LIP LNR 32ID*58OD
|
Facility
|
IP
|
$6,971.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$906.35 |
| Max. Negotiated Rate |
$6,693.07 |
| Rate for Payer: Aetna Commercial |
$5,368.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,438.12
|
| Rate for Payer: Cash Price |
$3,485.98
|
| Rate for Payer: Cigna Commercial |
$5,786.72
|
| Rate for Payer: First Health Commercial |
$6,623.35
|
| Rate for Payer: Humana Commercial |
$5,926.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,717.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,145.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,091.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,135.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,228.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,394.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$906.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,161.30
|
| Rate for Payer: PHCS Commercial |
$6,693.07
|
| Rate for Payer: United Healthcare All Payer |
$6,135.32
|
|
|
PINN MAR LIP LNR 32ID*58OD
|
Facility
|
OP
|
$6,971.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$906.35 |
| Max. Negotiated Rate |
$6,693.07 |
| Rate for Payer: Aetna Commercial |
$5,368.40
|
| Rate for Payer: Anthem Medicaid |
$2,397.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,438.12
|
| Rate for Payer: Cash Price |
$3,485.98
|
| Rate for Payer: Cigna Commercial |
$5,786.72
|
| Rate for Payer: First Health Commercial |
$6,623.35
|
| Rate for Payer: Humana Commercial |
$5,926.16
|
| Rate for Payer: Humana KY Medicaid |
$2,397.65
|
| Rate for Payer: Kentucky WC Medicaid |
$2,422.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,717.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,145.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,091.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,445.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,135.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,228.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,394.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$906.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,161.30
|
| Rate for Payer: PHCS Commercial |
$6,693.07
|
| Rate for Payer: United Healthcare All Payer |
$6,135.32
|
|
|
PINN MAR LIP LNR 32ID*60OD
|
Facility
|
IP
|
$6,971.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$906.35 |
| Max. Negotiated Rate |
$6,693.07 |
| Rate for Payer: Aetna Commercial |
$5,368.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,438.12
|
| Rate for Payer: Cash Price |
$3,485.98
|
| Rate for Payer: Cigna Commercial |
$5,786.72
|
| Rate for Payer: First Health Commercial |
$6,623.35
|
| Rate for Payer: Humana Commercial |
$5,926.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,717.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,145.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,091.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,135.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,228.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,394.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$906.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,161.30
|
| Rate for Payer: PHCS Commercial |
$6,693.07
|
| Rate for Payer: United Healthcare All Payer |
$6,135.32
|
|
|
PINN MAR LIP LNR 32ID*60OD
|
Facility
|
OP
|
$6,971.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$906.35 |
| Max. Negotiated Rate |
$6,693.07 |
| Rate for Payer: Aetna Commercial |
$5,368.40
|
| Rate for Payer: Anthem Medicaid |
$2,397.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,438.12
|
| Rate for Payer: Cash Price |
$3,485.98
|
| Rate for Payer: Cigna Commercial |
$5,786.72
|
| Rate for Payer: First Health Commercial |
$6,623.35
|
| Rate for Payer: Humana Commercial |
$5,926.16
|
| Rate for Payer: Humana KY Medicaid |
$2,397.65
|
| Rate for Payer: Kentucky WC Medicaid |
$2,422.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,717.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,145.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,091.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,445.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,135.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,228.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,394.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$906.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,161.30
|
| Rate for Payer: PHCS Commercial |
$6,693.07
|
| Rate for Payer: United Healthcare All Payer |
$6,135.32
|
|
|
PINN MAR LIP LNR 32ID*62OD
|
Facility
|
IP
|
$6,971.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$906.35 |
| Max. Negotiated Rate |
$6,693.07 |
| Rate for Payer: Aetna Commercial |
$5,368.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,438.12
|
| Rate for Payer: Cash Price |
$3,485.98
|
| Rate for Payer: Cigna Commercial |
$5,786.72
|
| Rate for Payer: First Health Commercial |
$6,623.35
|
| Rate for Payer: Humana Commercial |
$5,926.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,717.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,145.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,091.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,135.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,228.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,394.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$906.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,161.30
|
| Rate for Payer: PHCS Commercial |
$6,693.07
|
| Rate for Payer: United Healthcare All Payer |
$6,135.32
|
|
|
PINN MAR LIP LNR 32ID*62OD
|
Facility
|
OP
|
$6,971.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$906.35 |
| Max. Negotiated Rate |
$6,693.07 |
| Rate for Payer: Aetna Commercial |
$5,368.40
|
| Rate for Payer: Anthem Medicaid |
$2,397.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,438.12
|
| Rate for Payer: Cash Price |
$3,485.98
|
| Rate for Payer: Cigna Commercial |
$5,786.72
|
| Rate for Payer: First Health Commercial |
$6,623.35
|
| Rate for Payer: Humana Commercial |
$5,926.16
|
| Rate for Payer: Humana KY Medicaid |
$2,397.65
|
| Rate for Payer: Kentucky WC Medicaid |
$2,422.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,717.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,145.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,091.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,445.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,135.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,228.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,394.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$906.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,161.30
|
| Rate for Payer: PHCS Commercial |
$6,693.07
|
| Rate for Payer: United Healthcare All Payer |
$6,135.32
|
|
|
PINN MAR LIP LNR 32ID*64OD
|
Facility
|
IP
|
$5,176.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.95 |
| Max. Negotiated Rate |
$4,969.48 |
| Rate for Payer: Aetna Commercial |
$3,985.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,037.70
|
| Rate for Payer: Cash Price |
$2,588.27
|
| Rate for Payer: Cigna Commercial |
$4,296.53
|
| Rate for Payer: First Health Commercial |
$4,917.71
|
| Rate for Payer: Humana Commercial |
$4,400.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,244.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,820.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,555.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,882.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,035.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$672.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,604.73
|
| Rate for Payer: PHCS Commercial |
$4,969.48
|
| Rate for Payer: United Healthcare All Payer |
$4,555.36
|
|
|
PINN MAR LIP LNR 32ID*64OD
|
Facility
|
OP
|
$5,176.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.95 |
| Max. Negotiated Rate |
$4,969.48 |
| Rate for Payer: Aetna Commercial |
$3,985.94
|
| Rate for Payer: Anthem Medicaid |
$1,780.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,037.70
|
| Rate for Payer: Cash Price |
$2,588.27
|
| Rate for Payer: Cigna Commercial |
$4,296.53
|
| Rate for Payer: First Health Commercial |
$4,917.71
|
| Rate for Payer: Humana Commercial |
$4,400.06
|
| Rate for Payer: Humana KY Medicaid |
$1,780.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,798.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,244.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,820.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,815.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,555.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,882.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,035.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$672.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,604.73
|
| Rate for Payer: PHCS Commercial |
$4,969.48
|
| Rate for Payer: United Healthcare All Payer |
$4,555.36
|
|
|
PINN MAR LIP LNR 32ID*66OD
|
Facility
|
IP
|
$6,971.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$906.35 |
| Max. Negotiated Rate |
$6,693.07 |
| Rate for Payer: Aetna Commercial |
$5,368.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,438.12
|
| Rate for Payer: Cash Price |
$3,485.98
|
| Rate for Payer: Cigna Commercial |
$5,786.72
|
| Rate for Payer: First Health Commercial |
$6,623.35
|
| Rate for Payer: Humana Commercial |
$5,926.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,717.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,145.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,091.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,135.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,228.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,394.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$906.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,161.30
|
| Rate for Payer: PHCS Commercial |
$6,693.07
|
| Rate for Payer: United Healthcare All Payer |
$6,135.32
|
|
|
PINN MAR LIP LNR 32ID*66OD
|
Facility
|
OP
|
$6,971.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$906.35 |
| Max. Negotiated Rate |
$6,693.07 |
| Rate for Payer: Aetna Commercial |
$5,368.40
|
| Rate for Payer: Anthem Medicaid |
$2,397.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,438.12
|
| Rate for Payer: Cash Price |
$3,485.98
|
| Rate for Payer: Cigna Commercial |
$5,786.72
|
| Rate for Payer: First Health Commercial |
$6,623.35
|
| Rate for Payer: Humana Commercial |
$5,926.16
|
| Rate for Payer: Humana KY Medicaid |
$2,397.65
|
| Rate for Payer: Kentucky WC Medicaid |
$2,422.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,717.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,145.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,091.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,445.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,135.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,228.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,394.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$906.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,161.30
|
| Rate for Payer: PHCS Commercial |
$6,693.07
|
| Rate for Payer: United Healthcare All Payer |
$6,135.32
|
|
|
PINN MAR NEUT 36ID*56OD
|
Facility
|
OP
|
$8,603.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,118.40 |
| Max. Negotiated Rate |
$8,258.98 |
| Rate for Payer: Aetna Commercial |
$6,624.39
|
| Rate for Payer: Anthem Medicaid |
$2,958.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,710.42
|
| Rate for Payer: Cash Price |
$4,301.55
|
| Rate for Payer: Cigna Commercial |
$7,140.57
|
| Rate for Payer: First Health Commercial |
$8,172.94
|
| Rate for Payer: Humana Commercial |
$7,312.64
|
| Rate for Payer: Humana KY Medicaid |
$2,958.61
|
| Rate for Payer: Kentucky WC Medicaid |
$2,988.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,054.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,349.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,580.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,017.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,570.73
|
| Rate for Payer: Ohio Health Group HMO |
$6,452.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,720.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,118.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,666.96
|
| Rate for Payer: PHCS Commercial |
$8,258.98
|
| Rate for Payer: United Healthcare All Payer |
$7,570.73
|
|
|
PINN MAR NEUT 36ID*56OD
|
Facility
|
IP
|
$8,603.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,118.40 |
| Max. Negotiated Rate |
$8,258.98 |
| Rate for Payer: Aetna Commercial |
$6,624.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,710.42
|
| Rate for Payer: Cash Price |
$4,301.55
|
| Rate for Payer: Cigna Commercial |
$7,140.57
|
| Rate for Payer: First Health Commercial |
$8,172.94
|
| Rate for Payer: Humana Commercial |
$7,312.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,054.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,349.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,580.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,570.73
|
| Rate for Payer: Ohio Health Group HMO |
$6,452.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,720.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,118.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,666.96
|
| Rate for Payer: PHCS Commercial |
$8,258.98
|
| Rate for Payer: United Healthcare All Payer |
$7,570.73
|
|
|
PINN SECTOR HA ACET CUP 48MM
|
Facility
|
OP
|
$13,943.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,812.64 |
| Max. Negotiated Rate |
$13,385.66 |
| Rate for Payer: Aetna Commercial |
$10,736.42
|
| Rate for Payer: Anthem Medicaid |
$4,795.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,875.85
|
| Rate for Payer: Cash Price |
$6,971.70
|
| Rate for Payer: Cigna Commercial |
$11,573.02
|
| Rate for Payer: First Health Commercial |
$13,246.23
|
| Rate for Payer: Humana Commercial |
$11,851.89
|
| Rate for Payer: Humana KY Medicaid |
$4,795.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,843.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,433.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,290.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,183.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,891.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,270.19
|
| Rate for Payer: Ohio Health Group HMO |
$10,457.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,788.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,812.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,322.45
|
| Rate for Payer: PHCS Commercial |
$13,385.66
|
| Rate for Payer: United Healthcare All Payer |
$12,270.19
|
|
|
PINN SECTOR HA ACET CUP 48MM
|
Facility
|
IP
|
$13,943.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,812.64 |
| Max. Negotiated Rate |
$13,385.66 |
| Rate for Payer: Aetna Commercial |
$10,736.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,875.85
|
| Rate for Payer: Cash Price |
$6,971.70
|
| Rate for Payer: Cigna Commercial |
$11,573.02
|
| Rate for Payer: First Health Commercial |
$13,246.23
|
| Rate for Payer: Humana Commercial |
$11,851.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,433.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,290.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,183.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,270.19
|
| Rate for Payer: Ohio Health Group HMO |
$10,457.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,788.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,812.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,322.45
|
| Rate for Payer: PHCS Commercial |
$13,385.66
|
| Rate for Payer: United Healthcare All Payer |
$12,270.19
|
|
|
PINN SECTOR HA ACET CUP 50MM
|
Facility
|
IP
|
$13,943.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,812.64 |
| Max. Negotiated Rate |
$13,385.66 |
| Rate for Payer: Aetna Commercial |
$10,736.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,875.85
|
| Rate for Payer: Cash Price |
$6,971.70
|
| Rate for Payer: Cigna Commercial |
$11,573.02
|
| Rate for Payer: First Health Commercial |
$13,246.23
|
| Rate for Payer: Humana Commercial |
$11,851.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,433.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,290.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,183.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,270.19
|
| Rate for Payer: Ohio Health Group HMO |
$10,457.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,788.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,812.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,322.45
|
| Rate for Payer: PHCS Commercial |
$13,385.66
|
| Rate for Payer: United Healthcare All Payer |
$12,270.19
|
|
