|
REF LNR 22*50-52 20 DEG SZ E
|
Facility
|
IP
|
$5,573.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.57 |
| Max. Negotiated Rate |
$5,350.70 |
| Rate for Payer: Aetna Commercial |
$4,291.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,347.45
|
| Rate for Payer: Cash Price |
$2,786.82
|
| Rate for Payer: Cigna Commercial |
$4,626.13
|
| Rate for Payer: First Health Commercial |
$5,294.97
|
| Rate for Payer: Humana Commercial |
$4,737.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,570.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,113.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,672.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,904.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,180.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,114.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$724.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,727.83
|
| Rate for Payer: PHCS Commercial |
$5,350.70
|
| Rate for Payer: United Healthcare All Payer |
$4,904.81
|
|
|
REF LNR 22*54-56 20 DEG SZ F
|
Facility
|
OP
|
$5,573.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.57 |
| Max. Negotiated Rate |
$5,350.70 |
| Rate for Payer: Aetna Commercial |
$4,291.71
|
| Rate for Payer: Anthem Medicaid |
$1,916.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,347.45
|
| Rate for Payer: Cash Price |
$2,786.82
|
| Rate for Payer: Cigna Commercial |
$4,626.13
|
| Rate for Payer: First Health Commercial |
$5,294.97
|
| Rate for Payer: Humana Commercial |
$4,737.60
|
| Rate for Payer: Humana KY Medicaid |
$1,916.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,936.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,570.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,113.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,672.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,955.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,904.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,180.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,114.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$724.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,727.83
|
| Rate for Payer: PHCS Commercial |
$5,350.70
|
| Rate for Payer: United Healthcare All Payer |
$4,904.81
|
|
|
REF LNR 22*54-56 20 DEG SZ F
|
Facility
|
IP
|
$5,573.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.57 |
| Max. Negotiated Rate |
$5,350.70 |
| Rate for Payer: Aetna Commercial |
$4,291.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,347.45
|
| Rate for Payer: Cash Price |
$2,786.82
|
| Rate for Payer: Cigna Commercial |
$4,626.13
|
| Rate for Payer: First Health Commercial |
$5,294.97
|
| Rate for Payer: Humana Commercial |
$4,737.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,570.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,113.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,672.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,904.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,180.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,114.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$724.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,727.83
|
| Rate for Payer: PHCS Commercial |
$5,350.70
|
| Rate for Payer: United Healthcare All Payer |
$4,904.81
|
|
|
REF LNR 22*58-60 20 DEG SZ G
|
Facility
|
IP
|
$5,573.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.57 |
| Max. Negotiated Rate |
$5,350.70 |
| Rate for Payer: Aetna Commercial |
$4,291.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,347.45
|
| Rate for Payer: Cash Price |
$2,786.82
|
| Rate for Payer: Cigna Commercial |
$4,626.13
|
| Rate for Payer: First Health Commercial |
$5,294.97
|
| Rate for Payer: Humana Commercial |
$4,737.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,570.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,113.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,672.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,904.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,180.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,114.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$724.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,727.83
|
| Rate for Payer: PHCS Commercial |
$5,350.70
|
| Rate for Payer: United Healthcare All Payer |
$4,904.81
|
|
|
REF LNR 22*58-60 20 DEG SZ G
|
Facility
|
OP
|
$5,573.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.57 |
| Max. Negotiated Rate |
$5,350.70 |
| Rate for Payer: Aetna Commercial |
$4,291.71
|
| Rate for Payer: Anthem Medicaid |
$1,916.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,347.45
|
| Rate for Payer: Cash Price |
$2,786.82
|
| Rate for Payer: Cigna Commercial |
$4,626.13
|
| Rate for Payer: First Health Commercial |
$5,294.97
|
| Rate for Payer: Humana Commercial |
$4,737.60
|
| Rate for Payer: Humana KY Medicaid |
$1,916.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,936.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,570.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,113.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,672.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,955.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,904.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,180.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,114.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$724.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,727.83
|
| Rate for Payer: PHCS Commercial |
$5,350.70
|
| Rate for Payer: United Healthcare All Payer |
$4,904.81
|
|
|
REF LNR 22*62-64 20 DEG SZ H
|
Facility
|
IP
|
$5,573.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.57 |
| Max. Negotiated Rate |
$5,350.70 |
| Rate for Payer: Aetna Commercial |
$4,291.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,347.45
|
| Rate for Payer: Cash Price |
$2,786.82
|
| Rate for Payer: Cigna Commercial |
$4,626.13
|
| Rate for Payer: First Health Commercial |
$5,294.97
|
| Rate for Payer: Humana Commercial |
$4,737.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,570.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,113.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,672.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,904.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,180.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,114.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$724.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,727.83
|
| Rate for Payer: PHCS Commercial |
$5,350.70
|
| Rate for Payer: United Healthcare All Payer |
$4,904.81
|
|
|
REF LNR 22*62-64 20 DEG SZ H
|
Facility
|
OP
|
$5,573.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.57 |
| Max. Negotiated Rate |
$5,350.70 |
| Rate for Payer: Aetna Commercial |
$4,291.71
|
| Rate for Payer: Anthem Medicaid |
$1,916.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,347.45
|
| Rate for Payer: Cash Price |
$2,786.82
|
| Rate for Payer: Cigna Commercial |
$4,626.13
|
| Rate for Payer: First Health Commercial |
$5,294.97
|
| Rate for Payer: Humana Commercial |
$4,737.60
|
| Rate for Payer: Humana KY Medicaid |
$1,916.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,936.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,570.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,113.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,672.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,955.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,904.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,180.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,114.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$724.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,727.83
|
| Rate for Payer: PHCS Commercial |
$5,350.70
|
| Rate for Payer: United Healthcare All Payer |
$4,904.81
|
|
|
REF LNR 22*66-68 20 DEG SZ J
|
Facility
|
OP
|
$5,573.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.57 |
| Max. Negotiated Rate |
$5,350.70 |
| Rate for Payer: Aetna Commercial |
$4,291.71
|
| Rate for Payer: Anthem Medicaid |
$1,916.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,347.45
|
| Rate for Payer: Cash Price |
$2,786.82
|
| Rate for Payer: Cigna Commercial |
$4,626.13
|
| Rate for Payer: First Health Commercial |
$5,294.97
|
| Rate for Payer: Humana Commercial |
$4,737.60
|
| Rate for Payer: Humana KY Medicaid |
$1,916.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,936.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,570.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,113.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,672.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,955.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,904.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,180.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,114.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$724.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,727.83
|
| Rate for Payer: PHCS Commercial |
$5,350.70
|
| Rate for Payer: United Healthcare All Payer |
$4,904.81
|
|
|
REF LNR 22*66-68 20 DEG SZ J
|
Facility
|
IP
|
$5,573.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.57 |
| Max. Negotiated Rate |
$5,350.70 |
| Rate for Payer: Aetna Commercial |
$4,291.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,347.45
|
| Rate for Payer: Cash Price |
$2,786.82
|
| Rate for Payer: Cigna Commercial |
$4,626.13
|
| Rate for Payer: First Health Commercial |
$5,294.97
|
| Rate for Payer: Humana Commercial |
$4,737.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,570.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,113.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,672.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,904.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,180.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,114.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$724.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,727.83
|
| Rate for Payer: PHCS Commercial |
$5,350.70
|
| Rate for Payer: United Healthcare All Payer |
$4,904.81
|
|
|
REF LNR 22*70-76 20 DEG SZ K
|
Facility
|
IP
|
$5,573.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.57 |
| Max. Negotiated Rate |
$5,350.70 |
| Rate for Payer: Aetna Commercial |
$4,291.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,347.45
|
| Rate for Payer: Cash Price |
$2,786.82
|
| Rate for Payer: Cigna Commercial |
$4,626.13
|
| Rate for Payer: First Health Commercial |
$5,294.97
|
| Rate for Payer: Humana Commercial |
$4,737.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,570.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,113.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,672.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,904.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,180.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,114.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$724.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,727.83
|
| Rate for Payer: PHCS Commercial |
$5,350.70
|
| Rate for Payer: United Healthcare All Payer |
$4,904.81
|
|
|
REF LNR 22*70-76 20 DEG SZ K
|
Facility
|
OP
|
$5,573.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.57 |
| Max. Negotiated Rate |
$5,350.70 |
| Rate for Payer: Aetna Commercial |
$4,291.71
|
| Rate for Payer: Anthem Medicaid |
$1,916.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,347.45
|
| Rate for Payer: Cash Price |
$2,786.82
|
| Rate for Payer: Cigna Commercial |
$4,626.13
|
| Rate for Payer: First Health Commercial |
$5,294.97
|
| Rate for Payer: Humana Commercial |
$4,737.60
|
| Rate for Payer: Humana KY Medicaid |
$1,916.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,936.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,570.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,113.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,672.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,955.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,904.81
|
| Rate for Payer: Ohio Health Group HMO |
$4,180.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,114.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$724.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,727.83
|
| Rate for Payer: PHCS Commercial |
$5,350.70
|
| Rate for Payer: United Healthcare All Payer |
$4,904.81
|
|
|
REF LNR 22ID 0 DEG SZ B
|
Facility
|
IP
|
$5,267.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$684.74 |
| Max. Negotiated Rate |
$5,056.54 |
| Rate for Payer: Aetna Commercial |
$4,055.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,108.44
|
| Rate for Payer: Cash Price |
$2,633.61
|
| Rate for Payer: Cigna Commercial |
$4,371.80
|
| Rate for Payer: First Health Commercial |
$5,003.87
|
| Rate for Payer: Humana Commercial |
$4,477.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,319.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,887.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,580.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,635.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,950.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,053.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$684.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,632.84
|
| Rate for Payer: PHCS Commercial |
$5,056.54
|
| Rate for Payer: United Healthcare All Payer |
$4,635.16
|
|
|
REF LNR 22ID 0 DEG SZ B
|
Facility
|
OP
|
$5,267.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$684.74 |
| Max. Negotiated Rate |
$5,056.54 |
| Rate for Payer: Aetna Commercial |
$4,055.77
|
| Rate for Payer: Anthem Medicaid |
$1,811.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,108.44
|
| Rate for Payer: Cash Price |
$2,633.61
|
| Rate for Payer: Cigna Commercial |
$4,371.80
|
| Rate for Payer: First Health Commercial |
$5,003.87
|
| Rate for Payer: Humana Commercial |
$4,477.15
|
| Rate for Payer: Humana KY Medicaid |
$1,811.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,829.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,319.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,887.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,580.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,847.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,635.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,950.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,053.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$684.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,632.84
|
| Rate for Payer: PHCS Commercial |
$5,056.54
|
| Rate for Payer: United Healthcare All Payer |
$4,635.16
|
|
|
REF LNR 22ID 0 DEG SZ C
|
Facility
|
OP
|
$5,267.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$684.74 |
| Max. Negotiated Rate |
$5,056.54 |
| Rate for Payer: Aetna Commercial |
$4,055.77
|
| Rate for Payer: Anthem Medicaid |
$1,811.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,108.44
|
| Rate for Payer: Cash Price |
$2,633.61
|
| Rate for Payer: Cigna Commercial |
$4,371.80
|
| Rate for Payer: First Health Commercial |
$5,003.87
|
| Rate for Payer: Humana Commercial |
$4,477.15
|
| Rate for Payer: Humana KY Medicaid |
$1,811.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,829.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,319.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,887.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,580.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,847.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,635.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,950.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,053.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$684.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,632.84
|
| Rate for Payer: PHCS Commercial |
$5,056.54
|
| Rate for Payer: United Healthcare All Payer |
$4,635.16
|
|
|
REF LNR 22ID 0 DEG SZ C
|
Facility
|
IP
|
$5,267.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$684.74 |
| Max. Negotiated Rate |
$5,056.54 |
| Rate for Payer: Aetna Commercial |
$4,055.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,108.44
|
| Rate for Payer: Cash Price |
$2,633.61
|
| Rate for Payer: Cigna Commercial |
$4,371.80
|
| Rate for Payer: First Health Commercial |
$5,003.87
|
| Rate for Payer: Humana Commercial |
$4,477.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,319.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,887.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,580.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,635.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,950.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,053.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$684.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,632.84
|
| Rate for Payer: PHCS Commercial |
$5,056.54
|
| Rate for Payer: United Healthcare All Payer |
$4,635.16
|
|
|
REF LNR 22ID 0 DEG SZ D
|
Facility
|
OP
|
$5,267.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$684.74 |
| Max. Negotiated Rate |
$5,056.54 |
| Rate for Payer: Aetna Commercial |
$4,055.77
|
| Rate for Payer: Anthem Medicaid |
$1,811.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,108.44
|
| Rate for Payer: Cash Price |
$2,633.61
|
| Rate for Payer: Cigna Commercial |
$4,371.80
|
| Rate for Payer: First Health Commercial |
$5,003.87
|
| Rate for Payer: Humana Commercial |
$4,477.15
|
| Rate for Payer: Humana KY Medicaid |
$1,811.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,829.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,319.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,887.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,580.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,847.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,635.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,950.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,053.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$684.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,632.84
|
| Rate for Payer: PHCS Commercial |
$5,056.54
|
| Rate for Payer: United Healthcare All Payer |
$4,635.16
|
|
|
REF LNR 22ID 0 DEG SZ D
|
Facility
|
IP
|
$5,267.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$684.74 |
| Max. Negotiated Rate |
$5,056.54 |
| Rate for Payer: Aetna Commercial |
$4,055.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,108.44
|
| Rate for Payer: Cash Price |
$2,633.61
|
| Rate for Payer: Cigna Commercial |
$4,371.80
|
| Rate for Payer: First Health Commercial |
$5,003.87
|
| Rate for Payer: Humana Commercial |
$4,477.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,319.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,887.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,580.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,635.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,950.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,053.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$684.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,632.84
|
| Rate for Payer: PHCS Commercial |
$5,056.54
|
| Rate for Payer: United Healthcare All Payer |
$4,635.16
|
|
|
REF LNR 22ID 0 DEG SZ E
|
Facility
|
OP
|
$5,267.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$684.74 |
| Max. Negotiated Rate |
$5,056.54 |
| Rate for Payer: Aetna Commercial |
$4,055.77
|
| Rate for Payer: Anthem Medicaid |
$1,811.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,108.44
|
| Rate for Payer: Cash Price |
$2,633.61
|
| Rate for Payer: Cigna Commercial |
$4,371.80
|
| Rate for Payer: First Health Commercial |
$5,003.87
|
| Rate for Payer: Humana Commercial |
$4,477.15
|
| Rate for Payer: Humana KY Medicaid |
$1,811.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,829.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,319.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,887.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,580.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,847.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,635.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,950.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,053.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$684.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,632.84
|
| Rate for Payer: PHCS Commercial |
$5,056.54
|
| Rate for Payer: United Healthcare All Payer |
$4,635.16
|
|
|
REF LNR 22ID 0 DEG SZ E
|
Facility
|
IP
|
$5,267.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$684.74 |
| Max. Negotiated Rate |
$5,056.54 |
| Rate for Payer: Aetna Commercial |
$4,055.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,108.44
|
| Rate for Payer: Cash Price |
$2,633.61
|
| Rate for Payer: Cigna Commercial |
$4,371.80
|
| Rate for Payer: First Health Commercial |
$5,003.87
|
| Rate for Payer: Humana Commercial |
$4,477.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,319.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,887.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,580.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,635.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,950.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,053.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$684.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,632.84
|
| Rate for Payer: PHCS Commercial |
$5,056.54
|
| Rate for Payer: United Healthcare All Payer |
$4,635.16
|
|
|
REF LNR 22ID 0 DEG SZ F
|
Facility
|
OP
|
$5,267.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$684.74 |
| Max. Negotiated Rate |
$5,056.54 |
| Rate for Payer: Aetna Commercial |
$4,055.77
|
| Rate for Payer: Anthem Medicaid |
$1,811.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,108.44
|
| Rate for Payer: Cash Price |
$2,633.61
|
| Rate for Payer: Cigna Commercial |
$4,371.80
|
| Rate for Payer: First Health Commercial |
$5,003.87
|
| Rate for Payer: Humana Commercial |
$4,477.15
|
| Rate for Payer: Humana KY Medicaid |
$1,811.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,829.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,319.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,887.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,580.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,847.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,635.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,950.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,053.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$684.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,632.84
|
| Rate for Payer: PHCS Commercial |
$5,056.54
|
| Rate for Payer: United Healthcare All Payer |
$4,635.16
|
|
|
REF LNR 22ID 0 DEG SZ F
|
Facility
|
IP
|
$5,267.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$684.74 |
| Max. Negotiated Rate |
$5,056.54 |
| Rate for Payer: Aetna Commercial |
$4,055.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,108.44
|
| Rate for Payer: Cash Price |
$2,633.61
|
| Rate for Payer: Cigna Commercial |
$4,371.80
|
| Rate for Payer: First Health Commercial |
$5,003.87
|
| Rate for Payer: Humana Commercial |
$4,477.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,319.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,887.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,580.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,635.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,950.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,053.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$684.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,632.84
|
| Rate for Payer: PHCS Commercial |
$5,056.54
|
| Rate for Payer: United Healthcare All Payer |
$4,635.16
|
|
|
REF LNR 22ID 0 DEG SZ G
|
Facility
|
OP
|
$5,267.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$684.74 |
| Max. Negotiated Rate |
$5,056.54 |
| Rate for Payer: Aetna Commercial |
$4,055.77
|
| Rate for Payer: Anthem Medicaid |
$1,811.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,108.44
|
| Rate for Payer: Cash Price |
$2,633.61
|
| Rate for Payer: Cigna Commercial |
$4,371.80
|
| Rate for Payer: First Health Commercial |
$5,003.87
|
| Rate for Payer: Humana Commercial |
$4,477.15
|
| Rate for Payer: Humana KY Medicaid |
$1,811.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,829.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,319.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,887.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,580.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,847.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,635.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,950.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,053.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$684.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,632.84
|
| Rate for Payer: PHCS Commercial |
$5,056.54
|
| Rate for Payer: United Healthcare All Payer |
$4,635.16
|
|
|
REF LNR 22ID 0 DEG SZ G
|
Facility
|
IP
|
$5,267.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$684.74 |
| Max. Negotiated Rate |
$5,056.54 |
| Rate for Payer: Aetna Commercial |
$4,055.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,108.44
|
| Rate for Payer: Cash Price |
$2,633.61
|
| Rate for Payer: Cigna Commercial |
$4,371.80
|
| Rate for Payer: First Health Commercial |
$5,003.87
|
| Rate for Payer: Humana Commercial |
$4,477.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,319.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,887.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,580.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,635.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,950.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,053.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$684.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,632.84
|
| Rate for Payer: PHCS Commercial |
$5,056.54
|
| Rate for Payer: United Healthcare All Payer |
$4,635.16
|
|
|
REF LNR 22ID 0 DEG SZ H
|
Facility
|
OP
|
$5,267.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$684.74 |
| Max. Negotiated Rate |
$5,056.54 |
| Rate for Payer: Aetna Commercial |
$4,055.77
|
| Rate for Payer: Anthem Medicaid |
$1,811.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,108.44
|
| Rate for Payer: Cash Price |
$2,633.61
|
| Rate for Payer: Cigna Commercial |
$4,371.80
|
| Rate for Payer: First Health Commercial |
$5,003.87
|
| Rate for Payer: Humana Commercial |
$4,477.15
|
| Rate for Payer: Humana KY Medicaid |
$1,811.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,829.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,319.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,887.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,580.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,847.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,635.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,950.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,053.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$684.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,632.84
|
| Rate for Payer: PHCS Commercial |
$5,056.54
|
| Rate for Payer: United Healthcare All Payer |
$4,635.16
|
|
|
REF LNR 22ID 0 DEG SZ H
|
Facility
|
IP
|
$5,267.23
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$684.74 |
| Max. Negotiated Rate |
$5,056.54 |
| Rate for Payer: Aetna Commercial |
$4,055.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,108.44
|
| Rate for Payer: Cash Price |
$2,633.61
|
| Rate for Payer: Cigna Commercial |
$4,371.80
|
| Rate for Payer: First Health Commercial |
$5,003.87
|
| Rate for Payer: Humana Commercial |
$4,477.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,319.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,887.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,580.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,635.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,950.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,053.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$684.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,632.84
|
| Rate for Payer: PHCS Commercial |
$5,056.54
|
| Rate for Payer: United Healthcare All Payer |
$4,635.16
|
|
