|
REF LNR 26 ID 0 DEG SZ D
|
Facility
|
OP
|
$4,913.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.72 |
| Max. Negotiated Rate |
$4,716.67 |
| Rate for Payer: Aetna Commercial |
$3,783.16
|
| Rate for Payer: Anthem Medicaid |
$1,689.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,832.30
|
| Rate for Payer: Cash Price |
$2,456.60
|
| Rate for Payer: Cigna Commercial |
$4,077.96
|
| Rate for Payer: First Health Commercial |
$4,667.54
|
| Rate for Payer: Humana Commercial |
$4,176.22
|
| Rate for Payer: Humana KY Medicaid |
$1,689.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.09
|
| Rate for Payer: PHCS Commercial |
$4,716.67
|
| Rate for Payer: United Healthcare All Payer |
$4,323.62
|
|
|
REF LNR 26 ID 0 DEG SZ E
|
Facility
|
IP
|
$4,913.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.72 |
| Max. Negotiated Rate |
$4,716.67 |
| Rate for Payer: Aetna Commercial |
$3,783.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,832.30
|
| Rate for Payer: Cash Price |
$2,456.60
|
| Rate for Payer: Cigna Commercial |
$4,077.96
|
| Rate for Payer: First Health Commercial |
$4,667.54
|
| Rate for Payer: Humana Commercial |
$4,176.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.09
|
| Rate for Payer: PHCS Commercial |
$4,716.67
|
| Rate for Payer: United Healthcare All Payer |
$4,323.62
|
|
|
REF LNR 26 ID 0 DEG SZ E
|
Facility
|
OP
|
$4,913.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.72 |
| Max. Negotiated Rate |
$4,716.67 |
| Rate for Payer: Aetna Commercial |
$3,783.16
|
| Rate for Payer: Anthem Medicaid |
$1,689.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,832.30
|
| Rate for Payer: Cash Price |
$2,456.60
|
| Rate for Payer: Cigna Commercial |
$4,077.96
|
| Rate for Payer: First Health Commercial |
$4,667.54
|
| Rate for Payer: Humana Commercial |
$4,176.22
|
| Rate for Payer: Humana KY Medicaid |
$1,689.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.09
|
| Rate for Payer: PHCS Commercial |
$4,716.67
|
| Rate for Payer: United Healthcare All Payer |
$4,323.62
|
|
|
REF LNR 26 ID 0 DEG SZ F
|
Facility
|
IP
|
$4,913.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.72 |
| Max. Negotiated Rate |
$4,716.67 |
| Rate for Payer: Aetna Commercial |
$3,783.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,832.30
|
| Rate for Payer: Cash Price |
$2,456.60
|
| Rate for Payer: Cigna Commercial |
$4,077.96
|
| Rate for Payer: First Health Commercial |
$4,667.54
|
| Rate for Payer: Humana Commercial |
$4,176.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.09
|
| Rate for Payer: PHCS Commercial |
$4,716.67
|
| Rate for Payer: United Healthcare All Payer |
$4,323.62
|
|
|
REF LNR 26 ID 0 DEG SZ F
|
Facility
|
OP
|
$4,913.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.72 |
| Max. Negotiated Rate |
$4,716.67 |
| Rate for Payer: Aetna Commercial |
$3,783.16
|
| Rate for Payer: Anthem Medicaid |
$1,689.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,832.30
|
| Rate for Payer: Cash Price |
$2,456.60
|
| Rate for Payer: Cigna Commercial |
$4,077.96
|
| Rate for Payer: First Health Commercial |
$4,667.54
|
| Rate for Payer: Humana Commercial |
$4,176.22
|
| Rate for Payer: Humana KY Medicaid |
$1,689.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.09
|
| Rate for Payer: PHCS Commercial |
$4,716.67
|
| Rate for Payer: United Healthcare All Payer |
$4,323.62
|
|
|
REF LNR 26 ID 0 DEG SZ G
|
Facility
|
IP
|
$4,913.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.72 |
| Max. Negotiated Rate |
$4,716.67 |
| Rate for Payer: Aetna Commercial |
$3,783.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,832.30
|
| Rate for Payer: Cash Price |
$2,456.60
|
| Rate for Payer: Cigna Commercial |
$4,077.96
|
| Rate for Payer: First Health Commercial |
$4,667.54
|
| Rate for Payer: Humana Commercial |
$4,176.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.09
|
| Rate for Payer: PHCS Commercial |
$4,716.67
|
| Rate for Payer: United Healthcare All Payer |
$4,323.62
|
|
|
REF LNR 26 ID 0 DEG SZ G
|
Facility
|
OP
|
$4,913.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.72 |
| Max. Negotiated Rate |
$4,716.67 |
| Rate for Payer: Aetna Commercial |
$3,783.16
|
| Rate for Payer: Anthem Medicaid |
$1,689.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,832.30
|
| Rate for Payer: Cash Price |
$2,456.60
|
| Rate for Payer: Cigna Commercial |
$4,077.96
|
| Rate for Payer: First Health Commercial |
$4,667.54
|
| Rate for Payer: Humana Commercial |
$4,176.22
|
| Rate for Payer: Humana KY Medicaid |
$1,689.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.09
|
| Rate for Payer: PHCS Commercial |
$4,716.67
|
| Rate for Payer: United Healthcare All Payer |
$4,323.62
|
|
|
REF LNR 26 ID 0 DEG SZ H
|
Facility
|
IP
|
$4,913.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.72 |
| Max. Negotiated Rate |
$4,716.67 |
| Rate for Payer: Aetna Commercial |
$3,783.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,832.30
|
| Rate for Payer: Cash Price |
$2,456.60
|
| Rate for Payer: Cigna Commercial |
$4,077.96
|
| Rate for Payer: First Health Commercial |
$4,667.54
|
| Rate for Payer: Humana Commercial |
$4,176.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.09
|
| Rate for Payer: PHCS Commercial |
$4,716.67
|
| Rate for Payer: United Healthcare All Payer |
$4,323.62
|
|
|
REF LNR 26 ID 0 DEG SZ H
|
Facility
|
OP
|
$4,913.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.72 |
| Max. Negotiated Rate |
$4,716.67 |
| Rate for Payer: Aetna Commercial |
$3,783.16
|
| Rate for Payer: Anthem Medicaid |
$1,689.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,832.30
|
| Rate for Payer: Cash Price |
$2,456.60
|
| Rate for Payer: Cigna Commercial |
$4,077.96
|
| Rate for Payer: First Health Commercial |
$4,667.54
|
| Rate for Payer: Humana Commercial |
$4,176.22
|
| Rate for Payer: Humana KY Medicaid |
$1,689.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.09
|
| Rate for Payer: PHCS Commercial |
$4,716.67
|
| Rate for Payer: United Healthcare All Payer |
$4,323.62
|
|
|
REF LNR 26 ID 0 DEG SZ J
|
Facility
|
IP
|
$4,913.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.72 |
| Max. Negotiated Rate |
$4,716.67 |
| Rate for Payer: Aetna Commercial |
$3,783.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,832.30
|
| Rate for Payer: Cash Price |
$2,456.60
|
| Rate for Payer: Cigna Commercial |
$4,077.96
|
| Rate for Payer: First Health Commercial |
$4,667.54
|
| Rate for Payer: Humana Commercial |
$4,176.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.09
|
| Rate for Payer: PHCS Commercial |
$4,716.67
|
| Rate for Payer: United Healthcare All Payer |
$4,323.62
|
|
|
REF LNR 26 ID 0 DEG SZ J
|
Facility
|
OP
|
$4,913.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.72 |
| Max. Negotiated Rate |
$4,716.67 |
| Rate for Payer: Aetna Commercial |
$3,783.16
|
| Rate for Payer: Anthem Medicaid |
$1,689.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,832.30
|
| Rate for Payer: Cash Price |
$2,456.60
|
| Rate for Payer: Cigna Commercial |
$4,077.96
|
| Rate for Payer: First Health Commercial |
$4,667.54
|
| Rate for Payer: Humana Commercial |
$4,176.22
|
| Rate for Payer: Humana KY Medicaid |
$1,689.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.09
|
| Rate for Payer: PHCS Commercial |
$4,716.67
|
| Rate for Payer: United Healthcare All Payer |
$4,323.62
|
|
|
REF LNR 26 ID 0 DEG SZ K
|
Facility
|
IP
|
$4,913.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.72 |
| Max. Negotiated Rate |
$4,716.67 |
| Rate for Payer: Aetna Commercial |
$3,783.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,832.30
|
| Rate for Payer: Cash Price |
$2,456.60
|
| Rate for Payer: Cigna Commercial |
$4,077.96
|
| Rate for Payer: First Health Commercial |
$4,667.54
|
| Rate for Payer: Humana Commercial |
$4,176.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.09
|
| Rate for Payer: PHCS Commercial |
$4,716.67
|
| Rate for Payer: United Healthcare All Payer |
$4,323.62
|
|
|
REF LNR 26 ID 0 DEG SZ K
|
Facility
|
OP
|
$4,913.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.72 |
| Max. Negotiated Rate |
$4,716.67 |
| Rate for Payer: Aetna Commercial |
$3,783.16
|
| Rate for Payer: Anthem Medicaid |
$1,689.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,832.30
|
| Rate for Payer: Cash Price |
$2,456.60
|
| Rate for Payer: Cigna Commercial |
$4,077.96
|
| Rate for Payer: First Health Commercial |
$4,667.54
|
| Rate for Payer: Humana Commercial |
$4,176.22
|
| Rate for Payer: Humana KY Medicaid |
$1,689.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.09
|
| Rate for Payer: PHCS Commercial |
$4,716.67
|
| Rate for Payer: United Healthcare All Payer |
$4,323.62
|
|
|
REF LNR 28*46-48 0 DEG SZ D
|
Facility
|
OP
|
$4,913.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.72 |
| Max. Negotiated Rate |
$4,716.67 |
| Rate for Payer: Aetna Commercial |
$3,783.16
|
| Rate for Payer: Anthem Medicaid |
$1,689.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,832.30
|
| Rate for Payer: Cash Price |
$2,456.60
|
| Rate for Payer: Cigna Commercial |
$4,077.96
|
| Rate for Payer: First Health Commercial |
$4,667.54
|
| Rate for Payer: Humana Commercial |
$4,176.22
|
| Rate for Payer: Humana KY Medicaid |
$1,689.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.09
|
| Rate for Payer: PHCS Commercial |
$4,716.67
|
| Rate for Payer: United Healthcare All Payer |
$4,323.62
|
|
|
REF LNR 28*46-48 0 DEG SZ D
|
Facility
|
IP
|
$4,913.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.72 |
| Max. Negotiated Rate |
$4,716.67 |
| Rate for Payer: Aetna Commercial |
$3,783.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,832.30
|
| Rate for Payer: Cash Price |
$2,456.60
|
| Rate for Payer: Cigna Commercial |
$4,077.96
|
| Rate for Payer: First Health Commercial |
$4,667.54
|
| Rate for Payer: Humana Commercial |
$4,176.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.09
|
| Rate for Payer: PHCS Commercial |
$4,716.67
|
| Rate for Payer: United Healthcare All Payer |
$4,323.62
|
|
|
REF LNR 28*50-52 0 DEG SZ E
|
Facility
|
OP
|
$4,913.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.72 |
| Max. Negotiated Rate |
$4,716.67 |
| Rate for Payer: Aetna Commercial |
$3,783.16
|
| Rate for Payer: Anthem Medicaid |
$1,689.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,832.30
|
| Rate for Payer: Cash Price |
$2,456.60
|
| Rate for Payer: Cigna Commercial |
$4,077.96
|
| Rate for Payer: First Health Commercial |
$4,667.54
|
| Rate for Payer: Humana Commercial |
$4,176.22
|
| Rate for Payer: Humana KY Medicaid |
$1,689.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.09
|
| Rate for Payer: PHCS Commercial |
$4,716.67
|
| Rate for Payer: United Healthcare All Payer |
$4,323.62
|
|
|
REF LNR 28*50-52 0 DEG SZ E
|
Facility
|
IP
|
$4,913.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.72 |
| Max. Negotiated Rate |
$4,716.67 |
| Rate for Payer: Aetna Commercial |
$3,783.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,832.30
|
| Rate for Payer: Cash Price |
$2,456.60
|
| Rate for Payer: Cigna Commercial |
$4,077.96
|
| Rate for Payer: First Health Commercial |
$4,667.54
|
| Rate for Payer: Humana Commercial |
$4,176.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.09
|
| Rate for Payer: PHCS Commercial |
$4,716.67
|
| Rate for Payer: United Healthcare All Payer |
$4,323.62
|
|
|
REF LNR 28*54-56 0 DEG SZ F
|
Facility
|
IP
|
$4,913.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.72 |
| Max. Negotiated Rate |
$4,716.67 |
| Rate for Payer: Aetna Commercial |
$3,783.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,832.30
|
| Rate for Payer: Cash Price |
$2,456.60
|
| Rate for Payer: Cigna Commercial |
$4,077.96
|
| Rate for Payer: First Health Commercial |
$4,667.54
|
| Rate for Payer: Humana Commercial |
$4,176.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.09
|
| Rate for Payer: PHCS Commercial |
$4,716.67
|
| Rate for Payer: United Healthcare All Payer |
$4,323.62
|
|
|
REF LNR 28*54-56 0 DEG SZ F
|
Facility
|
OP
|
$4,913.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.72 |
| Max. Negotiated Rate |
$4,716.67 |
| Rate for Payer: Aetna Commercial |
$3,783.16
|
| Rate for Payer: Anthem Medicaid |
$1,689.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,832.30
|
| Rate for Payer: Cash Price |
$2,456.60
|
| Rate for Payer: Cigna Commercial |
$4,077.96
|
| Rate for Payer: First Health Commercial |
$4,667.54
|
| Rate for Payer: Humana Commercial |
$4,176.22
|
| Rate for Payer: Humana KY Medicaid |
$1,689.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.09
|
| Rate for Payer: PHCS Commercial |
$4,716.67
|
| Rate for Payer: United Healthcare All Payer |
$4,323.62
|
|
|
REF LNR 28*58-60 0 DEG SZ G
|
Facility
|
IP
|
$4,913.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.72 |
| Max. Negotiated Rate |
$4,716.67 |
| Rate for Payer: Aetna Commercial |
$3,783.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,832.30
|
| Rate for Payer: Cash Price |
$2,456.60
|
| Rate for Payer: Cigna Commercial |
$4,077.96
|
| Rate for Payer: First Health Commercial |
$4,667.54
|
| Rate for Payer: Humana Commercial |
$4,176.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.09
|
| Rate for Payer: PHCS Commercial |
$4,716.67
|
| Rate for Payer: United Healthcare All Payer |
$4,323.62
|
|
|
REF LNR 28*58-60 0 DEG SZ G
|
Facility
|
OP
|
$4,913.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.72 |
| Max. Negotiated Rate |
$4,716.67 |
| Rate for Payer: Aetna Commercial |
$3,783.16
|
| Rate for Payer: Anthem Medicaid |
$1,689.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,832.30
|
| Rate for Payer: Cash Price |
$2,456.60
|
| Rate for Payer: Cigna Commercial |
$4,077.96
|
| Rate for Payer: First Health Commercial |
$4,667.54
|
| Rate for Payer: Humana Commercial |
$4,176.22
|
| Rate for Payer: Humana KY Medicaid |
$1,689.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.09
|
| Rate for Payer: PHCS Commercial |
$4,716.67
|
| Rate for Payer: United Healthcare All Payer |
$4,323.62
|
|
|
REF LNR 28*62-64 0 DEG SZ H
|
Facility
|
IP
|
$4,913.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.72 |
| Max. Negotiated Rate |
$4,716.67 |
| Rate for Payer: Aetna Commercial |
$3,783.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,832.30
|
| Rate for Payer: Cash Price |
$2,456.60
|
| Rate for Payer: Cigna Commercial |
$4,077.96
|
| Rate for Payer: First Health Commercial |
$4,667.54
|
| Rate for Payer: Humana Commercial |
$4,176.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.09
|
| Rate for Payer: PHCS Commercial |
$4,716.67
|
| Rate for Payer: United Healthcare All Payer |
$4,323.62
|
|
|
REF LNR 28*62-64 0 DEG SZ H
|
Facility
|
OP
|
$4,913.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.72 |
| Max. Negotiated Rate |
$4,716.67 |
| Rate for Payer: Aetna Commercial |
$3,783.16
|
| Rate for Payer: Anthem Medicaid |
$1,689.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,832.30
|
| Rate for Payer: Cash Price |
$2,456.60
|
| Rate for Payer: Cigna Commercial |
$4,077.96
|
| Rate for Payer: First Health Commercial |
$4,667.54
|
| Rate for Payer: Humana Commercial |
$4,176.22
|
| Rate for Payer: Humana KY Medicaid |
$1,689.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.09
|
| Rate for Payer: PHCS Commercial |
$4,716.67
|
| Rate for Payer: United Healthcare All Payer |
$4,323.62
|
|
|
REF LNR 28*66-68 0 DEG SZ J
|
Facility
|
IP
|
$4,913.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.72 |
| Max. Negotiated Rate |
$4,716.67 |
| Rate for Payer: Aetna Commercial |
$3,783.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,832.30
|
| Rate for Payer: Cash Price |
$2,456.60
|
| Rate for Payer: Cigna Commercial |
$4,077.96
|
| Rate for Payer: First Health Commercial |
$4,667.54
|
| Rate for Payer: Humana Commercial |
$4,176.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.09
|
| Rate for Payer: PHCS Commercial |
$4,716.67
|
| Rate for Payer: United Healthcare All Payer |
$4,323.62
|
|
|
REF LNR 28*66-68 0 DEG SZ J
|
Facility
|
OP
|
$4,913.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.72 |
| Max. Negotiated Rate |
$4,716.67 |
| Rate for Payer: Aetna Commercial |
$3,783.16
|
| Rate for Payer: Anthem Medicaid |
$1,689.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,832.30
|
| Rate for Payer: Cash Price |
$2,456.60
|
| Rate for Payer: Cigna Commercial |
$4,077.96
|
| Rate for Payer: First Health Commercial |
$4,667.54
|
| Rate for Payer: Humana Commercial |
$4,176.22
|
| Rate for Payer: Humana KY Medicaid |
$1,689.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.09
|
| Rate for Payer: PHCS Commercial |
$4,716.67
|
| Rate for Payer: United Healthcare All Payer |
$4,323.62
|
|
