|
REF LNR 28*70-76 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 28*70-76 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 28ID 20 DEG SZ D
|
Facility
|
IP
|
$5,112.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$664.63 |
| Max. Negotiated Rate |
$4,908.02 |
| Rate for Payer: Aetna Commercial |
$3,936.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,987.77
|
| Rate for Payer: Cash Price |
$2,556.26
|
| Rate for Payer: Cigna Commercial |
$4,243.39
|
| Rate for Payer: First Health Commercial |
$4,856.89
|
| Rate for Payer: Humana Commercial |
$4,345.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,192.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,773.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,533.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,499.02
|
| Rate for Payer: Ohio Health Group HMO |
$3,834.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,022.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$664.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,584.88
|
| Rate for Payer: PHCS Commercial |
$4,908.02
|
| Rate for Payer: United Healthcare All Payer |
$4,499.02
|
|
|
REF LNR 28ID 20 DEG SZ D
|
Facility
|
OP
|
$5,112.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$664.63 |
| Max. Negotiated Rate |
$4,908.02 |
| Rate for Payer: Aetna Commercial |
$3,936.64
|
| Rate for Payer: Anthem Medicaid |
$1,758.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,987.77
|
| Rate for Payer: Cash Price |
$2,556.26
|
| Rate for Payer: Cigna Commercial |
$4,243.39
|
| Rate for Payer: First Health Commercial |
$4,856.89
|
| Rate for Payer: Humana Commercial |
$4,345.64
|
| Rate for Payer: Humana KY Medicaid |
$1,758.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,776.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,192.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,773.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,533.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,793.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,499.02
|
| Rate for Payer: Ohio Health Group HMO |
$3,834.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,022.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$664.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,584.88
|
| Rate for Payer: PHCS Commercial |
$4,908.02
|
| Rate for Payer: United Healthcare All Payer |
$4,499.02
|
|
|
REF LNR 28ID 50-52OD 20 DEGSZE
|
Facility
|
IP
|
$5,112.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$664.63 |
| Max. Negotiated Rate |
$4,908.02 |
| Rate for Payer: Aetna Commercial |
$3,936.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,987.77
|
| Rate for Payer: Cash Price |
$2,556.26
|
| Rate for Payer: Cigna Commercial |
$4,243.39
|
| Rate for Payer: First Health Commercial |
$4,856.89
|
| Rate for Payer: Humana Commercial |
$4,345.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,192.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,773.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,533.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,499.02
|
| Rate for Payer: Ohio Health Group HMO |
$3,834.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,022.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$664.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,584.88
|
| Rate for Payer: PHCS Commercial |
$4,908.02
|
| Rate for Payer: United Healthcare All Payer |
$4,499.02
|
|
|
REF LNR 28ID 50-52OD 20 DEGSZE
|
Facility
|
OP
|
$5,112.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$664.63 |
| Max. Negotiated Rate |
$4,908.02 |
| Rate for Payer: Aetna Commercial |
$3,936.64
|
| Rate for Payer: Anthem Medicaid |
$1,758.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,987.77
|
| Rate for Payer: Cash Price |
$2,556.26
|
| Rate for Payer: Cigna Commercial |
$4,243.39
|
| Rate for Payer: First Health Commercial |
$4,856.89
|
| Rate for Payer: Humana Commercial |
$4,345.64
|
| Rate for Payer: Humana KY Medicaid |
$1,758.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,776.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,192.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,773.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,533.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,793.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,499.02
|
| Rate for Payer: Ohio Health Group HMO |
$3,834.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,022.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$664.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,584.88
|
| Rate for Payer: PHCS Commercial |
$4,908.02
|
| Rate for Payer: United Healthcare All Payer |
$4,499.02
|
|
|
REF LNR 28ID 54-56OD 20 DEGSZF
|
Facility
|
IP
|
$5,112.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$664.63 |
| Max. Negotiated Rate |
$4,908.02 |
| Rate for Payer: Aetna Commercial |
$3,936.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,987.77
|
| Rate for Payer: Cash Price |
$2,556.26
|
| Rate for Payer: Cigna Commercial |
$4,243.39
|
| Rate for Payer: First Health Commercial |
$4,856.89
|
| Rate for Payer: Humana Commercial |
$4,345.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,192.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,773.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,533.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,499.02
|
| Rate for Payer: Ohio Health Group HMO |
$3,834.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,022.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$664.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,584.88
|
| Rate for Payer: PHCS Commercial |
$4,908.02
|
| Rate for Payer: United Healthcare All Payer |
$4,499.02
|
|
|
REF LNR 28ID 54-56OD 20 DEGSZF
|
Facility
|
OP
|
$5,112.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$664.63 |
| Max. Negotiated Rate |
$4,908.02 |
| Rate for Payer: Aetna Commercial |
$3,936.64
|
| Rate for Payer: Anthem Medicaid |
$1,758.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,987.77
|
| Rate for Payer: Cash Price |
$2,556.26
|
| Rate for Payer: Cigna Commercial |
$4,243.39
|
| Rate for Payer: First Health Commercial |
$4,856.89
|
| Rate for Payer: Humana Commercial |
$4,345.64
|
| Rate for Payer: Humana KY Medicaid |
$1,758.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,776.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,192.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,773.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,533.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,793.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,499.02
|
| Rate for Payer: Ohio Health Group HMO |
$3,834.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,022.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$664.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,584.88
|
| Rate for Payer: PHCS Commercial |
$4,908.02
|
| Rate for Payer: United Healthcare All Payer |
$4,499.02
|
|
|
REF LNR 28ID 58-60OD 20 DEGSZG
|
Facility
|
IP
|
$5,112.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$664.63 |
| Max. Negotiated Rate |
$4,908.02 |
| Rate for Payer: Aetna Commercial |
$3,936.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,987.77
|
| Rate for Payer: Cash Price |
$2,556.26
|
| Rate for Payer: Cigna Commercial |
$4,243.39
|
| Rate for Payer: First Health Commercial |
$4,856.89
|
| Rate for Payer: Humana Commercial |
$4,345.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,192.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,773.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,533.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,499.02
|
| Rate for Payer: Ohio Health Group HMO |
$3,834.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,022.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$664.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,584.88
|
| Rate for Payer: PHCS Commercial |
$4,908.02
|
| Rate for Payer: United Healthcare All Payer |
$4,499.02
|
|
|
REF LNR 28ID 58-60OD 20 DEGSZG
|
Facility
|
OP
|
$5,112.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$664.63 |
| Max. Negotiated Rate |
$4,908.02 |
| Rate for Payer: Aetna Commercial |
$3,936.64
|
| Rate for Payer: Anthem Medicaid |
$1,758.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,987.77
|
| Rate for Payer: Cash Price |
$2,556.26
|
| Rate for Payer: Cigna Commercial |
$4,243.39
|
| Rate for Payer: First Health Commercial |
$4,856.89
|
| Rate for Payer: Humana Commercial |
$4,345.64
|
| Rate for Payer: Humana KY Medicaid |
$1,758.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,776.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,192.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,773.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,533.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,793.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,499.02
|
| Rate for Payer: Ohio Health Group HMO |
$3,834.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,022.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$664.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,584.88
|
| Rate for Payer: PHCS Commercial |
$4,908.02
|
| Rate for Payer: United Healthcare All Payer |
$4,499.02
|
|
|
REF LNR 28ID 62-64OD 20 DEGSZH
|
Facility
|
IP
|
$5,112.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$664.63 |
| Max. Negotiated Rate |
$4,908.02 |
| Rate for Payer: Aetna Commercial |
$3,936.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,987.77
|
| Rate for Payer: Cash Price |
$2,556.26
|
| Rate for Payer: Cigna Commercial |
$4,243.39
|
| Rate for Payer: First Health Commercial |
$4,856.89
|
| Rate for Payer: Humana Commercial |
$4,345.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,192.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,773.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,533.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,499.02
|
| Rate for Payer: Ohio Health Group HMO |
$3,834.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,022.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$664.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,584.88
|
| Rate for Payer: PHCS Commercial |
$4,908.02
|
| Rate for Payer: United Healthcare All Payer |
$4,499.02
|
|
|
REF LNR 28ID 62-64OD 20 DEGSZH
|
Facility
|
OP
|
$5,112.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$664.63 |
| Max. Negotiated Rate |
$4,908.02 |
| Rate for Payer: Aetna Commercial |
$3,936.64
|
| Rate for Payer: Anthem Medicaid |
$1,758.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,987.77
|
| Rate for Payer: Cash Price |
$2,556.26
|
| Rate for Payer: Cigna Commercial |
$4,243.39
|
| Rate for Payer: First Health Commercial |
$4,856.89
|
| Rate for Payer: Humana Commercial |
$4,345.64
|
| Rate for Payer: Humana KY Medicaid |
$1,758.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,776.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,192.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,773.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,533.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,793.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,499.02
|
| Rate for Payer: Ohio Health Group HMO |
$3,834.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,022.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$664.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,584.88
|
| Rate for Payer: PHCS Commercial |
$4,908.02
|
| Rate for Payer: United Healthcare All Payer |
$4,499.02
|
|
|
REF LNR 28ID 66-68OD 20 DEGSZJ
|
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 28ID 66-68OD 20 DEGSZJ
|
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 28ID 70-76OD 20 DEGSZK
|
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 28ID 70-76OD 20 DEGSZK
|
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 32ID 50-52OD 20 DEGSZE
|
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 32ID 50-52OD 20 DEGSZE
|
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 32ID 54-56OD 20 DEGSZF
|
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 32ID 54-56OD 20 DEGSZF
|
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 32ID 58-60OD 20 DEGSZG
|
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 32ID 58-60OD 20 DEGSZG
|
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 32ID 62-64OD 20 DEGSZH
|
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 32ID 62-64OD 20 DEGSZH
|
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 32ID 66-68OD 20 DEGSZJ
|
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
|
|
