|
REF LNR 28*66-68 0 DEG SZ J
|
Facility
|
IP
|
$4,907.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.10 |
| Max. Negotiated Rate |
$4,710.72 |
| Rate for Payer: Aetna Commercial |
$3,778.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,827.46
|
| Rate for Payer: Cash Price |
$2,453.50
|
| Rate for Payer: Cigna Commercial |
$4,072.81
|
| Rate for Payer: First Health Commercial |
$4,661.65
|
| Rate for Payer: Humana Commercial |
$4,170.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,621.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,472.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,318.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,680.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,269.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.83
|
| Rate for Payer: PHCS Commercial |
$4,710.72
|
| Rate for Payer: United Healthcare All Payer |
$4,318.16
|
|
|
REF LNR 28*66-68 0 DEG SZ J
|
Facility
|
OP
|
$4,907.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.10 |
| Max. Negotiated Rate |
$4,710.72 |
| Rate for Payer: Aetna Commercial |
$3,778.39
|
| Rate for Payer: Anthem Medicaid |
$1,687.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,827.46
|
| Rate for Payer: Cash Price |
$2,453.50
|
| Rate for Payer: Cigna Commercial |
$4,072.81
|
| Rate for Payer: First Health Commercial |
$4,661.65
|
| Rate for Payer: Humana Commercial |
$4,170.95
|
| Rate for Payer: Humana KY Medicaid |
$1,687.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1,704.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,621.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,472.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,721.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,318.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,680.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,269.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.83
|
| Rate for Payer: PHCS Commercial |
$4,710.72
|
| Rate for Payer: United Healthcare All Payer |
$4,318.16
|
|
|
REF LNR 28*70-76 0 DEG SZ K
|
Facility
|
OP
|
$4,907.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.10 |
| Max. Negotiated Rate |
$4,710.72 |
| Rate for Payer: Aetna Commercial |
$3,778.39
|
| Rate for Payer: Anthem Medicaid |
$1,687.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,827.46
|
| Rate for Payer: Cash Price |
$2,453.50
|
| Rate for Payer: Cigna Commercial |
$4,072.81
|
| Rate for Payer: First Health Commercial |
$4,661.65
|
| Rate for Payer: Humana Commercial |
$4,170.95
|
| Rate for Payer: Humana KY Medicaid |
$1,687.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1,704.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,621.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,472.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,721.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,318.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,680.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,269.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.83
|
| Rate for Payer: PHCS Commercial |
$4,710.72
|
| Rate for Payer: United Healthcare All Payer |
$4,318.16
|
|
|
REF LNR 28*70-76 0 DEG SZ K
|
Facility
|
IP
|
$4,907.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.10 |
| Max. Negotiated Rate |
$4,710.72 |
| Rate for Payer: Aetna Commercial |
$3,778.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,827.46
|
| Rate for Payer: Cash Price |
$2,453.50
|
| Rate for Payer: Cigna Commercial |
$4,072.81
|
| Rate for Payer: First Health Commercial |
$4,661.65
|
| Rate for Payer: Humana Commercial |
$4,170.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,621.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,472.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,318.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,680.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,269.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.83
|
| Rate for Payer: PHCS Commercial |
$4,710.72
|
| Rate for Payer: United Healthcare All Payer |
$4,318.16
|
|
|
REF LNR 28ID 20 DEG SZ D
|
Facility
|
IP
|
$5,120.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,536.17 |
| Max. Negotiated Rate |
$4,915.74 |
| Rate for Payer: Aetna Commercial |
$3,942.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,994.04
|
| Rate for Payer: Cash Price |
$2,560.28
|
| Rate for Payer: Cigna Commercial |
$4,250.06
|
| Rate for Payer: First Health Commercial |
$4,864.53
|
| Rate for Payer: Humana Commercial |
$4,352.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,198.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,778.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,536.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,506.09
|
| Rate for Payer: Ohio Health Group HMO |
$3,840.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,096.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,454.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,533.19
|
| Rate for Payer: PHCS Commercial |
$4,915.74
|
| Rate for Payer: United Healthcare All Payer |
$4,506.09
|
|
|
REF LNR 28ID 20 DEG SZ D
|
Facility
|
OP
|
$5,120.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,536.17 |
| Max. Negotiated Rate |
$4,915.74 |
| Rate for Payer: Aetna Commercial |
$3,942.83
|
| Rate for Payer: Anthem Medicaid |
$1,760.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,994.04
|
| Rate for Payer: Cash Price |
$2,560.28
|
| Rate for Payer: Cigna Commercial |
$4,250.06
|
| Rate for Payer: First Health Commercial |
$4,864.53
|
| Rate for Payer: Humana Commercial |
$4,352.48
|
| Rate for Payer: Humana KY Medicaid |
$1,760.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,778.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,198.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,778.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,536.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,796.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,506.09
|
| Rate for Payer: Ohio Health Group HMO |
$3,840.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,096.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,454.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,533.19
|
| Rate for Payer: PHCS Commercial |
$4,915.74
|
| Rate for Payer: United Healthcare All Payer |
$4,506.09
|
|
|
REF LNR 28ID 50-52OD 20 DEGSZE
|
Facility
|
IP
|
$5,120.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,536.17 |
| Max. Negotiated Rate |
$4,915.74 |
| Rate for Payer: Aetna Commercial |
$3,942.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,994.04
|
| Rate for Payer: Cash Price |
$2,560.28
|
| Rate for Payer: Cigna Commercial |
$4,250.06
|
| Rate for Payer: First Health Commercial |
$4,864.53
|
| Rate for Payer: Humana Commercial |
$4,352.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,198.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,778.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,536.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,506.09
|
| Rate for Payer: Ohio Health Group HMO |
$3,840.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,096.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,454.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,533.19
|
| Rate for Payer: PHCS Commercial |
$4,915.74
|
| Rate for Payer: United Healthcare All Payer |
$4,506.09
|
|
|
REF LNR 28ID 50-52OD 20 DEGSZE
|
Facility
|
OP
|
$5,120.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,536.17 |
| Max. Negotiated Rate |
$4,915.74 |
| Rate for Payer: Aetna Commercial |
$3,942.83
|
| Rate for Payer: Anthem Medicaid |
$1,760.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,994.04
|
| Rate for Payer: Cash Price |
$2,560.28
|
| Rate for Payer: Cigna Commercial |
$4,250.06
|
| Rate for Payer: First Health Commercial |
$4,864.53
|
| Rate for Payer: Humana Commercial |
$4,352.48
|
| Rate for Payer: Humana KY Medicaid |
$1,760.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,778.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,198.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,778.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,536.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,796.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,506.09
|
| Rate for Payer: Ohio Health Group HMO |
$3,840.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,096.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,454.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,533.19
|
| Rate for Payer: PHCS Commercial |
$4,915.74
|
| Rate for Payer: United Healthcare All Payer |
$4,506.09
|
|
|
REF LNR 28ID 54-56OD 20 DEGSZF
|
Facility
|
IP
|
$5,120.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,536.17 |
| Max. Negotiated Rate |
$4,915.74 |
| Rate for Payer: Aetna Commercial |
$3,942.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,994.04
|
| Rate for Payer: Cash Price |
$2,560.28
|
| Rate for Payer: Cigna Commercial |
$4,250.06
|
| Rate for Payer: First Health Commercial |
$4,864.53
|
| Rate for Payer: Humana Commercial |
$4,352.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,198.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,778.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,536.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,506.09
|
| Rate for Payer: Ohio Health Group HMO |
$3,840.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,096.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,454.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,533.19
|
| Rate for Payer: PHCS Commercial |
$4,915.74
|
| Rate for Payer: United Healthcare All Payer |
$4,506.09
|
|
|
REF LNR 28ID 54-56OD 20 DEGSZF
|
Facility
|
OP
|
$5,120.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,536.17 |
| Max. Negotiated Rate |
$4,915.74 |
| Rate for Payer: Aetna Commercial |
$3,942.83
|
| Rate for Payer: Anthem Medicaid |
$1,760.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,994.04
|
| Rate for Payer: Cash Price |
$2,560.28
|
| Rate for Payer: Cigna Commercial |
$4,250.06
|
| Rate for Payer: First Health Commercial |
$4,864.53
|
| Rate for Payer: Humana Commercial |
$4,352.48
|
| Rate for Payer: Humana KY Medicaid |
$1,760.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,778.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,198.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,778.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,536.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,796.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,506.09
|
| Rate for Payer: Ohio Health Group HMO |
$3,840.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,096.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,454.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,533.19
|
| Rate for Payer: PHCS Commercial |
$4,915.74
|
| Rate for Payer: United Healthcare All Payer |
$4,506.09
|
|
|
REF LNR 28ID 58-60OD 20 DEGSZG
|
Facility
|
OP
|
$5,120.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,536.17 |
| Max. Negotiated Rate |
$4,915.74 |
| Rate for Payer: Aetna Commercial |
$3,942.83
|
| Rate for Payer: Anthem Medicaid |
$1,760.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,994.04
|
| Rate for Payer: Cash Price |
$2,560.28
|
| Rate for Payer: Cigna Commercial |
$4,250.06
|
| Rate for Payer: First Health Commercial |
$4,864.53
|
| Rate for Payer: Humana Commercial |
$4,352.48
|
| Rate for Payer: Humana KY Medicaid |
$1,760.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,778.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,198.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,778.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,536.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,796.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,506.09
|
| Rate for Payer: Ohio Health Group HMO |
$3,840.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,096.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,454.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,533.19
|
| Rate for Payer: PHCS Commercial |
$4,915.74
|
| Rate for Payer: United Healthcare All Payer |
$4,506.09
|
|
|
REF LNR 28ID 58-60OD 20 DEGSZG
|
Facility
|
IP
|
$5,120.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,536.17 |
| Max. Negotiated Rate |
$4,915.74 |
| Rate for Payer: Aetna Commercial |
$3,942.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,994.04
|
| Rate for Payer: Cash Price |
$2,560.28
|
| Rate for Payer: Cigna Commercial |
$4,250.06
|
| Rate for Payer: First Health Commercial |
$4,864.53
|
| Rate for Payer: Humana Commercial |
$4,352.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,198.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,778.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,536.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,506.09
|
| Rate for Payer: Ohio Health Group HMO |
$3,840.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,096.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,454.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,533.19
|
| Rate for Payer: PHCS Commercial |
$4,915.74
|
| Rate for Payer: United Healthcare All Payer |
$4,506.09
|
|
|
REF LNR 28ID 62-64OD 20 DEGSZH
|
Facility
|
OP
|
$5,120.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,536.17 |
| Max. Negotiated Rate |
$4,915.74 |
| Rate for Payer: Aetna Commercial |
$3,942.83
|
| Rate for Payer: Anthem Medicaid |
$1,760.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,994.04
|
| Rate for Payer: Cash Price |
$2,560.28
|
| Rate for Payer: Cigna Commercial |
$4,250.06
|
| Rate for Payer: First Health Commercial |
$4,864.53
|
| Rate for Payer: Humana Commercial |
$4,352.48
|
| Rate for Payer: Humana KY Medicaid |
$1,760.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,778.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,198.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,778.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,536.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,796.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,506.09
|
| Rate for Payer: Ohio Health Group HMO |
$3,840.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,096.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,454.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,533.19
|
| Rate for Payer: PHCS Commercial |
$4,915.74
|
| Rate for Payer: United Healthcare All Payer |
$4,506.09
|
|
|
REF LNR 28ID 62-64OD 20 DEGSZH
|
Facility
|
IP
|
$5,120.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,536.17 |
| Max. Negotiated Rate |
$4,915.74 |
| Rate for Payer: Aetna Commercial |
$3,942.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,994.04
|
| Rate for Payer: Cash Price |
$2,560.28
|
| Rate for Payer: Cigna Commercial |
$4,250.06
|
| Rate for Payer: First Health Commercial |
$4,864.53
|
| Rate for Payer: Humana Commercial |
$4,352.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,198.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,778.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,536.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,506.09
|
| Rate for Payer: Ohio Health Group HMO |
$3,840.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,096.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,454.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,533.19
|
| Rate for Payer: PHCS Commercial |
$4,915.74
|
| Rate for Payer: United Healthcare All Payer |
$4,506.09
|
|
|
REF LNR 28ID 66-68OD 20 DEGSZJ
|
Facility
|
OP
|
$5,614.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.39 |
| Max. Negotiated Rate |
$5,390.04 |
| Rate for Payer: Aetna Commercial |
$4,323.26
|
| Rate for Payer: Anthem Medicaid |
$1,930.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,379.40
|
| Rate for Payer: Cash Price |
$2,807.31
|
| Rate for Payer: Cigna Commercial |
$4,660.13
|
| Rate for Payer: First Health Commercial |
$5,333.89
|
| Rate for Payer: Humana Commercial |
$4,772.43
|
| Rate for Payer: Humana KY Medicaid |
$1,930.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,950.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,603.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,143.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,969.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,940.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,210.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,491.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,884.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.09
|
| Rate for Payer: PHCS Commercial |
$5,390.04
|
| Rate for Payer: United Healthcare All Payer |
$4,940.87
|
|
|
REF LNR 28ID 66-68OD 20 DEGSZJ
|
Facility
|
IP
|
$5,614.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.39 |
| Max. Negotiated Rate |
$5,390.04 |
| Rate for Payer: Aetna Commercial |
$4,323.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,379.40
|
| Rate for Payer: Cash Price |
$2,807.31
|
| Rate for Payer: Cigna Commercial |
$4,660.13
|
| Rate for Payer: First Health Commercial |
$5,333.89
|
| Rate for Payer: Humana Commercial |
$4,772.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,603.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,143.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,940.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,210.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,491.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,884.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.09
|
| Rate for Payer: PHCS Commercial |
$5,390.04
|
| Rate for Payer: United Healthcare All Payer |
$4,940.87
|
|
|
REF LNR 28ID 70-76OD 20 DEGSZK
|
Facility
|
OP
|
$5,614.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.39 |
| Max. Negotiated Rate |
$5,390.04 |
| Rate for Payer: Aetna Commercial |
$4,323.26
|
| Rate for Payer: Anthem Medicaid |
$1,930.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,379.40
|
| Rate for Payer: Cash Price |
$2,807.31
|
| Rate for Payer: Cigna Commercial |
$4,660.13
|
| Rate for Payer: First Health Commercial |
$5,333.89
|
| Rate for Payer: Humana Commercial |
$4,772.43
|
| Rate for Payer: Humana KY Medicaid |
$1,930.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,950.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,603.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,143.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,969.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,940.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,210.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,491.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,884.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.09
|
| Rate for Payer: PHCS Commercial |
$5,390.04
|
| Rate for Payer: United Healthcare All Payer |
$4,940.87
|
|
|
REF LNR 28ID 70-76OD 20 DEGSZK
|
Facility
|
IP
|
$5,614.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.39 |
| Max. Negotiated Rate |
$5,390.04 |
| Rate for Payer: Aetna Commercial |
$4,323.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,379.40
|
| Rate for Payer: Cash Price |
$2,807.31
|
| Rate for Payer: Cigna Commercial |
$4,660.13
|
| Rate for Payer: First Health Commercial |
$5,333.89
|
| Rate for Payer: Humana Commercial |
$4,772.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,603.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,143.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,940.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,210.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,491.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,884.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.09
|
| Rate for Payer: PHCS Commercial |
$5,390.04
|
| Rate for Payer: United Healthcare All Payer |
$4,940.87
|
|
|
REF LNR 32ID 50-52OD 20 DEGSZE
|
Facility
|
IP
|
$5,614.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.39 |
| Max. Negotiated Rate |
$5,390.04 |
| Rate for Payer: Aetna Commercial |
$4,323.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,379.40
|
| Rate for Payer: Cash Price |
$2,807.31
|
| Rate for Payer: Cigna Commercial |
$4,660.13
|
| Rate for Payer: First Health Commercial |
$5,333.89
|
| Rate for Payer: Humana Commercial |
$4,772.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,603.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,143.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,940.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,210.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,491.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,884.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.09
|
| Rate for Payer: PHCS Commercial |
$5,390.04
|
| Rate for Payer: United Healthcare All Payer |
$4,940.87
|
|
|
REF LNR 32ID 50-52OD 20 DEGSZE
|
Facility
|
OP
|
$5,614.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.39 |
| Max. Negotiated Rate |
$5,390.04 |
| Rate for Payer: Aetna Commercial |
$4,323.26
|
| Rate for Payer: Anthem Medicaid |
$1,930.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,379.40
|
| Rate for Payer: Cash Price |
$2,807.31
|
| Rate for Payer: Cigna Commercial |
$4,660.13
|
| Rate for Payer: First Health Commercial |
$5,333.89
|
| Rate for Payer: Humana Commercial |
$4,772.43
|
| Rate for Payer: Humana KY Medicaid |
$1,930.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,950.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,603.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,143.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,969.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,940.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,210.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,491.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,884.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.09
|
| Rate for Payer: PHCS Commercial |
$5,390.04
|
| Rate for Payer: United Healthcare All Payer |
$4,940.87
|
|
|
REF LNR 32ID 54-56OD 20 DEGSZF
|
Facility
|
IP
|
$5,614.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.39 |
| Max. Negotiated Rate |
$5,390.04 |
| Rate for Payer: Aetna Commercial |
$4,323.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,379.40
|
| Rate for Payer: Cash Price |
$2,807.31
|
| Rate for Payer: Cigna Commercial |
$4,660.13
|
| Rate for Payer: First Health Commercial |
$5,333.89
|
| Rate for Payer: Humana Commercial |
$4,772.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,603.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,143.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,940.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,210.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,491.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,884.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.09
|
| Rate for Payer: PHCS Commercial |
$5,390.04
|
| Rate for Payer: United Healthcare All Payer |
$4,940.87
|
|
|
REF LNR 32ID 54-56OD 20 DEGSZF
|
Facility
|
OP
|
$5,614.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.39 |
| Max. Negotiated Rate |
$5,390.04 |
| Rate for Payer: Aetna Commercial |
$4,323.26
|
| Rate for Payer: Anthem Medicaid |
$1,930.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,379.40
|
| Rate for Payer: Cash Price |
$2,807.31
|
| Rate for Payer: Cigna Commercial |
$4,660.13
|
| Rate for Payer: First Health Commercial |
$5,333.89
|
| Rate for Payer: Humana Commercial |
$4,772.43
|
| Rate for Payer: Humana KY Medicaid |
$1,930.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,950.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,603.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,143.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,969.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,940.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,210.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,491.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,884.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.09
|
| Rate for Payer: PHCS Commercial |
$5,390.04
|
| Rate for Payer: United Healthcare All Payer |
$4,940.87
|
|
|
REF LNR 32ID 58-60OD 20 DEGSZG
|
Facility
|
OP
|
$5,614.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.39 |
| Max. Negotiated Rate |
$5,390.04 |
| Rate for Payer: Aetna Commercial |
$4,323.26
|
| Rate for Payer: Anthem Medicaid |
$1,930.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,379.40
|
| Rate for Payer: Cash Price |
$2,807.31
|
| Rate for Payer: Cigna Commercial |
$4,660.13
|
| Rate for Payer: First Health Commercial |
$5,333.89
|
| Rate for Payer: Humana Commercial |
$4,772.43
|
| Rate for Payer: Humana KY Medicaid |
$1,930.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,950.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,603.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,143.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,969.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,940.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,210.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,491.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,884.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.09
|
| Rate for Payer: PHCS Commercial |
$5,390.04
|
| Rate for Payer: United Healthcare All Payer |
$4,940.87
|
|
|
REF LNR 32ID 58-60OD 20 DEGSZG
|
Facility
|
IP
|
$5,614.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.39 |
| Max. Negotiated Rate |
$5,390.04 |
| Rate for Payer: Aetna Commercial |
$4,323.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,379.40
|
| Rate for Payer: Cash Price |
$2,807.31
|
| Rate for Payer: Cigna Commercial |
$4,660.13
|
| Rate for Payer: First Health Commercial |
$5,333.89
|
| Rate for Payer: Humana Commercial |
$4,772.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,603.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,143.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,940.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,210.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,491.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,884.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.09
|
| Rate for Payer: PHCS Commercial |
$5,390.04
|
| Rate for Payer: United Healthcare All Payer |
$4,940.87
|
|
|
REF LNR 32ID 62-64OD 20 DEGSZH
|
Facility
|
IP
|
$5,614.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.39 |
| Max. Negotiated Rate |
$5,390.04 |
| Rate for Payer: Aetna Commercial |
$4,323.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,379.40
|
| Rate for Payer: Cash Price |
$2,807.31
|
| Rate for Payer: Cigna Commercial |
$4,660.13
|
| Rate for Payer: First Health Commercial |
$5,333.89
|
| Rate for Payer: Humana Commercial |
$4,772.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,603.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,143.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,940.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,210.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,491.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,884.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.09
|
| Rate for Payer: PHCS Commercial |
$5,390.04
|
| Rate for Payer: United Healthcare All Payer |
$4,940.87
|
|
