|
LINER LGVITY CONSTRAINED HH 28
|
Facility
|
IP
|
$17,534.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.50 |
| Max. Negotiated Rate |
$16,833.20 |
| Rate for Payer: Aetna Commercial |
$13,501.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,676.97
|
| Rate for Payer: Cash Price |
$8,767.29
|
| Rate for Payer: Cigna Commercial |
$14,553.70
|
| Rate for Payer: First Health Commercial |
$16,657.85
|
| Rate for Payer: Humana Commercial |
$14,904.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,378.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,940.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,260.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,430.43
|
| Rate for Payer: Ohio Health Group HMO |
$13,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,506.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,435.72
|
| Rate for Payer: PHCS Commercial |
$16,833.20
|
| Rate for Payer: United Healthcare All Payer |
$15,430.43
|
|
|
LINER LGVITY CONSTRAINED HH 28
|
Facility
|
OP
|
$17,534.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.50 |
| Max. Negotiated Rate |
$16,833.20 |
| Rate for Payer: Aetna Commercial |
$13,501.63
|
| Rate for Payer: Anthem Medicaid |
$6,030.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,676.97
|
| Rate for Payer: Cash Price |
$8,767.29
|
| Rate for Payer: Cigna Commercial |
$14,553.70
|
| Rate for Payer: First Health Commercial |
$16,657.85
|
| Rate for Payer: Humana Commercial |
$14,904.39
|
| Rate for Payer: Humana KY Medicaid |
$6,030.14
|
| Rate for Payer: Kentucky WC Medicaid |
$6,091.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,378.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,940.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,260.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,151.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,430.43
|
| Rate for Payer: Ohio Health Group HMO |
$13,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,506.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,435.72
|
| Rate for Payer: PHCS Commercial |
$16,833.20
|
| Rate for Payer: United Healthcare All Payer |
$15,430.43
|
|
|
LINER LGVITY CONSTRAINED II 28
|
Facility
|
OP
|
$17,534.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.50 |
| Max. Negotiated Rate |
$16,833.20 |
| Rate for Payer: Aetna Commercial |
$13,501.63
|
| Rate for Payer: Anthem Medicaid |
$6,030.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,676.97
|
| Rate for Payer: Cash Price |
$8,767.29
|
| Rate for Payer: Cigna Commercial |
$14,553.70
|
| Rate for Payer: First Health Commercial |
$16,657.85
|
| Rate for Payer: Humana Commercial |
$14,904.39
|
| Rate for Payer: Humana KY Medicaid |
$6,030.14
|
| Rate for Payer: Kentucky WC Medicaid |
$6,091.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,378.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,940.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,260.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,151.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,430.43
|
| Rate for Payer: Ohio Health Group HMO |
$13,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,506.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,435.72
|
| Rate for Payer: PHCS Commercial |
$16,833.20
|
| Rate for Payer: United Healthcare All Payer |
$15,430.43
|
|
|
LINER LGVITY CONSTRAINED II 28
|
Facility
|
IP
|
$17,534.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.50 |
| Max. Negotiated Rate |
$16,833.20 |
| Rate for Payer: Aetna Commercial |
$13,501.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,676.97
|
| Rate for Payer: Cash Price |
$8,767.29
|
| Rate for Payer: Cigna Commercial |
$14,553.70
|
| Rate for Payer: First Health Commercial |
$16,657.85
|
| Rate for Payer: Humana Commercial |
$14,904.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,378.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,940.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,260.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,430.43
|
| Rate for Payer: Ohio Health Group HMO |
$13,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,506.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,435.72
|
| Rate for Payer: PHCS Commercial |
$16,833.20
|
| Rate for Payer: United Healthcare All Payer |
$15,430.43
|
|
|
LINER LGVITY CONSTRAINED KK 32
|
Facility
|
IP
|
$17,534.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.50 |
| Max. Negotiated Rate |
$16,833.20 |
| Rate for Payer: Aetna Commercial |
$13,501.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,676.97
|
| Rate for Payer: Cash Price |
$8,767.29
|
| Rate for Payer: Cigna Commercial |
$14,553.70
|
| Rate for Payer: First Health Commercial |
$16,657.85
|
| Rate for Payer: Humana Commercial |
$14,904.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,378.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,940.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,260.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,430.43
|
| Rate for Payer: Ohio Health Group HMO |
$13,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,506.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,435.72
|
| Rate for Payer: PHCS Commercial |
$16,833.20
|
| Rate for Payer: United Healthcare All Payer |
$15,430.43
|
|
|
LINER LGVITY CONSTRAINED KK 32
|
Facility
|
OP
|
$17,534.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.50 |
| Max. Negotiated Rate |
$16,833.20 |
| Rate for Payer: Aetna Commercial |
$13,501.63
|
| Rate for Payer: Anthem Medicaid |
$6,030.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,676.97
|
| Rate for Payer: Cash Price |
$8,767.29
|
| Rate for Payer: Cigna Commercial |
$14,553.70
|
| Rate for Payer: First Health Commercial |
$16,657.85
|
| Rate for Payer: Humana Commercial |
$14,904.39
|
| Rate for Payer: Humana KY Medicaid |
$6,030.14
|
| Rate for Payer: Kentucky WC Medicaid |
$6,091.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,378.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,940.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,260.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,151.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,430.43
|
| Rate for Payer: Ohio Health Group HMO |
$13,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,506.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,435.72
|
| Rate for Payer: PHCS Commercial |
$16,833.20
|
| Rate for Payer: United Healthcare All Payer |
$15,430.43
|
|
|
LINER LGVITY CONSTRAINED LL 28
|
Facility
|
IP
|
$17,534.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.50 |
| Max. Negotiated Rate |
$16,833.20 |
| Rate for Payer: Aetna Commercial |
$13,501.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,676.97
|
| Rate for Payer: Cash Price |
$8,767.29
|
| Rate for Payer: Cigna Commercial |
$14,553.70
|
| Rate for Payer: First Health Commercial |
$16,657.85
|
| Rate for Payer: Humana Commercial |
$14,904.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,378.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,940.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,260.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,430.43
|
| Rate for Payer: Ohio Health Group HMO |
$13,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,506.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,435.72
|
| Rate for Payer: PHCS Commercial |
$16,833.20
|
| Rate for Payer: United Healthcare All Payer |
$15,430.43
|
|
|
LINER LGVITY CONSTRAINED LL 28
|
Facility
|
OP
|
$17,534.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.50 |
| Max. Negotiated Rate |
$16,833.20 |
| Rate for Payer: Aetna Commercial |
$13,501.63
|
| Rate for Payer: Anthem Medicaid |
$6,030.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,676.97
|
| Rate for Payer: Cash Price |
$8,767.29
|
| Rate for Payer: Cigna Commercial |
$14,553.70
|
| Rate for Payer: First Health Commercial |
$16,657.85
|
| Rate for Payer: Humana Commercial |
$14,904.39
|
| Rate for Payer: Humana KY Medicaid |
$6,030.14
|
| Rate for Payer: Kentucky WC Medicaid |
$6,091.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,378.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,940.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,260.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,151.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,430.43
|
| Rate for Payer: Ohio Health Group HMO |
$13,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,506.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,435.72
|
| Rate for Payer: PHCS Commercial |
$16,833.20
|
| Rate for Payer: United Healthcare All Payer |
$15,430.43
|
|
|
LINER LGVITY CONSTRAINED LL 32
|
Facility
|
IP
|
$17,534.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.50 |
| Max. Negotiated Rate |
$16,833.20 |
| Rate for Payer: Aetna Commercial |
$13,501.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,676.97
|
| Rate for Payer: Cash Price |
$8,767.29
|
| Rate for Payer: Cigna Commercial |
$14,553.70
|
| Rate for Payer: First Health Commercial |
$16,657.85
|
| Rate for Payer: Humana Commercial |
$14,904.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,378.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,940.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,260.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,430.43
|
| Rate for Payer: Ohio Health Group HMO |
$13,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,506.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,435.72
|
| Rate for Payer: PHCS Commercial |
$16,833.20
|
| Rate for Payer: United Healthcare All Payer |
$15,430.43
|
|
|
LINER LGVITY CONSTRAINED LL 32
|
Facility
|
OP
|
$17,534.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.50 |
| Max. Negotiated Rate |
$16,833.20 |
| Rate for Payer: Aetna Commercial |
$13,501.63
|
| Rate for Payer: Anthem Medicaid |
$6,030.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,676.97
|
| Rate for Payer: Cash Price |
$8,767.29
|
| Rate for Payer: Cigna Commercial |
$14,553.70
|
| Rate for Payer: First Health Commercial |
$16,657.85
|
| Rate for Payer: Humana Commercial |
$14,904.39
|
| Rate for Payer: Humana KY Medicaid |
$6,030.14
|
| Rate for Payer: Kentucky WC Medicaid |
$6,091.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,378.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,940.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,260.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,151.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,430.43
|
| Rate for Payer: Ohio Health Group HMO |
$13,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,506.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,435.72
|
| Rate for Payer: PHCS Commercial |
$16,833.20
|
| Rate for Payer: United Healthcare All Payer |
$15,430.43
|
|
|
LINER LGVITY CONSTRAINED MM 32
|
Facility
|
OP
|
$17,534.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.50 |
| Max. Negotiated Rate |
$16,833.20 |
| Rate for Payer: Aetna Commercial |
$13,501.63
|
| Rate for Payer: Anthem Medicaid |
$6,030.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,676.97
|
| Rate for Payer: Cash Price |
$8,767.29
|
| Rate for Payer: Cigna Commercial |
$14,553.70
|
| Rate for Payer: First Health Commercial |
$16,657.85
|
| Rate for Payer: Humana Commercial |
$14,904.39
|
| Rate for Payer: Humana KY Medicaid |
$6,030.14
|
| Rate for Payer: Kentucky WC Medicaid |
$6,091.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,378.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,940.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,260.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,151.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,430.43
|
| Rate for Payer: Ohio Health Group HMO |
$13,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,506.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,435.72
|
| Rate for Payer: PHCS Commercial |
$16,833.20
|
| Rate for Payer: United Healthcare All Payer |
$15,430.43
|
|
|
LINER LGVITY CONSTRAINED MM 32
|
Facility
|
IP
|
$17,534.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.50 |
| Max. Negotiated Rate |
$16,833.20 |
| Rate for Payer: Aetna Commercial |
$13,501.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,676.97
|
| Rate for Payer: Cash Price |
$8,767.29
|
| Rate for Payer: Cigna Commercial |
$14,553.70
|
| Rate for Payer: First Health Commercial |
$16,657.85
|
| Rate for Payer: Humana Commercial |
$14,904.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,378.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,940.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,260.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,430.43
|
| Rate for Payer: Ohio Health Group HMO |
$13,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,506.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,435.72
|
| Rate for Payer: PHCS Commercial |
$16,833.20
|
| Rate for Payer: United Healthcare All Payer |
$15,430.43
|
|
|
LINER LGVITY CONSTRAINED MM 36
|
Facility
|
IP
|
$17,534.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.50 |
| Max. Negotiated Rate |
$16,833.20 |
| Rate for Payer: Aetna Commercial |
$13,501.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,676.97
|
| Rate for Payer: Cash Price |
$8,767.29
|
| Rate for Payer: Cigna Commercial |
$14,553.70
|
| Rate for Payer: First Health Commercial |
$16,657.85
|
| Rate for Payer: Humana Commercial |
$14,904.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,378.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,940.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,260.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,430.43
|
| Rate for Payer: Ohio Health Group HMO |
$13,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,506.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,435.72
|
| Rate for Payer: PHCS Commercial |
$16,833.20
|
| Rate for Payer: United Healthcare All Payer |
$15,430.43
|
|
|
LINER LGVITY CONSTRAINED MM 36
|
Facility
|
OP
|
$17,534.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.50 |
| Max. Negotiated Rate |
$16,833.20 |
| Rate for Payer: Aetna Commercial |
$13,501.63
|
| Rate for Payer: Anthem Medicaid |
$6,030.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,676.97
|
| Rate for Payer: Cash Price |
$8,767.29
|
| Rate for Payer: Cigna Commercial |
$14,553.70
|
| Rate for Payer: First Health Commercial |
$16,657.85
|
| Rate for Payer: Humana Commercial |
$14,904.39
|
| Rate for Payer: Humana KY Medicaid |
$6,030.14
|
| Rate for Payer: Kentucky WC Medicaid |
$6,091.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,378.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,940.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,260.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,151.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,430.43
|
| Rate for Payer: Ohio Health Group HMO |
$13,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,506.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,435.72
|
| Rate for Payer: PHCS Commercial |
$16,833.20
|
| Rate for Payer: United Healthcare All Payer |
$15,430.43
|
|
|
LINER LGVITY CONSTRAINED NN 32
|
Facility
|
OP
|
$17,534.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.50 |
| Max. Negotiated Rate |
$16,833.20 |
| Rate for Payer: Aetna Commercial |
$13,501.63
|
| Rate for Payer: Anthem Medicaid |
$6,030.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,676.97
|
| Rate for Payer: Cash Price |
$8,767.29
|
| Rate for Payer: Cigna Commercial |
$14,553.70
|
| Rate for Payer: First Health Commercial |
$16,657.85
|
| Rate for Payer: Humana Commercial |
$14,904.39
|
| Rate for Payer: Humana KY Medicaid |
$6,030.14
|
| Rate for Payer: Kentucky WC Medicaid |
$6,091.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,378.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,940.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,260.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,151.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,430.43
|
| Rate for Payer: Ohio Health Group HMO |
$13,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,506.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,435.72
|
| Rate for Payer: PHCS Commercial |
$16,833.20
|
| Rate for Payer: United Healthcare All Payer |
$15,430.43
|
|
|
LINER LGVITY CONSTRAINED NN 32
|
Facility
|
IP
|
$17,534.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.50 |
| Max. Negotiated Rate |
$16,833.20 |
| Rate for Payer: Aetna Commercial |
$13,501.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,676.97
|
| Rate for Payer: Cash Price |
$8,767.29
|
| Rate for Payer: Cigna Commercial |
$14,553.70
|
| Rate for Payer: First Health Commercial |
$16,657.85
|
| Rate for Payer: Humana Commercial |
$14,904.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,378.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,940.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,260.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,430.43
|
| Rate for Payer: Ohio Health Group HMO |
$13,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,506.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,435.72
|
| Rate for Payer: PHCS Commercial |
$16,833.20
|
| Rate for Payer: United Healthcare All Payer |
$15,430.43
|
|
|
LINER LGVITY CONSTRAINED NN 36
|
Facility
|
IP
|
$17,534.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.50 |
| Max. Negotiated Rate |
$16,833.20 |
| Rate for Payer: Aetna Commercial |
$13,501.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,676.97
|
| Rate for Payer: Cash Price |
$8,767.29
|
| Rate for Payer: Cigna Commercial |
$14,553.70
|
| Rate for Payer: First Health Commercial |
$16,657.85
|
| Rate for Payer: Humana Commercial |
$14,904.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,378.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,940.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,260.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,430.43
|
| Rate for Payer: Ohio Health Group HMO |
$13,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,506.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,435.72
|
| Rate for Payer: PHCS Commercial |
$16,833.20
|
| Rate for Payer: United Healthcare All Payer |
$15,430.43
|
|
|
LINER LGVITY CONSTRAINED NN 36
|
Facility
|
OP
|
$17,534.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.50 |
| Max. Negotiated Rate |
$16,833.20 |
| Rate for Payer: Aetna Commercial |
$13,501.63
|
| Rate for Payer: Anthem Medicaid |
$6,030.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,676.97
|
| Rate for Payer: Cash Price |
$8,767.29
|
| Rate for Payer: Cigna Commercial |
$14,553.70
|
| Rate for Payer: First Health Commercial |
$16,657.85
|
| Rate for Payer: Humana Commercial |
$14,904.39
|
| Rate for Payer: Humana KY Medicaid |
$6,030.14
|
| Rate for Payer: Kentucky WC Medicaid |
$6,091.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,378.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,940.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,260.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,151.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,430.43
|
| Rate for Payer: Ohio Health Group HMO |
$13,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,506.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,435.72
|
| Rate for Payer: PHCS Commercial |
$16,833.20
|
| Rate for Payer: United Healthcare All Payer |
$15,430.43
|
|
|
LINER LGVITY CONSTRAINED OO 32
|
Facility
|
IP
|
$17,534.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.50 |
| Max. Negotiated Rate |
$16,833.20 |
| Rate for Payer: Aetna Commercial |
$13,501.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,676.97
|
| Rate for Payer: Cash Price |
$8,767.29
|
| Rate for Payer: Cigna Commercial |
$14,553.70
|
| Rate for Payer: First Health Commercial |
$16,657.85
|
| Rate for Payer: Humana Commercial |
$14,904.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,378.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,940.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,260.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,430.43
|
| Rate for Payer: Ohio Health Group HMO |
$13,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,506.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,435.72
|
| Rate for Payer: PHCS Commercial |
$16,833.20
|
| Rate for Payer: United Healthcare All Payer |
$15,430.43
|
|
|
LINER LGVITY CONSTRAINED OO 32
|
Facility
|
OP
|
$17,534.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.50 |
| Max. Negotiated Rate |
$16,833.20 |
| Rate for Payer: Aetna Commercial |
$13,501.63
|
| Rate for Payer: Anthem Medicaid |
$6,030.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,676.97
|
| Rate for Payer: Cash Price |
$8,767.29
|
| Rate for Payer: Cigna Commercial |
$14,553.70
|
| Rate for Payer: First Health Commercial |
$16,657.85
|
| Rate for Payer: Humana Commercial |
$14,904.39
|
| Rate for Payer: Humana KY Medicaid |
$6,030.14
|
| Rate for Payer: Kentucky WC Medicaid |
$6,091.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,378.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,940.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,260.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,151.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,430.43
|
| Rate for Payer: Ohio Health Group HMO |
$13,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,506.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,435.72
|
| Rate for Payer: PHCS Commercial |
$16,833.20
|
| Rate for Payer: United Healthcare All Payer |
$15,430.43
|
|
|
LINER LGVITY CONSTRAINED OO 36
|
Facility
|
IP
|
$17,534.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.50 |
| Max. Negotiated Rate |
$16,833.20 |
| Rate for Payer: Aetna Commercial |
$13,501.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,676.97
|
| Rate for Payer: Cash Price |
$8,767.29
|
| Rate for Payer: Cigna Commercial |
$14,553.70
|
| Rate for Payer: First Health Commercial |
$16,657.85
|
| Rate for Payer: Humana Commercial |
$14,904.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,378.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,940.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,260.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,430.43
|
| Rate for Payer: Ohio Health Group HMO |
$13,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,506.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,435.72
|
| Rate for Payer: PHCS Commercial |
$16,833.20
|
| Rate for Payer: United Healthcare All Payer |
$15,430.43
|
|
|
LINER LGVITY CONSTRAINED OO 36
|
Facility
|
OP
|
$17,534.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.50 |
| Max. Negotiated Rate |
$16,833.20 |
| Rate for Payer: Aetna Commercial |
$13,501.63
|
| Rate for Payer: Anthem Medicaid |
$6,030.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,676.97
|
| Rate for Payer: Cash Price |
$8,767.29
|
| Rate for Payer: Cigna Commercial |
$14,553.70
|
| Rate for Payer: First Health Commercial |
$16,657.85
|
| Rate for Payer: Humana Commercial |
$14,904.39
|
| Rate for Payer: Humana KY Medicaid |
$6,030.14
|
| Rate for Payer: Kentucky WC Medicaid |
$6,091.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,378.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,940.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,260.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,151.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,430.43
|
| Rate for Payer: Ohio Health Group HMO |
$13,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,506.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,435.72
|
| Rate for Payer: PHCS Commercial |
$16,833.20
|
| Rate for Payer: United Healthcare All Payer |
$15,430.43
|
|
|
LINER LGVITY CONSTRAINED PP 32
|
Facility
|
OP
|
$17,534.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.50 |
| Max. Negotiated Rate |
$16,833.20 |
| Rate for Payer: Aetna Commercial |
$13,501.63
|
| Rate for Payer: Anthem Medicaid |
$6,030.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,676.97
|
| Rate for Payer: Cash Price |
$8,767.29
|
| Rate for Payer: Cigna Commercial |
$14,553.70
|
| Rate for Payer: First Health Commercial |
$16,657.85
|
| Rate for Payer: Humana Commercial |
$14,904.39
|
| Rate for Payer: Humana KY Medicaid |
$6,030.14
|
| Rate for Payer: Kentucky WC Medicaid |
$6,091.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,378.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,940.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,260.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,151.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,430.43
|
| Rate for Payer: Ohio Health Group HMO |
$13,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,506.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,435.72
|
| Rate for Payer: PHCS Commercial |
$16,833.20
|
| Rate for Payer: United Healthcare All Payer |
$15,430.43
|
|
|
LINER LGVITY CONSTRAINED PP 32
|
Facility
|
IP
|
$17,534.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.50 |
| Max. Negotiated Rate |
$16,833.20 |
| Rate for Payer: Aetna Commercial |
$13,501.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,676.97
|
| Rate for Payer: Cash Price |
$8,767.29
|
| Rate for Payer: Cigna Commercial |
$14,553.70
|
| Rate for Payer: First Health Commercial |
$16,657.85
|
| Rate for Payer: Humana Commercial |
$14,904.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,378.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,940.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,260.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,430.43
|
| Rate for Payer: Ohio Health Group HMO |
$13,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,506.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,435.72
|
| Rate for Payer: PHCS Commercial |
$16,833.20
|
| Rate for Payer: United Healthcare All Payer |
$15,430.43
|
|
|
LINER LGVITY CONSTRAINED PP 36
|
Facility
|
IP
|
$17,534.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.50 |
| Max. Negotiated Rate |
$16,833.20 |
| Rate for Payer: Aetna Commercial |
$13,501.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,676.97
|
| Rate for Payer: Cash Price |
$8,767.29
|
| Rate for Payer: Cigna Commercial |
$14,553.70
|
| Rate for Payer: First Health Commercial |
$16,657.85
|
| Rate for Payer: Humana Commercial |
$14,904.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,378.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,940.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,260.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,430.43
|
| Rate for Payer: Ohio Health Group HMO |
$13,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,506.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,435.72
|
| Rate for Payer: PHCS Commercial |
$16,833.20
|
| Rate for Payer: United Healthcare All Payer |
$15,430.43
|
|
