|
LINER LONGEVITY NEU IT TT 32
|
Facility
|
OP
|
$6,614.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$859.85 |
| Max. Negotiated Rate |
$6,349.68 |
| Rate for Payer: Aetna Commercial |
$5,092.97
|
| Rate for Payer: Anthem Medicaid |
$2,274.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,159.12
|
| Rate for Payer: Cash Price |
$3,307.12
|
| Rate for Payer: Cigna Commercial |
$5,489.83
|
| Rate for Payer: First Health Commercial |
$6,283.54
|
| Rate for Payer: Humana Commercial |
$5,622.11
|
| Rate for Payer: Humana KY Medicaid |
$2,274.64
|
| Rate for Payer: Kentucky WC Medicaid |
$2,297.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,423.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,881.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,984.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,320.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,820.54
|
| Rate for Payer: Ohio Health Group HMO |
$4,960.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,322.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$859.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,050.42
|
| Rate for Payer: PHCS Commercial |
$6,349.68
|
| Rate for Payer: United Healthcare All Payer |
$5,820.54
|
|
|
LINER LONGEVITY NEU IT TT 36
|
Facility
|
OP
|
$6,614.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$859.85 |
| Max. Negotiated Rate |
$6,349.68 |
| Rate for Payer: Aetna Commercial |
$5,092.97
|
| Rate for Payer: Anthem Medicaid |
$2,274.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,159.12
|
| Rate for Payer: Cash Price |
$3,307.12
|
| Rate for Payer: Cigna Commercial |
$5,489.83
|
| Rate for Payer: First Health Commercial |
$6,283.54
|
| Rate for Payer: Humana Commercial |
$5,622.11
|
| Rate for Payer: Humana KY Medicaid |
$2,274.64
|
| Rate for Payer: Kentucky WC Medicaid |
$2,297.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,423.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,881.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,984.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,320.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,820.54
|
| Rate for Payer: Ohio Health Group HMO |
$4,960.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,322.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$859.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,050.42
|
| Rate for Payer: PHCS Commercial |
$6,349.68
|
| Rate for Payer: United Healthcare All Payer |
$5,820.54
|
|
|
LINER LONGEVITY NEU IT TT 36
|
Facility
|
IP
|
$6,614.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$859.85 |
| Max. Negotiated Rate |
$6,349.68 |
| Rate for Payer: Aetna Commercial |
$5,092.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,159.12
|
| Rate for Payer: Cash Price |
$3,307.12
|
| Rate for Payer: Cigna Commercial |
$5,489.83
|
| Rate for Payer: First Health Commercial |
$6,283.54
|
| Rate for Payer: Humana Commercial |
$5,622.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,423.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,881.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,984.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,820.54
|
| Rate for Payer: Ohio Health Group HMO |
$4,960.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,322.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$859.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,050.42
|
| Rate for Payer: PHCS Commercial |
$6,349.68
|
| Rate for Payer: United Healthcare All Payer |
$5,820.54
|
|
|
LINER LONGEVITY NEU IT TT 40
|
Facility
|
OP
|
$6,614.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$859.85 |
| Max. Negotiated Rate |
$6,349.68 |
| Rate for Payer: Aetna Commercial |
$5,092.97
|
| Rate for Payer: Anthem Medicaid |
$2,274.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,159.12
|
| Rate for Payer: Cash Price |
$3,307.12
|
| Rate for Payer: Cigna Commercial |
$5,489.83
|
| Rate for Payer: First Health Commercial |
$6,283.54
|
| Rate for Payer: Humana Commercial |
$5,622.11
|
| Rate for Payer: Humana KY Medicaid |
$2,274.64
|
| Rate for Payer: Kentucky WC Medicaid |
$2,297.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,423.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,881.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,984.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,320.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,820.54
|
| Rate for Payer: Ohio Health Group HMO |
$4,960.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,322.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$859.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,050.42
|
| Rate for Payer: PHCS Commercial |
$6,349.68
|
| Rate for Payer: United Healthcare All Payer |
$5,820.54
|
|
|
LINER LONGEVITY NEU IT TT 40
|
Facility
|
IP
|
$6,614.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$859.85 |
| Max. Negotiated Rate |
$6,349.68 |
| Rate for Payer: Aetna Commercial |
$5,092.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,159.12
|
| Rate for Payer: Cash Price |
$3,307.12
|
| Rate for Payer: Cigna Commercial |
$5,489.83
|
| Rate for Payer: First Health Commercial |
$6,283.54
|
| Rate for Payer: Humana Commercial |
$5,622.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,423.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,881.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,984.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,820.54
|
| Rate for Payer: Ohio Health Group HMO |
$4,960.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,322.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$859.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,050.42
|
| Rate for Payer: PHCS Commercial |
$6,349.68
|
| Rate for Payer: United Healthcare All Payer |
$5,820.54
|
|
|
LINER LONGEVITY NEU IT UU 32
|
Facility
|
OP
|
$6,614.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$859.85 |
| Max. Negotiated Rate |
$6,349.68 |
| Rate for Payer: Aetna Commercial |
$5,092.97
|
| Rate for Payer: Anthem Medicaid |
$2,274.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,159.12
|
| Rate for Payer: Cash Price |
$3,307.12
|
| Rate for Payer: Cigna Commercial |
$5,489.83
|
| Rate for Payer: First Health Commercial |
$6,283.54
|
| Rate for Payer: Humana Commercial |
$5,622.11
|
| Rate for Payer: Humana KY Medicaid |
$2,274.64
|
| Rate for Payer: Kentucky WC Medicaid |
$2,297.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,423.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,881.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,984.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,320.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,820.54
|
| Rate for Payer: Ohio Health Group HMO |
$4,960.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,322.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$859.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,050.42
|
| Rate for Payer: PHCS Commercial |
$6,349.68
|
| Rate for Payer: United Healthcare All Payer |
$5,820.54
|
|
|
LINER LONGEVITY NEU IT UU 32
|
Facility
|
IP
|
$6,614.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$859.85 |
| Max. Negotiated Rate |
$6,349.68 |
| Rate for Payer: Aetna Commercial |
$5,092.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,159.12
|
| Rate for Payer: Cash Price |
$3,307.12
|
| Rate for Payer: Cigna Commercial |
$5,489.83
|
| Rate for Payer: First Health Commercial |
$6,283.54
|
| Rate for Payer: Humana Commercial |
$5,622.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,423.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,881.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,984.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,820.54
|
| Rate for Payer: Ohio Health Group HMO |
$4,960.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,322.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$859.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,050.42
|
| Rate for Payer: PHCS Commercial |
$6,349.68
|
| Rate for Payer: United Healthcare All Payer |
$5,820.54
|
|
|
LINER LONGEVITY NEU IT UU 36
|
Facility
|
IP
|
$7,307.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$950.01 |
| Max. Negotiated Rate |
$7,015.44 |
| Rate for Payer: Aetna Commercial |
$5,626.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,700.04
|
| Rate for Payer: Cash Price |
$3,653.88
|
| Rate for Payer: Cigna Commercial |
$6,065.43
|
| Rate for Payer: First Health Commercial |
$6,942.36
|
| Rate for Payer: Humana Commercial |
$6,211.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,992.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,393.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,192.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,430.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,480.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,461.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$950.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,265.40
|
| Rate for Payer: PHCS Commercial |
$7,015.44
|
| Rate for Payer: United Healthcare All Payer |
$6,430.82
|
|
|
LINER LONGEVITY NEU IT UU 36
|
Facility
|
OP
|
$7,307.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$950.01 |
| Max. Negotiated Rate |
$7,015.44 |
| Rate for Payer: Aetna Commercial |
$5,626.97
|
| Rate for Payer: Anthem Medicaid |
$2,513.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,700.04
|
| Rate for Payer: Cash Price |
$3,653.88
|
| Rate for Payer: Cigna Commercial |
$6,065.43
|
| Rate for Payer: First Health Commercial |
$6,942.36
|
| Rate for Payer: Humana Commercial |
$6,211.59
|
| Rate for Payer: Humana KY Medicaid |
$2,513.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,538.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,992.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,393.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,192.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,563.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,430.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,480.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,461.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$950.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,265.40
|
| Rate for Payer: PHCS Commercial |
$7,015.44
|
| Rate for Payer: United Healthcare All Payer |
$6,430.82
|
|
|
LINER LONGEVITY NEU IT UU 40
|
Facility
|
OP
|
$7,307.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$950.01 |
| Max. Negotiated Rate |
$7,015.44 |
| Rate for Payer: Aetna Commercial |
$5,626.97
|
| Rate for Payer: Anthem Medicaid |
$2,513.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,700.04
|
| Rate for Payer: Cash Price |
$3,653.88
|
| Rate for Payer: Cigna Commercial |
$6,065.43
|
| Rate for Payer: First Health Commercial |
$6,942.36
|
| Rate for Payer: Humana Commercial |
$6,211.59
|
| Rate for Payer: Humana KY Medicaid |
$2,513.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,538.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,992.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,393.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,192.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,563.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,430.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,480.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,461.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$950.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,265.40
|
| Rate for Payer: PHCS Commercial |
$7,015.44
|
| Rate for Payer: United Healthcare All Payer |
$6,430.82
|
|
|
LINER LONGEVITY NEU IT UU 40
|
Facility
|
IP
|
$7,307.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$950.01 |
| Max. Negotiated Rate |
$7,015.44 |
| Rate for Payer: Aetna Commercial |
$5,626.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,700.04
|
| Rate for Payer: Cash Price |
$3,653.88
|
| Rate for Payer: Cigna Commercial |
$6,065.43
|
| Rate for Payer: First Health Commercial |
$6,942.36
|
| Rate for Payer: Humana Commercial |
$6,211.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,992.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,393.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,192.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,430.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,480.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,461.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$950.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,265.40
|
| Rate for Payer: PHCS Commercial |
$7,015.44
|
| Rate for Payer: United Healthcare All Payer |
$6,430.82
|
|
|
LINER LONGEVITY NEU IT VV 32
|
Facility
|
IP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
LINER LONGEVITY NEU IT VV 32
|
Facility
|
OP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem Medicaid |
$2,280.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Humana KY Medicaid |
$2,280.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,304.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,326.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
LINER LONGEVITY NEU IT VV 36
|
Facility
|
IP
|
$7,307.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$950.01 |
| Max. Negotiated Rate |
$7,015.44 |
| Rate for Payer: Aetna Commercial |
$5,626.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,700.04
|
| Rate for Payer: Cash Price |
$3,653.88
|
| Rate for Payer: Cigna Commercial |
$6,065.43
|
| Rate for Payer: First Health Commercial |
$6,942.36
|
| Rate for Payer: Humana Commercial |
$6,211.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,992.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,393.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,192.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,430.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,480.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,461.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$950.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,265.40
|
| Rate for Payer: PHCS Commercial |
$7,015.44
|
| Rate for Payer: United Healthcare All Payer |
$6,430.82
|
|
|
LINER LONGEVITY NEU IT VV 36
|
Facility
|
OP
|
$7,307.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$950.01 |
| Max. Negotiated Rate |
$7,015.44 |
| Rate for Payer: Aetna Commercial |
$5,626.97
|
| Rate for Payer: Anthem Medicaid |
$2,513.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,700.04
|
| Rate for Payer: Cash Price |
$3,653.88
|
| Rate for Payer: Cigna Commercial |
$6,065.43
|
| Rate for Payer: First Health Commercial |
$6,942.36
|
| Rate for Payer: Humana Commercial |
$6,211.59
|
| Rate for Payer: Humana KY Medicaid |
$2,513.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,538.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,992.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,393.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,192.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,563.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,430.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,480.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,461.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$950.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,265.40
|
| Rate for Payer: PHCS Commercial |
$7,015.44
|
| Rate for Payer: United Healthcare All Payer |
$6,430.82
|
|
|
LINER LONGEVITY NEU IT VV 40
|
Facility
|
IP
|
$7,307.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$950.01 |
| Max. Negotiated Rate |
$7,015.44 |
| Rate for Payer: Aetna Commercial |
$5,626.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,700.04
|
| Rate for Payer: Cash Price |
$3,653.88
|
| Rate for Payer: Cigna Commercial |
$6,065.43
|
| Rate for Payer: First Health Commercial |
$6,942.36
|
| Rate for Payer: Humana Commercial |
$6,211.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,992.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,393.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,192.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,430.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,480.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,461.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$950.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,265.40
|
| Rate for Payer: PHCS Commercial |
$7,015.44
|
| Rate for Payer: United Healthcare All Payer |
$6,430.82
|
|
|
LINER LONGEVITY NEU IT VV 40
|
Facility
|
OP
|
$7,307.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$950.01 |
| Max. Negotiated Rate |
$7,015.44 |
| Rate for Payer: Aetna Commercial |
$5,626.97
|
| Rate for Payer: Anthem Medicaid |
$2,513.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,700.04
|
| Rate for Payer: Cash Price |
$3,653.88
|
| Rate for Payer: Cigna Commercial |
$6,065.43
|
| Rate for Payer: First Health Commercial |
$6,942.36
|
| Rate for Payer: Humana Commercial |
$6,211.59
|
| Rate for Payer: Humana KY Medicaid |
$2,513.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,538.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,992.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,393.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,192.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,563.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,430.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,480.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,461.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$950.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,265.40
|
| Rate for Payer: PHCS Commercial |
$7,015.44
|
| Rate for Payer: United Healthcare All Payer |
$6,430.82
|
|
|
LINER LONGEVITY OFFSET7MM FF28
|
Facility
|
OP
|
$6,614.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$859.85 |
| Max. Negotiated Rate |
$6,349.68 |
| Rate for Payer: Aetna Commercial |
$5,092.97
|
| Rate for Payer: Anthem Medicaid |
$2,274.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,159.12
|
| Rate for Payer: Cash Price |
$3,307.12
|
| Rate for Payer: Cigna Commercial |
$5,489.83
|
| Rate for Payer: First Health Commercial |
$6,283.54
|
| Rate for Payer: Humana Commercial |
$5,622.11
|
| Rate for Payer: Humana KY Medicaid |
$2,274.64
|
| Rate for Payer: Kentucky WC Medicaid |
$2,297.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,423.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,881.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,984.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,320.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,820.54
|
| Rate for Payer: Ohio Health Group HMO |
$4,960.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,322.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$859.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,050.42
|
| Rate for Payer: PHCS Commercial |
$6,349.68
|
| Rate for Payer: United Healthcare All Payer |
$5,820.54
|
|
|
LINER LONGEVITY OFFSET7MM FF28
|
Facility
|
IP
|
$6,614.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$859.85 |
| Max. Negotiated Rate |
$6,349.68 |
| Rate for Payer: Aetna Commercial |
$5,092.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,159.12
|
| Rate for Payer: Cash Price |
$3,307.12
|
| Rate for Payer: Cigna Commercial |
$5,489.83
|
| Rate for Payer: First Health Commercial |
$6,283.54
|
| Rate for Payer: Humana Commercial |
$5,622.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,423.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,881.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,984.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,820.54
|
| Rate for Payer: Ohio Health Group HMO |
$4,960.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,322.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$859.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,050.42
|
| Rate for Payer: PHCS Commercial |
$6,349.68
|
| Rate for Payer: United Healthcare All Payer |
$5,820.54
|
|
|
LINER LONGEVITY OFFSET7MM UU32
|
Facility
|
OP
|
$6,614.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$859.85 |
| Max. Negotiated Rate |
$6,349.68 |
| Rate for Payer: Aetna Commercial |
$5,092.97
|
| Rate for Payer: Anthem Medicaid |
$2,274.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,159.12
|
| Rate for Payer: Cash Price |
$3,307.12
|
| Rate for Payer: Cigna Commercial |
$5,489.83
|
| Rate for Payer: First Health Commercial |
$6,283.54
|
| Rate for Payer: Humana Commercial |
$5,622.11
|
| Rate for Payer: Humana KY Medicaid |
$2,274.64
|
| Rate for Payer: Kentucky WC Medicaid |
$2,297.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,423.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,881.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,984.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,320.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,820.54
|
| Rate for Payer: Ohio Health Group HMO |
$4,960.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,322.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$859.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,050.42
|
| Rate for Payer: PHCS Commercial |
$6,349.68
|
| Rate for Payer: United Healthcare All Payer |
$5,820.54
|
|
|
LINER LONGEVITY OFFSET7MM UU32
|
Facility
|
IP
|
$6,614.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$859.85 |
| Max. Negotiated Rate |
$6,349.68 |
| Rate for Payer: Aetna Commercial |
$5,092.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,159.12
|
| Rate for Payer: Cash Price |
$3,307.12
|
| Rate for Payer: Cigna Commercial |
$5,489.83
|
| Rate for Payer: First Health Commercial |
$6,283.54
|
| Rate for Payer: Humana Commercial |
$5,622.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,423.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,881.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,984.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,820.54
|
| Rate for Payer: Ohio Health Group HMO |
$4,960.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,322.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$859.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,050.42
|
| Rate for Payer: PHCS Commercial |
$6,349.68
|
| Rate for Payer: United Healthcare All Payer |
$5,820.54
|
|
|
LINER LONGEVITY OFFSET7MM UU36
|
Facility
|
OP
|
$7,307.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$950.01 |
| Max. Negotiated Rate |
$7,015.44 |
| Rate for Payer: Aetna Commercial |
$5,626.97
|
| Rate for Payer: Anthem Medicaid |
$2,513.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,700.04
|
| Rate for Payer: Cash Price |
$3,653.88
|
| Rate for Payer: Cigna Commercial |
$6,065.43
|
| Rate for Payer: First Health Commercial |
$6,942.36
|
| Rate for Payer: Humana Commercial |
$6,211.59
|
| Rate for Payer: Humana KY Medicaid |
$2,513.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,538.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,992.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,393.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,192.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,563.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,430.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,480.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,461.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$950.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,265.40
|
| Rate for Payer: PHCS Commercial |
$7,015.44
|
| Rate for Payer: United Healthcare All Payer |
$6,430.82
|
|
|
LINER LONGEVITY OFFSET7MM UU36
|
Facility
|
IP
|
$7,307.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$950.01 |
| Max. Negotiated Rate |
$7,015.44 |
| Rate for Payer: Aetna Commercial |
$5,626.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,700.04
|
| Rate for Payer: Cash Price |
$3,653.88
|
| Rate for Payer: Cigna Commercial |
$6,065.43
|
| Rate for Payer: First Health Commercial |
$6,942.36
|
| Rate for Payer: Humana Commercial |
$6,211.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,992.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,393.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,192.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,430.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,480.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,461.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$950.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,265.40
|
| Rate for Payer: PHCS Commercial |
$7,015.44
|
| Rate for Payer: United Healthcare All Payer |
$6,430.82
|
|
|
LINER LONGVITY CONSTRAIN KK 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 LONGVITY CONSTRAIN KK 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
|
|
