|
LINER LGVITY CONSTRAINED LL 32
|
Facility
|
IP
|
$18,104.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,431.49 |
| Max. Negotiated Rate |
$17,380.78 |
| Rate for Payer: Aetna Commercial |
$13,940.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,121.88
|
| Rate for Payer: Cash Price |
$9,052.49
|
| Rate for Payer: Cigna Commercial |
$15,027.13
|
| Rate for Payer: First Health Commercial |
$17,199.73
|
| Rate for Payer: Humana Commercial |
$15,389.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,846.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,361.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,431.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,932.38
|
| Rate for Payer: Ohio Health Group HMO |
$13,578.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,483.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,751.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,492.44
|
| Rate for Payer: PHCS Commercial |
$17,380.78
|
| Rate for Payer: United Healthcare All Payer |
$15,932.38
|
|
|
LINER LGVITY CONSTRAINED LL 32
|
Facility
|
OP
|
$18,104.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,431.49 |
| Max. Negotiated Rate |
$17,380.78 |
| Rate for Payer: Aetna Commercial |
$13,940.83
|
| Rate for Payer: Anthem Medicaid |
$6,226.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,121.88
|
| Rate for Payer: Cash Price |
$9,052.49
|
| Rate for Payer: Cigna Commercial |
$15,027.13
|
| Rate for Payer: First Health Commercial |
$17,199.73
|
| Rate for Payer: Humana Commercial |
$15,389.23
|
| Rate for Payer: Humana KY Medicaid |
$6,226.30
|
| Rate for Payer: Kentucky WC Medicaid |
$6,289.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,846.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,361.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,431.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,351.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,932.38
|
| Rate for Payer: Ohio Health Group HMO |
$13,578.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,483.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,751.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,492.44
|
| Rate for Payer: PHCS Commercial |
$17,380.78
|
| Rate for Payer: United Healthcare All Payer |
$15,932.38
|
|
|
LINER LGVITY CONSTRAINED MM 32
|
Facility
|
OP
|
$18,104.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,431.49 |
| Max. Negotiated Rate |
$17,380.78 |
| Rate for Payer: Aetna Commercial |
$13,940.83
|
| Rate for Payer: Anthem Medicaid |
$6,226.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,121.88
|
| Rate for Payer: Cash Price |
$9,052.49
|
| Rate for Payer: Cigna Commercial |
$15,027.13
|
| Rate for Payer: First Health Commercial |
$17,199.73
|
| Rate for Payer: Humana Commercial |
$15,389.23
|
| Rate for Payer: Humana KY Medicaid |
$6,226.30
|
| Rate for Payer: Kentucky WC Medicaid |
$6,289.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,846.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,361.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,431.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,351.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,932.38
|
| Rate for Payer: Ohio Health Group HMO |
$13,578.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,483.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,751.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,492.44
|
| Rate for Payer: PHCS Commercial |
$17,380.78
|
| Rate for Payer: United Healthcare All Payer |
$15,932.38
|
|
|
LINER LGVITY CONSTRAINED MM 32
|
Facility
|
IP
|
$18,104.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,431.49 |
| Max. Negotiated Rate |
$17,380.78 |
| Rate for Payer: Aetna Commercial |
$13,940.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,121.88
|
| Rate for Payer: Cash Price |
$9,052.49
|
| Rate for Payer: Cigna Commercial |
$15,027.13
|
| Rate for Payer: First Health Commercial |
$17,199.73
|
| Rate for Payer: Humana Commercial |
$15,389.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,846.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,361.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,431.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,932.38
|
| Rate for Payer: Ohio Health Group HMO |
$13,578.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,483.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,751.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,492.44
|
| Rate for Payer: PHCS Commercial |
$17,380.78
|
| Rate for Payer: United Healthcare All Payer |
$15,932.38
|
|
|
LINER LGVITY CONSTRAINED MM 36
|
Facility
|
OP
|
$18,104.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,431.49 |
| Max. Negotiated Rate |
$17,380.78 |
| Rate for Payer: Aetna Commercial |
$13,940.83
|
| Rate for Payer: Anthem Medicaid |
$6,226.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,121.88
|
| Rate for Payer: Cash Price |
$9,052.49
|
| Rate for Payer: Cigna Commercial |
$15,027.13
|
| Rate for Payer: First Health Commercial |
$17,199.73
|
| Rate for Payer: Humana Commercial |
$15,389.23
|
| Rate for Payer: Humana KY Medicaid |
$6,226.30
|
| Rate for Payer: Kentucky WC Medicaid |
$6,289.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,846.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,361.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,431.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,351.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,932.38
|
| Rate for Payer: Ohio Health Group HMO |
$13,578.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,483.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,751.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,492.44
|
| Rate for Payer: PHCS Commercial |
$17,380.78
|
| Rate for Payer: United Healthcare All Payer |
$15,932.38
|
|
|
LINER LGVITY CONSTRAINED MM 36
|
Facility
|
IP
|
$18,104.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,431.49 |
| Max. Negotiated Rate |
$17,380.78 |
| Rate for Payer: Aetna Commercial |
$13,940.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,121.88
|
| Rate for Payer: Cash Price |
$9,052.49
|
| Rate for Payer: Cigna Commercial |
$15,027.13
|
| Rate for Payer: First Health Commercial |
$17,199.73
|
| Rate for Payer: Humana Commercial |
$15,389.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,846.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,361.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,431.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,932.38
|
| Rate for Payer: Ohio Health Group HMO |
$13,578.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,483.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,751.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,492.44
|
| Rate for Payer: PHCS Commercial |
$17,380.78
|
| Rate for Payer: United Healthcare All Payer |
$15,932.38
|
|
|
LINER LGVITY CONSTRAINED NN 32
|
Facility
|
IP
|
$18,104.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,431.49 |
| Max. Negotiated Rate |
$17,380.78 |
| Rate for Payer: Aetna Commercial |
$13,940.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,121.88
|
| Rate for Payer: Cash Price |
$9,052.49
|
| Rate for Payer: Cigna Commercial |
$15,027.13
|
| Rate for Payer: First Health Commercial |
$17,199.73
|
| Rate for Payer: Humana Commercial |
$15,389.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,846.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,361.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,431.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,932.38
|
| Rate for Payer: Ohio Health Group HMO |
$13,578.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,483.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,751.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,492.44
|
| Rate for Payer: PHCS Commercial |
$17,380.78
|
| Rate for Payer: United Healthcare All Payer |
$15,932.38
|
|
|
LINER LGVITY CONSTRAINED NN 32
|
Facility
|
OP
|
$18,104.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,431.49 |
| Max. Negotiated Rate |
$17,380.78 |
| Rate for Payer: Aetna Commercial |
$13,940.83
|
| Rate for Payer: Anthem Medicaid |
$6,226.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,121.88
|
| Rate for Payer: Cash Price |
$9,052.49
|
| Rate for Payer: Cigna Commercial |
$15,027.13
|
| Rate for Payer: First Health Commercial |
$17,199.73
|
| Rate for Payer: Humana Commercial |
$15,389.23
|
| Rate for Payer: Humana KY Medicaid |
$6,226.30
|
| Rate for Payer: Kentucky WC Medicaid |
$6,289.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,846.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,361.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,431.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,351.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,932.38
|
| Rate for Payer: Ohio Health Group HMO |
$13,578.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,483.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,751.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,492.44
|
| Rate for Payer: PHCS Commercial |
$17,380.78
|
| Rate for Payer: United Healthcare All Payer |
$15,932.38
|
|
|
LINER LGVITY CONSTRAINED NN 36
|
Facility
|
OP
|
$18,104.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,431.49 |
| Max. Negotiated Rate |
$17,380.78 |
| Rate for Payer: Aetna Commercial |
$13,940.83
|
| Rate for Payer: Anthem Medicaid |
$6,226.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,121.88
|
| Rate for Payer: Cash Price |
$9,052.49
|
| Rate for Payer: Cigna Commercial |
$15,027.13
|
| Rate for Payer: First Health Commercial |
$17,199.73
|
| Rate for Payer: Humana Commercial |
$15,389.23
|
| Rate for Payer: Humana KY Medicaid |
$6,226.30
|
| Rate for Payer: Kentucky WC Medicaid |
$6,289.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,846.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,361.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,431.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,351.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,932.38
|
| Rate for Payer: Ohio Health Group HMO |
$13,578.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,483.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,751.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,492.44
|
| Rate for Payer: PHCS Commercial |
$17,380.78
|
| Rate for Payer: United Healthcare All Payer |
$15,932.38
|
|
|
LINER LGVITY CONSTRAINED NN 36
|
Facility
|
IP
|
$18,104.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,431.49 |
| Max. Negotiated Rate |
$17,380.78 |
| Rate for Payer: Aetna Commercial |
$13,940.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,121.88
|
| Rate for Payer: Cash Price |
$9,052.49
|
| Rate for Payer: Cigna Commercial |
$15,027.13
|
| Rate for Payer: First Health Commercial |
$17,199.73
|
| Rate for Payer: Humana Commercial |
$15,389.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,846.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,361.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,431.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,932.38
|
| Rate for Payer: Ohio Health Group HMO |
$13,578.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,483.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,751.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,492.44
|
| Rate for Payer: PHCS Commercial |
$17,380.78
|
| Rate for Payer: United Healthcare All Payer |
$15,932.38
|
|
|
LINER LGVITY CONSTRAINED OO 32
|
Facility
|
IP
|
$18,104.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,431.49 |
| Max. Negotiated Rate |
$17,380.78 |
| Rate for Payer: Aetna Commercial |
$13,940.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,121.88
|
| Rate for Payer: Cash Price |
$9,052.49
|
| Rate for Payer: Cigna Commercial |
$15,027.13
|
| Rate for Payer: First Health Commercial |
$17,199.73
|
| Rate for Payer: Humana Commercial |
$15,389.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,846.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,361.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,431.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,932.38
|
| Rate for Payer: Ohio Health Group HMO |
$13,578.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,483.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,751.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,492.44
|
| Rate for Payer: PHCS Commercial |
$17,380.78
|
| Rate for Payer: United Healthcare All Payer |
$15,932.38
|
|
|
LINER LGVITY CONSTRAINED OO 32
|
Facility
|
OP
|
$18,104.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,431.49 |
| Max. Negotiated Rate |
$17,380.78 |
| Rate for Payer: Aetna Commercial |
$13,940.83
|
| Rate for Payer: Anthem Medicaid |
$6,226.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,121.88
|
| Rate for Payer: Cash Price |
$9,052.49
|
| Rate for Payer: Cigna Commercial |
$15,027.13
|
| Rate for Payer: First Health Commercial |
$17,199.73
|
| Rate for Payer: Humana Commercial |
$15,389.23
|
| Rate for Payer: Humana KY Medicaid |
$6,226.30
|
| Rate for Payer: Kentucky WC Medicaid |
$6,289.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,846.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,361.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,431.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,351.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,932.38
|
| Rate for Payer: Ohio Health Group HMO |
$13,578.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,483.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,751.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,492.44
|
| Rate for Payer: PHCS Commercial |
$17,380.78
|
| Rate for Payer: United Healthcare All Payer |
$15,932.38
|
|
|
LINER LGVITY CONSTRAINED OO 36
|
Facility
|
OP
|
$18,104.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,431.49 |
| Max. Negotiated Rate |
$17,380.78 |
| Rate for Payer: Aetna Commercial |
$13,940.83
|
| Rate for Payer: Anthem Medicaid |
$6,226.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,121.88
|
| Rate for Payer: Cash Price |
$9,052.49
|
| Rate for Payer: Cigna Commercial |
$15,027.13
|
| Rate for Payer: First Health Commercial |
$17,199.73
|
| Rate for Payer: Humana Commercial |
$15,389.23
|
| Rate for Payer: Humana KY Medicaid |
$6,226.30
|
| Rate for Payer: Kentucky WC Medicaid |
$6,289.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,846.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,361.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,431.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,351.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,932.38
|
| Rate for Payer: Ohio Health Group HMO |
$13,578.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,483.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,751.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,492.44
|
| Rate for Payer: PHCS Commercial |
$17,380.78
|
| Rate for Payer: United Healthcare All Payer |
$15,932.38
|
|
|
LINER LGVITY CONSTRAINED OO 36
|
Facility
|
IP
|
$18,104.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,431.49 |
| Max. Negotiated Rate |
$17,380.78 |
| Rate for Payer: Aetna Commercial |
$13,940.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,121.88
|
| Rate for Payer: Cash Price |
$9,052.49
|
| Rate for Payer: Cigna Commercial |
$15,027.13
|
| Rate for Payer: First Health Commercial |
$17,199.73
|
| Rate for Payer: Humana Commercial |
$15,389.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,846.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,361.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,431.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,932.38
|
| Rate for Payer: Ohio Health Group HMO |
$13,578.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,483.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,751.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,492.44
|
| Rate for Payer: PHCS Commercial |
$17,380.78
|
| Rate for Payer: United Healthcare All Payer |
$15,932.38
|
|
|
LINER LGVITY CONSTRAINED PP 32
|
Facility
|
OP
|
$18,104.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,431.49 |
| Max. Negotiated Rate |
$17,380.78 |
| Rate for Payer: Aetna Commercial |
$13,940.83
|
| Rate for Payer: Anthem Medicaid |
$6,226.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,121.88
|
| Rate for Payer: Cash Price |
$9,052.49
|
| Rate for Payer: Cigna Commercial |
$15,027.13
|
| Rate for Payer: First Health Commercial |
$17,199.73
|
| Rate for Payer: Humana Commercial |
$15,389.23
|
| Rate for Payer: Humana KY Medicaid |
$6,226.30
|
| Rate for Payer: Kentucky WC Medicaid |
$6,289.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,846.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,361.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,431.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,351.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,932.38
|
| Rate for Payer: Ohio Health Group HMO |
$13,578.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,483.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,751.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,492.44
|
| Rate for Payer: PHCS Commercial |
$17,380.78
|
| Rate for Payer: United Healthcare All Payer |
$15,932.38
|
|
|
LINER LGVITY CONSTRAINED PP 32
|
Facility
|
IP
|
$18,104.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,431.49 |
| Max. Negotiated Rate |
$17,380.78 |
| Rate for Payer: Aetna Commercial |
$13,940.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,121.88
|
| Rate for Payer: Cash Price |
$9,052.49
|
| Rate for Payer: Cigna Commercial |
$15,027.13
|
| Rate for Payer: First Health Commercial |
$17,199.73
|
| Rate for Payer: Humana Commercial |
$15,389.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,846.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,361.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,431.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,932.38
|
| Rate for Payer: Ohio Health Group HMO |
$13,578.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,483.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,751.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,492.44
|
| Rate for Payer: PHCS Commercial |
$17,380.78
|
| Rate for Payer: United Healthcare All Payer |
$15,932.38
|
|
|
LINER LGVITY CONSTRAINED PP 36
|
Facility
|
OP
|
$18,104.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,431.49 |
| Max. Negotiated Rate |
$17,380.78 |
| Rate for Payer: Aetna Commercial |
$13,940.83
|
| Rate for Payer: Anthem Medicaid |
$6,226.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,121.88
|
| Rate for Payer: Cash Price |
$9,052.49
|
| Rate for Payer: Cigna Commercial |
$15,027.13
|
| Rate for Payer: First Health Commercial |
$17,199.73
|
| Rate for Payer: Humana Commercial |
$15,389.23
|
| Rate for Payer: Humana KY Medicaid |
$6,226.30
|
| Rate for Payer: Kentucky WC Medicaid |
$6,289.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,846.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,361.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,431.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,351.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,932.38
|
| Rate for Payer: Ohio Health Group HMO |
$13,578.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,483.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,751.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,492.44
|
| Rate for Payer: PHCS Commercial |
$17,380.78
|
| Rate for Payer: United Healthcare All Payer |
$15,932.38
|
|
|
LINER LGVITY CONSTRAINED PP 36
|
Facility
|
IP
|
$18,104.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,431.49 |
| Max. Negotiated Rate |
$17,380.78 |
| Rate for Payer: Aetna Commercial |
$13,940.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,121.88
|
| Rate for Payer: Cash Price |
$9,052.49
|
| Rate for Payer: Cigna Commercial |
$15,027.13
|
| Rate for Payer: First Health Commercial |
$17,199.73
|
| Rate for Payer: Humana Commercial |
$15,389.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,846.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,361.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,431.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,932.38
|
| Rate for Payer: Ohio Health Group HMO |
$13,578.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,483.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,751.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,492.44
|
| Rate for Payer: PHCS Commercial |
$17,380.78
|
| Rate for Payer: United Healthcare All Payer |
$15,932.38
|
|
|
LINER LGVITY CONSTRAINED QU 32
|
Facility
|
OP
|
$18,104.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,431.49 |
| Max. Negotiated Rate |
$17,380.78 |
| Rate for Payer: Aetna Commercial |
$13,940.83
|
| Rate for Payer: Anthem Medicaid |
$6,226.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,121.88
|
| Rate for Payer: Cash Price |
$9,052.49
|
| Rate for Payer: Cigna Commercial |
$15,027.13
|
| Rate for Payer: First Health Commercial |
$17,199.73
|
| Rate for Payer: Humana Commercial |
$15,389.23
|
| Rate for Payer: Humana KY Medicaid |
$6,226.30
|
| Rate for Payer: Kentucky WC Medicaid |
$6,289.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,846.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,361.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,431.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,351.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,932.38
|
| Rate for Payer: Ohio Health Group HMO |
$13,578.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,483.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,751.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,492.44
|
| Rate for Payer: PHCS Commercial |
$17,380.78
|
| Rate for Payer: United Healthcare All Payer |
$15,932.38
|
|
|
LINER LGVITY CONSTRAINED QU 32
|
Facility
|
IP
|
$18,104.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,431.49 |
| Max. Negotiated Rate |
$17,380.78 |
| Rate for Payer: Aetna Commercial |
$13,940.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,121.88
|
| Rate for Payer: Cash Price |
$9,052.49
|
| Rate for Payer: Cigna Commercial |
$15,027.13
|
| Rate for Payer: First Health Commercial |
$17,199.73
|
| Rate for Payer: Humana Commercial |
$15,389.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,846.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,361.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,431.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,932.38
|
| Rate for Payer: Ohio Health Group HMO |
$13,578.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,483.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,751.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,492.44
|
| Rate for Payer: PHCS Commercial |
$17,380.78
|
| Rate for Payer: United Healthcare All Payer |
$15,932.38
|
|
|
LINER LGVITY CONSTRAINED QU 36
|
Facility
|
OP
|
$18,104.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,431.49 |
| Max. Negotiated Rate |
$17,380.78 |
| Rate for Payer: Aetna Commercial |
$13,940.83
|
| Rate for Payer: Anthem Medicaid |
$6,226.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,121.88
|
| Rate for Payer: Cash Price |
$9,052.49
|
| Rate for Payer: Cigna Commercial |
$15,027.13
|
| Rate for Payer: First Health Commercial |
$17,199.73
|
| Rate for Payer: Humana Commercial |
$15,389.23
|
| Rate for Payer: Humana KY Medicaid |
$6,226.30
|
| Rate for Payer: Kentucky WC Medicaid |
$6,289.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,846.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,361.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,431.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,351.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,932.38
|
| Rate for Payer: Ohio Health Group HMO |
$13,578.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,483.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,751.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,492.44
|
| Rate for Payer: PHCS Commercial |
$17,380.78
|
| Rate for Payer: United Healthcare All Payer |
$15,932.38
|
|
|
LINER LGVITY CONSTRAINED QU 36
|
Facility
|
IP
|
$18,104.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,431.49 |
| Max. Negotiated Rate |
$17,380.78 |
| Rate for Payer: Aetna Commercial |
$13,940.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,121.88
|
| Rate for Payer: Cash Price |
$9,052.49
|
| Rate for Payer: Cigna Commercial |
$15,027.13
|
| Rate for Payer: First Health Commercial |
$17,199.73
|
| Rate for Payer: Humana Commercial |
$15,389.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,846.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,361.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,431.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,932.38
|
| Rate for Payer: Ohio Health Group HMO |
$13,578.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,483.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,751.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,492.44
|
| Rate for Payer: PHCS Commercial |
$17,380.78
|
| Rate for Payer: United Healthcare All Payer |
$15,932.38
|
|
|
LINER LGVITY CONSTRAINED RR 32
|
Facility
|
OP
|
$18,104.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,431.49 |
| Max. Negotiated Rate |
$17,380.78 |
| Rate for Payer: Aetna Commercial |
$13,940.83
|
| Rate for Payer: Anthem Medicaid |
$6,226.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,121.88
|
| Rate for Payer: Cash Price |
$9,052.49
|
| Rate for Payer: Cigna Commercial |
$15,027.13
|
| Rate for Payer: First Health Commercial |
$17,199.73
|
| Rate for Payer: Humana Commercial |
$15,389.23
|
| Rate for Payer: Humana KY Medicaid |
$6,226.30
|
| Rate for Payer: Kentucky WC Medicaid |
$6,289.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,846.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,361.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,431.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,351.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,932.38
|
| Rate for Payer: Ohio Health Group HMO |
$13,578.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,483.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,751.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,492.44
|
| Rate for Payer: PHCS Commercial |
$17,380.78
|
| Rate for Payer: United Healthcare All Payer |
$15,932.38
|
|
|
LINER LGVITY CONSTRAINED RR 32
|
Facility
|
IP
|
$18,104.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,431.49 |
| Max. Negotiated Rate |
$17,380.78 |
| Rate for Payer: Aetna Commercial |
$13,940.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,121.88
|
| Rate for Payer: Cash Price |
$9,052.49
|
| Rate for Payer: Cigna Commercial |
$15,027.13
|
| Rate for Payer: First Health Commercial |
$17,199.73
|
| Rate for Payer: Humana Commercial |
$15,389.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,846.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,361.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,431.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,932.38
|
| Rate for Payer: Ohio Health Group HMO |
$13,578.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,483.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,751.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,492.44
|
| Rate for Payer: PHCS Commercial |
$17,380.78
|
| Rate for Payer: United Healthcare All Payer |
$15,932.38
|
|
|
LINER LGVITY CONSTRAINED RR 36
|
Facility
|
IP
|
$18,104.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,431.49 |
| Max. Negotiated Rate |
$17,380.78 |
| Rate for Payer: Aetna Commercial |
$13,940.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,121.88
|
| Rate for Payer: Cash Price |
$9,052.49
|
| Rate for Payer: Cigna Commercial |
$15,027.13
|
| Rate for Payer: First Health Commercial |
$17,199.73
|
| Rate for Payer: Humana Commercial |
$15,389.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,846.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,361.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,431.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,932.38
|
| Rate for Payer: Ohio Health Group HMO |
$13,578.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,483.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,751.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,492.44
|
| Rate for Payer: PHCS Commercial |
$17,380.78
|
| Rate for Payer: United Healthcare All Payer |
$15,932.38
|
|
