|
LINER LNGEVITY OFFST 7MM TT 32
|
Facility
|
OP
|
$6,814.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,044.28 |
| Max. Negotiated Rate |
$6,541.68 |
| Rate for Payer: Aetna Commercial |
$5,246.97
|
| Rate for Payer: Anthem Medicaid |
$2,343.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.11
|
| Rate for Payer: Cash Price |
$3,407.12
|
| Rate for Payer: Cigna Commercial |
$5,655.83
|
| Rate for Payer: First Health Commercial |
$6,473.54
|
| Rate for Payer: Humana Commercial |
$5,792.11
|
| Rate for Payer: Humana KY Medicaid |
$2,343.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,367.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,587.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,028.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,390.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,996.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,110.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,451.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,928.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,701.83
|
| Rate for Payer: PHCS Commercial |
$6,541.68
|
| Rate for Payer: United Healthcare All Payer |
$5,996.54
|
|
|
LINER LNGEVITY OFFST 7MM TT 36
|
Facility
|
OP
|
$7,507.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,252.32 |
| Max. Negotiated Rate |
$7,207.44 |
| Rate for Payer: Aetna Commercial |
$5,780.97
|
| Rate for Payer: Anthem Medicaid |
$2,581.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,856.05
|
| Rate for Payer: Cash Price |
$3,753.88
|
| Rate for Payer: Cigna Commercial |
$6,231.43
|
| Rate for Payer: First Health Commercial |
$7,132.36
|
| Rate for Payer: Humana Commercial |
$6,381.59
|
| Rate for Payer: Humana KY Medicaid |
$2,581.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,608.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,156.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,540.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,252.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,633.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,606.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,630.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,006.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,531.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,180.35
|
| Rate for Payer: PHCS Commercial |
$7,207.44
|
| Rate for Payer: United Healthcare All Payer |
$6,606.82
|
|
|
LINER LNGEVITY OFFST 7MM TT 36
|
Facility
|
IP
|
$7,507.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,252.32 |
| Max. Negotiated Rate |
$7,207.44 |
| Rate for Payer: Aetna Commercial |
$5,780.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,856.05
|
| Rate for Payer: Cash Price |
$3,753.88
|
| Rate for Payer: Cigna Commercial |
$6,231.43
|
| Rate for Payer: First Health Commercial |
$7,132.36
|
| Rate for Payer: Humana Commercial |
$6,381.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,156.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,540.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,252.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,606.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,630.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,006.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,531.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,180.35
|
| Rate for Payer: PHCS Commercial |
$7,207.44
|
| Rate for Payer: United Healthcare All Payer |
$6,606.82
|
|
|
LINER LNGEVITY OFFST 7MM UU 32
|
Facility
|
IP
|
$6,814.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,044.28 |
| Max. Negotiated Rate |
$6,541.68 |
| Rate for Payer: Aetna Commercial |
$5,246.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.11
|
| Rate for Payer: Cash Price |
$3,407.12
|
| Rate for Payer: Cigna Commercial |
$5,655.83
|
| Rate for Payer: First Health Commercial |
$6,473.54
|
| Rate for Payer: Humana Commercial |
$5,792.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,587.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,028.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,996.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,110.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,451.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,928.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,701.83
|
| Rate for Payer: PHCS Commercial |
$6,541.68
|
| Rate for Payer: United Healthcare All Payer |
$5,996.54
|
|
|
LINER LNGEVITY OFFST 7MM UU 32
|
Facility
|
OP
|
$6,814.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,044.28 |
| Max. Negotiated Rate |
$6,541.68 |
| Rate for Payer: Aetna Commercial |
$5,246.97
|
| Rate for Payer: Anthem Medicaid |
$2,343.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.11
|
| Rate for Payer: Cash Price |
$3,407.12
|
| Rate for Payer: Cigna Commercial |
$5,655.83
|
| Rate for Payer: First Health Commercial |
$6,473.54
|
| Rate for Payer: Humana Commercial |
$5,792.11
|
| Rate for Payer: Humana KY Medicaid |
$2,343.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,367.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,587.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,028.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,390.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,996.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,110.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,451.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,928.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,701.83
|
| Rate for Payer: PHCS Commercial |
$6,541.68
|
| Rate for Payer: United Healthcare All Payer |
$5,996.54
|
|
|
LINER LNGEVITY OFFST 7MM UU 36
|
Facility
|
IP
|
$6,814.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,044.28 |
| Max. Negotiated Rate |
$6,541.68 |
| Rate for Payer: Aetna Commercial |
$5,246.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.11
|
| Rate for Payer: Cash Price |
$3,407.12
|
| Rate for Payer: Cigna Commercial |
$5,655.83
|
| Rate for Payer: First Health Commercial |
$6,473.54
|
| Rate for Payer: Humana Commercial |
$5,792.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,587.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,028.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,996.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,110.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,451.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,928.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,701.83
|
| Rate for Payer: PHCS Commercial |
$6,541.68
|
| Rate for Payer: United Healthcare All Payer |
$5,996.54
|
|
|
LINER LNGEVITY OFFST 7MM UU 36
|
Facility
|
OP
|
$6,814.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,044.28 |
| Max. Negotiated Rate |
$6,541.68 |
| Rate for Payer: Aetna Commercial |
$5,246.97
|
| Rate for Payer: Anthem Medicaid |
$2,343.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.11
|
| Rate for Payer: Cash Price |
$3,407.12
|
| Rate for Payer: Cigna Commercial |
$5,655.83
|
| Rate for Payer: First Health Commercial |
$6,473.54
|
| Rate for Payer: Humana Commercial |
$5,792.11
|
| Rate for Payer: Humana KY Medicaid |
$2,343.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,367.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,587.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,028.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,390.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,996.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,110.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,451.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,928.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,701.83
|
| Rate for Payer: PHCS Commercial |
$6,541.68
|
| Rate for Payer: United Healthcare All Payer |
$5,996.54
|
|
|
LINER LONGEVITY ELEV IT CC 22
|
Facility
|
OP
|
$7,507.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,252.32 |
| Max. Negotiated Rate |
$7,207.44 |
| Rate for Payer: Aetna Commercial |
$5,780.97
|
| Rate for Payer: Anthem Medicaid |
$2,581.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,856.05
|
| Rate for Payer: Cash Price |
$3,753.88
|
| Rate for Payer: Cigna Commercial |
$6,231.43
|
| Rate for Payer: First Health Commercial |
$7,132.36
|
| Rate for Payer: Humana Commercial |
$6,381.59
|
| Rate for Payer: Humana KY Medicaid |
$2,581.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,608.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,156.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,540.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,252.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,633.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,606.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,630.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,006.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,531.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,180.35
|
| Rate for Payer: PHCS Commercial |
$7,207.44
|
| Rate for Payer: United Healthcare All Payer |
$6,606.82
|
|
|
LINER LONGEVITY ELEV IT CC 22
|
Facility
|
IP
|
$7,507.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,252.32 |
| Max. Negotiated Rate |
$7,207.44 |
| Rate for Payer: Aetna Commercial |
$5,780.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,856.05
|
| Rate for Payer: Cash Price |
$3,753.88
|
| Rate for Payer: Cigna Commercial |
$6,231.43
|
| Rate for Payer: First Health Commercial |
$7,132.36
|
| Rate for Payer: Humana Commercial |
$6,381.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,156.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,540.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,252.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,606.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,630.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,006.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,531.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,180.35
|
| Rate for Payer: PHCS Commercial |
$7,207.44
|
| Rate for Payer: United Healthcare All Payer |
$6,606.82
|
|
|
LINER LONGEVITY ELEV IT DD 22
|
Facility
|
IP
|
$7,507.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,252.32 |
| Max. Negotiated Rate |
$7,207.44 |
| Rate for Payer: Aetna Commercial |
$5,780.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,856.05
|
| Rate for Payer: Cash Price |
$3,753.88
|
| Rate for Payer: Cigna Commercial |
$6,231.43
|
| Rate for Payer: First Health Commercial |
$7,132.36
|
| Rate for Payer: Humana Commercial |
$6,381.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,156.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,540.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,252.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,606.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,630.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,006.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,531.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,180.35
|
| Rate for Payer: PHCS Commercial |
$7,207.44
|
| Rate for Payer: United Healthcare All Payer |
$6,606.82
|
|
|
LINER LONGEVITY ELEV IT DD 22
|
Facility
|
OP
|
$7,507.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,252.32 |
| Max. Negotiated Rate |
$7,207.44 |
| Rate for Payer: Aetna Commercial |
$5,780.97
|
| Rate for Payer: Anthem Medicaid |
$2,581.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,856.05
|
| Rate for Payer: Cash Price |
$3,753.88
|
| Rate for Payer: Cigna Commercial |
$6,231.43
|
| Rate for Payer: First Health Commercial |
$7,132.36
|
| Rate for Payer: Humana Commercial |
$6,381.59
|
| Rate for Payer: Humana KY Medicaid |
$2,581.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,608.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,156.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,540.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,252.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,633.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,606.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,630.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,006.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,531.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,180.35
|
| Rate for Payer: PHCS Commercial |
$7,207.44
|
| Rate for Payer: United Healthcare All Payer |
$6,606.82
|
|
|
LINER LONGEVITY ELEV IT EE 22
|
Facility
|
IP
|
$7,507.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,252.32 |
| Max. Negotiated Rate |
$7,207.44 |
| Rate for Payer: Aetna Commercial |
$5,780.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,856.05
|
| Rate for Payer: Cash Price |
$3,753.88
|
| Rate for Payer: Cigna Commercial |
$6,231.43
|
| Rate for Payer: First Health Commercial |
$7,132.36
|
| Rate for Payer: Humana Commercial |
$6,381.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,156.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,540.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,252.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,606.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,630.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,006.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,531.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,180.35
|
| Rate for Payer: PHCS Commercial |
$7,207.44
|
| Rate for Payer: United Healthcare All Payer |
$6,606.82
|
|
|
LINER LONGEVITY ELEV IT EE 22
|
Facility
|
OP
|
$7,507.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,252.32 |
| Max. Negotiated Rate |
$7,207.44 |
| Rate for Payer: Aetna Commercial |
$5,780.97
|
| Rate for Payer: Anthem Medicaid |
$2,581.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,856.05
|
| Rate for Payer: Cash Price |
$3,753.88
|
| Rate for Payer: Cigna Commercial |
$6,231.43
|
| Rate for Payer: First Health Commercial |
$7,132.36
|
| Rate for Payer: Humana Commercial |
$6,381.59
|
| Rate for Payer: Humana KY Medicaid |
$2,581.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,608.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,156.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,540.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,252.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,633.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,606.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,630.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,006.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,531.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,180.35
|
| Rate for Payer: PHCS Commercial |
$7,207.44
|
| Rate for Payer: United Healthcare All Payer |
$6,606.82
|
|
|
LINER LONGEVITY ELEV IT EE 28
|
Facility
|
OP
|
$7,507.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,252.32 |
| Max. Negotiated Rate |
$7,207.44 |
| Rate for Payer: Aetna Commercial |
$5,780.97
|
| Rate for Payer: Anthem Medicaid |
$2,581.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,856.05
|
| Rate for Payer: Cash Price |
$3,753.88
|
| Rate for Payer: Cigna Commercial |
$6,231.43
|
| Rate for Payer: First Health Commercial |
$7,132.36
|
| Rate for Payer: Humana Commercial |
$6,381.59
|
| Rate for Payer: Humana KY Medicaid |
$2,581.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,608.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,156.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,540.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,252.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,633.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,606.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,630.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,006.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,531.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,180.35
|
| Rate for Payer: PHCS Commercial |
$7,207.44
|
| Rate for Payer: United Healthcare All Payer |
$6,606.82
|
|
|
LINER LONGEVITY ELEV IT EE 28
|
Facility
|
IP
|
$7,507.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,252.32 |
| Max. Negotiated Rate |
$7,207.44 |
| Rate for Payer: Aetna Commercial |
$5,780.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,856.05
|
| Rate for Payer: Cash Price |
$3,753.88
|
| Rate for Payer: Cigna Commercial |
$6,231.43
|
| Rate for Payer: First Health Commercial |
$7,132.36
|
| Rate for Payer: Humana Commercial |
$6,381.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,156.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,540.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,252.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,606.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,630.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,006.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,531.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,180.35
|
| Rate for Payer: PHCS Commercial |
$7,207.44
|
| Rate for Payer: United Healthcare All Payer |
$6,606.82
|
|
|
LINER LONGEVITY ELEV IT FF22
|
Facility
|
IP
|
$7,507.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,252.32 |
| Max. Negotiated Rate |
$7,207.44 |
| Rate for Payer: Aetna Commercial |
$5,780.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,856.05
|
| Rate for Payer: Cash Price |
$3,753.88
|
| Rate for Payer: Cigna Commercial |
$6,231.43
|
| Rate for Payer: First Health Commercial |
$7,132.36
|
| Rate for Payer: Humana Commercial |
$6,381.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,156.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,540.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,252.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,606.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,630.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,006.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,531.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,180.35
|
| Rate for Payer: PHCS Commercial |
$7,207.44
|
| Rate for Payer: United Healthcare All Payer |
$6,606.82
|
|
|
LINER LONGEVITY ELEV IT FF22
|
Facility
|
OP
|
$7,507.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,252.32 |
| Max. Negotiated Rate |
$7,207.44 |
| Rate for Payer: Aetna Commercial |
$5,780.97
|
| Rate for Payer: Anthem Medicaid |
$2,581.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,856.05
|
| Rate for Payer: Cash Price |
$3,753.88
|
| Rate for Payer: Cigna Commercial |
$6,231.43
|
| Rate for Payer: First Health Commercial |
$7,132.36
|
| Rate for Payer: Humana Commercial |
$6,381.59
|
| Rate for Payer: Humana KY Medicaid |
$2,581.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,608.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,156.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,540.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,252.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,633.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,606.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,630.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,006.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,531.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,180.35
|
| Rate for Payer: PHCS Commercial |
$7,207.44
|
| Rate for Payer: United Healthcare All Payer |
$6,606.82
|
|
|
LINER LONGEVITY ELEV IT FF28
|
Facility
|
OP
|
$7,507.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,252.32 |
| Max. Negotiated Rate |
$7,207.44 |
| Rate for Payer: Aetna Commercial |
$5,780.97
|
| Rate for Payer: Anthem Medicaid |
$2,581.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,856.05
|
| Rate for Payer: Cash Price |
$3,753.88
|
| Rate for Payer: Cigna Commercial |
$6,231.43
|
| Rate for Payer: First Health Commercial |
$7,132.36
|
| Rate for Payer: Humana Commercial |
$6,381.59
|
| Rate for Payer: Humana KY Medicaid |
$2,581.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,608.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,156.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,540.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,252.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,633.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,606.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,630.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,006.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,531.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,180.35
|
| Rate for Payer: PHCS Commercial |
$7,207.44
|
| Rate for Payer: United Healthcare All Payer |
$6,606.82
|
|
|
LINER LONGEVITY ELEV IT FF28
|
Facility
|
IP
|
$7,507.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,252.32 |
| Max. Negotiated Rate |
$7,207.44 |
| Rate for Payer: Aetna Commercial |
$5,780.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,856.05
|
| Rate for Payer: Cash Price |
$3,753.88
|
| Rate for Payer: Cigna Commercial |
$6,231.43
|
| Rate for Payer: First Health Commercial |
$7,132.36
|
| Rate for Payer: Humana Commercial |
$6,381.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,156.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,540.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,252.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,606.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,630.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,006.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,531.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,180.35
|
| Rate for Payer: PHCS Commercial |
$7,207.44
|
| Rate for Payer: United Healthcare All Payer |
$6,606.82
|
|
|
LINER LONGEVITY ELEV IT GG28
|
Facility
|
OP
|
$7,507.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,252.32 |
| Max. Negotiated Rate |
$7,207.44 |
| Rate for Payer: Aetna Commercial |
$5,780.97
|
| Rate for Payer: Anthem Medicaid |
$2,581.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,856.05
|
| Rate for Payer: Cash Price |
$3,753.88
|
| Rate for Payer: Cigna Commercial |
$6,231.43
|
| Rate for Payer: First Health Commercial |
$7,132.36
|
| Rate for Payer: Humana Commercial |
$6,381.59
|
| Rate for Payer: Humana KY Medicaid |
$2,581.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,608.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,156.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,540.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,252.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,633.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,606.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,630.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,006.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,531.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,180.35
|
| Rate for Payer: PHCS Commercial |
$7,207.44
|
| Rate for Payer: United Healthcare All Payer |
$6,606.82
|
|
|
LINER LONGEVITY ELEV IT GG28
|
Facility
|
IP
|
$7,507.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,252.32 |
| Max. Negotiated Rate |
$7,207.44 |
| Rate for Payer: Aetna Commercial |
$5,780.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,856.05
|
| Rate for Payer: Cash Price |
$3,753.88
|
| Rate for Payer: Cigna Commercial |
$6,231.43
|
| Rate for Payer: First Health Commercial |
$7,132.36
|
| Rate for Payer: Humana Commercial |
$6,381.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,156.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,540.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,252.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,606.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,630.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,006.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,531.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,180.35
|
| Rate for Payer: PHCS Commercial |
$7,207.44
|
| Rate for Payer: United Healthcare All Payer |
$6,606.82
|
|
|
LINER LONGEVITY ELEV IT GG 32
|
Facility
|
OP
|
$7,507.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,252.32 |
| Max. Negotiated Rate |
$7,207.44 |
| Rate for Payer: Aetna Commercial |
$5,780.97
|
| Rate for Payer: Anthem Medicaid |
$2,581.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,856.05
|
| Rate for Payer: Cash Price |
$3,753.88
|
| Rate for Payer: Cigna Commercial |
$6,231.43
|
| Rate for Payer: First Health Commercial |
$7,132.36
|
| Rate for Payer: Humana Commercial |
$6,381.59
|
| Rate for Payer: Humana KY Medicaid |
$2,581.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,608.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,156.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,540.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,252.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,633.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,606.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,630.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,006.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,531.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,180.35
|
| Rate for Payer: PHCS Commercial |
$7,207.44
|
| Rate for Payer: United Healthcare All Payer |
$6,606.82
|
|
|
LINER LONGEVITY ELEV IT GG 32
|
Facility
|
IP
|
$7,507.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,252.32 |
| Max. Negotiated Rate |
$7,207.44 |
| Rate for Payer: Aetna Commercial |
$5,780.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,856.05
|
| Rate for Payer: Cash Price |
$3,753.88
|
| Rate for Payer: Cigna Commercial |
$6,231.43
|
| Rate for Payer: First Health Commercial |
$7,132.36
|
| Rate for Payer: Humana Commercial |
$6,381.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,156.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,540.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,252.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,606.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,630.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,006.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,531.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,180.35
|
| Rate for Payer: PHCS Commercial |
$7,207.44
|
| Rate for Payer: United Healthcare All Payer |
$6,606.82
|
|
|
LINER LONGEVITY ELEV IT HH 28
|
Facility
|
OP
|
$7,507.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,252.32 |
| Max. Negotiated Rate |
$7,207.44 |
| Rate for Payer: Aetna Commercial |
$5,780.97
|
| Rate for Payer: Anthem Medicaid |
$2,581.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,856.05
|
| Rate for Payer: Cash Price |
$3,753.88
|
| Rate for Payer: Cigna Commercial |
$6,231.43
|
| Rate for Payer: First Health Commercial |
$7,132.36
|
| Rate for Payer: Humana Commercial |
$6,381.59
|
| Rate for Payer: Humana KY Medicaid |
$2,581.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,608.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,156.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,540.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,252.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,633.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,606.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,630.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,006.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,531.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,180.35
|
| Rate for Payer: PHCS Commercial |
$7,207.44
|
| Rate for Payer: United Healthcare All Payer |
$6,606.82
|
|
|
LINER LONGEVITY ELEV IT HH 28
|
Facility
|
IP
|
$7,507.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,252.32 |
| Max. Negotiated Rate |
$7,207.44 |
| Rate for Payer: Aetna Commercial |
$5,780.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,856.05
|
| Rate for Payer: Cash Price |
$3,753.88
|
| Rate for Payer: Cigna Commercial |
$6,231.43
|
| Rate for Payer: First Health Commercial |
$7,132.36
|
| Rate for Payer: Humana Commercial |
$6,381.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,156.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,540.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,252.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,606.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,630.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,006.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,531.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,180.35
|
| Rate for Payer: PHCS Commercial |
$7,207.44
|
| Rate for Payer: United Healthcare All Payer |
$6,606.82
|
|
