|
LINER LONGEVITY NEU IT UU 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 LONGEVITY NEU IT UU 40
|
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 NEU IT UU 40
|
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 NEU IT VV 32
|
Facility
|
OP
|
$6,832.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,049.75 |
| Max. Negotiated Rate |
$6,559.20 |
| Rate for Payer: Aetna Commercial |
$5,261.02
|
| Rate for Payer: Anthem Medicaid |
$2,349.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,329.35
|
| Rate for Payer: Cash Price |
$3,416.25
|
| Rate for Payer: Cigna Commercial |
$5,670.98
|
| Rate for Payer: First Health Commercial |
$6,490.88
|
| Rate for Payer: Humana Commercial |
$5,807.62
|
| Rate for Payer: Humana KY Medicaid |
$2,349.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,373.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,602.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,042.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,049.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,396.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,012.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,124.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,466.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,944.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,714.43
|
| Rate for Payer: PHCS Commercial |
$6,559.20
|
| Rate for Payer: United Healthcare All Payer |
$6,012.60
|
|
|
LINER LONGEVITY NEU IT VV 32
|
Facility
|
IP
|
$6,832.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,049.75 |
| Max. Negotiated Rate |
$6,559.20 |
| Rate for Payer: Aetna Commercial |
$5,261.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,329.35
|
| Rate for Payer: Cash Price |
$3,416.25
|
| Rate for Payer: Cigna Commercial |
$5,670.98
|
| Rate for Payer: First Health Commercial |
$6,490.88
|
| Rate for Payer: Humana Commercial |
$5,807.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,602.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,042.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,049.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,012.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,124.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,466.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,944.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,714.43
|
| Rate for Payer: PHCS Commercial |
$6,559.20
|
| Rate for Payer: United Healthcare All Payer |
$6,012.60
|
|
|
LINER LONGEVITY NEU IT VV 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 LONGEVITY NEU IT VV 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 LONGEVITY NEU IT VV 40
|
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 NEU IT VV 40
|
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 OFFSET7MM FF28
|
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 LONGEVITY OFFSET7MM FF28
|
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 OFFSET7MM UU32
|
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 LONGEVITY OFFSET7MM UU32
|
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 OFFSET7MM UU36
|
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 OFFSET7MM UU36
|
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 LONGVITY CONSTRAIN KK 28
|
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 LONGVITY CONSTRAIN KK 28
|
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 MDM 36MM C
|
Facility
|
IP
|
$11,353.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,406.14 |
| Max. Negotiated Rate |
$10,899.65 |
| Rate for Payer: Aetna Commercial |
$8,742.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,855.96
|
| Rate for Payer: Cash Price |
$5,676.90
|
| Rate for Payer: Cigna Commercial |
$9,423.65
|
| Rate for Payer: First Health Commercial |
$10,786.11
|
| Rate for Payer: Humana Commercial |
$9,650.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,310.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,379.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,406.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,991.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,515.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,083.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,877.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,834.12
|
| Rate for Payer: PHCS Commercial |
$10,899.65
|
| Rate for Payer: United Healthcare All Payer |
$9,991.34
|
|
|
LINER MDM 36MM C
|
Facility
|
OP
|
$11,353.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,406.14 |
| Max. Negotiated Rate |
$10,899.65 |
| Rate for Payer: Aetna Commercial |
$8,742.43
|
| Rate for Payer: Anthem Medicaid |
$3,904.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,855.96
|
| Rate for Payer: Cash Price |
$5,676.90
|
| Rate for Payer: Cigna Commercial |
$9,423.65
|
| Rate for Payer: First Health Commercial |
$10,786.11
|
| Rate for Payer: Humana Commercial |
$9,650.73
|
| Rate for Payer: Humana KY Medicaid |
$3,904.57
|
| Rate for Payer: Kentucky WC Medicaid |
$3,944.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,310.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,379.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,406.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,982.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,991.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,515.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,083.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,877.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,834.12
|
| Rate for Payer: PHCS Commercial |
$10,899.65
|
| Rate for Payer: United Healthcare All Payer |
$9,991.34
|
|
|
LINER MDM 38MM D
|
Facility
|
IP
|
$11,353.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,406.14 |
| Max. Negotiated Rate |
$10,899.65 |
| Rate for Payer: Aetna Commercial |
$8,742.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,855.96
|
| Rate for Payer: Cash Price |
$5,676.90
|
| Rate for Payer: Cigna Commercial |
$9,423.65
|
| Rate for Payer: First Health Commercial |
$10,786.11
|
| Rate for Payer: Humana Commercial |
$9,650.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,310.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,379.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,406.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,991.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,515.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,083.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,877.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,834.12
|
| Rate for Payer: PHCS Commercial |
$10,899.65
|
| Rate for Payer: United Healthcare All Payer |
$9,991.34
|
|
|
LINER MDM 38MM D
|
Facility
|
OP
|
$11,353.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,406.14 |
| Max. Negotiated Rate |
$10,899.65 |
| Rate for Payer: Aetna Commercial |
$8,742.43
|
| Rate for Payer: Anthem Medicaid |
$3,904.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,855.96
|
| Rate for Payer: Cash Price |
$5,676.90
|
| Rate for Payer: Cigna Commercial |
$9,423.65
|
| Rate for Payer: First Health Commercial |
$10,786.11
|
| Rate for Payer: Humana Commercial |
$9,650.73
|
| Rate for Payer: Humana KY Medicaid |
$3,904.57
|
| Rate for Payer: Kentucky WC Medicaid |
$3,944.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,310.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,379.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,406.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,982.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,991.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,515.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,083.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,877.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,834.12
|
| Rate for Payer: PHCS Commercial |
$10,899.65
|
| Rate for Payer: United Healthcare All Payer |
$9,991.34
|
|
|
LINER MDM 42MM E
|
Facility
|
OP
|
$11,353.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,406.14 |
| Max. Negotiated Rate |
$10,899.65 |
| Rate for Payer: Aetna Commercial |
$8,742.43
|
| Rate for Payer: Anthem Medicaid |
$3,904.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,855.96
|
| Rate for Payer: Cash Price |
$5,676.90
|
| Rate for Payer: Cigna Commercial |
$9,423.65
|
| Rate for Payer: First Health Commercial |
$10,786.11
|
| Rate for Payer: Humana Commercial |
$9,650.73
|
| Rate for Payer: Humana KY Medicaid |
$3,904.57
|
| Rate for Payer: Kentucky WC Medicaid |
$3,944.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,310.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,379.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,406.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,982.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,991.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,515.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,083.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,877.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,834.12
|
| Rate for Payer: PHCS Commercial |
$10,899.65
|
| Rate for Payer: United Healthcare All Payer |
$9,991.34
|
|
|
LINER MDM 42MM E
|
Facility
|
IP
|
$11,353.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,406.14 |
| Max. Negotiated Rate |
$10,899.65 |
| Rate for Payer: Aetna Commercial |
$8,742.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,855.96
|
| Rate for Payer: Cash Price |
$5,676.90
|
| Rate for Payer: Cigna Commercial |
$9,423.65
|
| Rate for Payer: First Health Commercial |
$10,786.11
|
| Rate for Payer: Humana Commercial |
$9,650.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,310.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,379.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,406.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,991.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,515.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,083.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,877.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,834.12
|
| Rate for Payer: PHCS Commercial |
$10,899.65
|
| Rate for Payer: United Healthcare All Payer |
$9,991.34
|
|
|
LINER MDM 46MM F
|
Facility
|
OP
|
$11,353.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,406.14 |
| Max. Negotiated Rate |
$10,899.65 |
| Rate for Payer: Aetna Commercial |
$8,742.43
|
| Rate for Payer: Anthem Medicaid |
$3,904.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,855.96
|
| Rate for Payer: Cash Price |
$5,676.90
|
| Rate for Payer: Cigna Commercial |
$9,423.65
|
| Rate for Payer: First Health Commercial |
$10,786.11
|
| Rate for Payer: Humana Commercial |
$9,650.73
|
| Rate for Payer: Humana KY Medicaid |
$3,904.57
|
| Rate for Payer: Kentucky WC Medicaid |
$3,944.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,310.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,379.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,406.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,982.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,991.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,515.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,083.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,877.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,834.12
|
| Rate for Payer: PHCS Commercial |
$10,899.65
|
| Rate for Payer: United Healthcare All Payer |
$9,991.34
|
|
|
LINER MDM 46MM F
|
Facility
|
IP
|
$11,353.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,406.14 |
| Max. Negotiated Rate |
$10,899.65 |
| Rate for Payer: Aetna Commercial |
$8,742.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,855.96
|
| Rate for Payer: Cash Price |
$5,676.90
|
| Rate for Payer: Cigna Commercial |
$9,423.65
|
| Rate for Payer: First Health Commercial |
$10,786.11
|
| Rate for Payer: Humana Commercial |
$9,650.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,310.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,379.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,406.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,991.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,515.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,083.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,877.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,834.12
|
| Rate for Payer: PHCS Commercial |
$10,899.65
|
| Rate for Payer: United Healthcare All Payer |
$9,991.34
|
|
