|
LINER DISP TRL 20 DEG28ID 46OD
|
Facility
|
OP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem Medicaid |
$705.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Humana KY Medicaid |
$705.01
|
| Rate for Payer: Kentucky WC Medicaid |
$712.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
|
LINER DISP TRL 20 DEG28ID 48OD
|
Facility
|
OP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem Medicaid |
$705.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Humana KY Medicaid |
$705.01
|
| Rate for Payer: Kentucky WC Medicaid |
$712.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
|
LINER DISP TRL 20 DEG28ID 48OD
|
Facility
|
IP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
|
LINER DISP TRL 20 DEG28ID 50OD
|
Facility
|
IP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
|
LINER DISP TRL 20 DEG28ID 50OD
|
Facility
|
OP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem Medicaid |
$705.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Humana KY Medicaid |
$705.01
|
| Rate for Payer: Kentucky WC Medicaid |
$712.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
|
LINER DISP TRL 20 DEG28ID 52OD
|
Facility
|
OP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem Medicaid |
$705.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Humana KY Medicaid |
$705.01
|
| Rate for Payer: Kentucky WC Medicaid |
$712.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
|
LINER DISP TRL 20 DEG28ID 52OD
|
Facility
|
IP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
|
LINER DISP TRL 20 DEG28ID 54OD
|
Facility
|
IP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
|
LINER DISP TRL 20 DEG28ID 54OD
|
Facility
|
OP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem Medicaid |
$705.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Humana KY Medicaid |
$705.01
|
| Rate for Payer: Kentucky WC Medicaid |
$712.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
|
LINER DISP TRL 20 DEG28ID 56OD
|
Facility
|
OP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem Medicaid |
$705.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Humana KY Medicaid |
$705.01
|
| Rate for Payer: Kentucky WC Medicaid |
$712.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
|
LINER DISP TRL 20 DEG28ID 56OD
|
Facility
|
IP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
|
LINER DISP TRL 20 DEG28ID 58OD
|
Facility
|
OP
|
$1,929.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$250.85 |
| Max. Negotiated Rate |
$1,852.42 |
| Rate for Payer: Aetna Commercial |
$1,485.79
|
| Rate for Payer: Anthem Medicaid |
$663.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,505.09
|
| Rate for Payer: Cash Price |
$964.80
|
| Rate for Payer: Cigna Commercial |
$1,601.57
|
| Rate for Payer: First Health Commercial |
$1,833.12
|
| Rate for Payer: Humana Commercial |
$1,640.16
|
| Rate for Payer: Humana KY Medicaid |
$663.59
|
| Rate for Payer: Kentucky WC Medicaid |
$670.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,582.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,424.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$578.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$676.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,698.05
|
| Rate for Payer: Ohio Health Group HMO |
$1,447.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$598.18
|
| Rate for Payer: PHCS Commercial |
$1,852.42
|
| Rate for Payer: United Healthcare All Payer |
$1,698.05
|
|
|
LINER DISP TRL 20 DEG28ID 58OD
|
Facility
|
IP
|
$1,929.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$250.85 |
| Max. Negotiated Rate |
$1,852.42 |
| Rate for Payer: Aetna Commercial |
$1,485.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,505.09
|
| Rate for Payer: Cash Price |
$964.80
|
| Rate for Payer: Cigna Commercial |
$1,601.57
|
| Rate for Payer: First Health Commercial |
$1,833.12
|
| Rate for Payer: Humana Commercial |
$1,640.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,582.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,424.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$578.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,698.05
|
| Rate for Payer: Ohio Health Group HMO |
$1,447.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$598.18
|
| Rate for Payer: PHCS Commercial |
$1,852.42
|
| Rate for Payer: United Healthcare All Payer |
$1,698.05
|
|
|
LINER DISP TRL 20 DEG28ID 60OD
|
Facility
|
IP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
|
LINER DISP TRL 20 DEG28ID 60OD
|
Facility
|
OP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem Medicaid |
$705.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Humana KY Medicaid |
$705.01
|
| Rate for Payer: Kentucky WC Medicaid |
$712.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
|
LINER DUAL MOBILITY 36/48
|
Facility
|
OP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.38 |
| Max. Negotiated Rate |
$8,820.00 |
| Rate for Payer: Aetna Commercial |
$7,074.38
|
| Rate for Payer: Anthem Medicaid |
$3,159.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,166.25
|
| Rate for Payer: Cash Price |
$4,593.75
|
| Rate for Payer: Cigna Commercial |
$7,625.62
|
| Rate for Payer: First Health Commercial |
$8,728.12
|
| Rate for Payer: Humana Commercial |
$7,809.38
|
| Rate for Payer: Humana KY Medicaid |
$3,159.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,191.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,780.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,222.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,085.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,194.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,848.12
|
| Rate for Payer: PHCS Commercial |
$8,820.00
|
| Rate for Payer: United Healthcare All Payer |
$8,085.00
|
|
|
LINER DUAL MOBILITY 36/48
|
Facility
|
IP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.38 |
| Max. Negotiated Rate |
$8,820.00 |
| Rate for Payer: Aetna Commercial |
$7,074.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,166.25
|
| Rate for Payer: Cash Price |
$4,593.75
|
| Rate for Payer: Cigna Commercial |
$7,625.62
|
| Rate for Payer: First Health Commercial |
$8,728.12
|
| Rate for Payer: Humana Commercial |
$7,809.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,780.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,085.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,194.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,848.12
|
| Rate for Payer: PHCS Commercial |
$8,820.00
|
| Rate for Payer: United Healthcare All Payer |
$8,085.00
|
|
|
LINER DUAL MOBILITY 38/50
|
Facility
|
OP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.38 |
| Max. Negotiated Rate |
$8,820.00 |
| Rate for Payer: Aetna Commercial |
$7,074.38
|
| Rate for Payer: Anthem Medicaid |
$3,159.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,166.25
|
| Rate for Payer: Cash Price |
$4,593.75
|
| Rate for Payer: Cigna Commercial |
$7,625.62
|
| Rate for Payer: First Health Commercial |
$8,728.12
|
| Rate for Payer: Humana Commercial |
$7,809.38
|
| Rate for Payer: Humana KY Medicaid |
$3,159.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,191.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,780.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,222.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,085.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,194.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,848.12
|
| Rate for Payer: PHCS Commercial |
$8,820.00
|
| Rate for Payer: United Healthcare All Payer |
$8,085.00
|
|
|
LINER DUAL MOBILITY 38/50
|
Facility
|
IP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.38 |
| Max. Negotiated Rate |
$8,820.00 |
| Rate for Payer: Aetna Commercial |
$7,074.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,166.25
|
| Rate for Payer: Cash Price |
$4,593.75
|
| Rate for Payer: Cigna Commercial |
$7,625.62
|
| Rate for Payer: First Health Commercial |
$8,728.12
|
| Rate for Payer: Humana Commercial |
$7,809.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,780.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,085.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,194.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,848.12
|
| Rate for Payer: PHCS Commercial |
$8,820.00
|
| Rate for Payer: United Healthcare All Payer |
$8,085.00
|
|
|
LINER DUAL MOBILITY 40/52
|
Facility
|
OP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.38 |
| Max. Negotiated Rate |
$8,820.00 |
| Rate for Payer: Aetna Commercial |
$7,074.38
|
| Rate for Payer: Anthem Medicaid |
$3,159.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,166.25
|
| Rate for Payer: Cash Price |
$4,593.75
|
| Rate for Payer: Cigna Commercial |
$7,625.62
|
| Rate for Payer: First Health Commercial |
$8,728.12
|
| Rate for Payer: Humana Commercial |
$7,809.38
|
| Rate for Payer: Humana KY Medicaid |
$3,159.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,191.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,780.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,222.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,085.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,194.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,848.12
|
| Rate for Payer: PHCS Commercial |
$8,820.00
|
| Rate for Payer: United Healthcare All Payer |
$8,085.00
|
|
|
LINER DUAL MOBILITY 40/52
|
Facility
|
IP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.38 |
| Max. Negotiated Rate |
$8,820.00 |
| Rate for Payer: Aetna Commercial |
$7,074.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,166.25
|
| Rate for Payer: Cash Price |
$4,593.75
|
| Rate for Payer: Cigna Commercial |
$7,625.62
|
| Rate for Payer: First Health Commercial |
$8,728.12
|
| Rate for Payer: Humana Commercial |
$7,809.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,780.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,085.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,194.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,848.12
|
| Rate for Payer: PHCS Commercial |
$8,820.00
|
| Rate for Payer: United Healthcare All Payer |
$8,085.00
|
|
|
LINER DUAL MOBILITY 42/54
|
Facility
|
IP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.38 |
| Max. Negotiated Rate |
$8,820.00 |
| Rate for Payer: Aetna Commercial |
$7,074.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,166.25
|
| Rate for Payer: Cash Price |
$4,593.75
|
| Rate for Payer: Cigna Commercial |
$7,625.62
|
| Rate for Payer: First Health Commercial |
$8,728.12
|
| Rate for Payer: Humana Commercial |
$7,809.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,780.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,085.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,194.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,848.12
|
| Rate for Payer: PHCS Commercial |
$8,820.00
|
| Rate for Payer: United Healthcare All Payer |
$8,085.00
|
|
|
LINER DUAL MOBILITY 42/54
|
Facility
|
OP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.38 |
| Max. Negotiated Rate |
$8,820.00 |
| Rate for Payer: Aetna Commercial |
$7,074.38
|
| Rate for Payer: Anthem Medicaid |
$3,159.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,166.25
|
| Rate for Payer: Cash Price |
$4,593.75
|
| Rate for Payer: Cigna Commercial |
$7,625.62
|
| Rate for Payer: First Health Commercial |
$8,728.12
|
| Rate for Payer: Humana Commercial |
$7,809.38
|
| Rate for Payer: Humana KY Medicaid |
$3,159.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,191.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,780.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,222.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,085.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,194.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,848.12
|
| Rate for Payer: PHCS Commercial |
$8,820.00
|
| Rate for Payer: United Healthcare All Payer |
$8,085.00
|
|
|
LINER DUAL MOBILITY 44/56
|
Facility
|
OP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.38 |
| Max. Negotiated Rate |
$8,820.00 |
| Rate for Payer: Aetna Commercial |
$7,074.38
|
| Rate for Payer: Anthem Medicaid |
$3,159.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,166.25
|
| Rate for Payer: Cash Price |
$4,593.75
|
| Rate for Payer: Cigna Commercial |
$7,625.62
|
| Rate for Payer: First Health Commercial |
$8,728.12
|
| Rate for Payer: Humana Commercial |
$7,809.38
|
| Rate for Payer: Humana KY Medicaid |
$3,159.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,191.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,780.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,222.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,085.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,194.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,848.12
|
| Rate for Payer: PHCS Commercial |
$8,820.00
|
| Rate for Payer: United Healthcare All Payer |
$8,085.00
|
|
|
LINER DUAL MOBILITY 44/56
|
Facility
|
IP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.38 |
| Max. Negotiated Rate |
$8,820.00 |
| Rate for Payer: Aetna Commercial |
$7,074.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,166.25
|
| Rate for Payer: Cash Price |
$4,593.75
|
| Rate for Payer: Cigna Commercial |
$7,625.62
|
| Rate for Payer: First Health Commercial |
$8,728.12
|
| Rate for Payer: Humana Commercial |
$7,809.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,780.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,085.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,194.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,848.12
|
| Rate for Payer: PHCS Commercial |
$8,820.00
|
| Rate for Payer: United Healthcare All Payer |
$8,085.00
|
|
