|
LINER DUAL MOBILITY 44/58
|
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 44/58
|
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 46/60
|
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 46/60
|
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 48/62
|
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 48/62
|
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 50/64
|
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 50/64
|
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 52/66-70
|
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 52/66-70
|
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 EPOLY HI WALL 32*23
|
Facility
|
IP
|
$12,060.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,567.80 |
| Max. Negotiated Rate |
$11,577.60 |
| Rate for Payer: Aetna Commercial |
$9,286.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,406.80
|
| Rate for Payer: Cash Price |
$6,030.00
|
| Rate for Payer: Cigna Commercial |
$10,009.80
|
| Rate for Payer: First Health Commercial |
$11,457.00
|
| Rate for Payer: Humana Commercial |
$10,251.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,889.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,900.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,618.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,612.80
|
| Rate for Payer: Ohio Health Group HMO |
$9,045.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,412.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,567.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,738.60
|
| Rate for Payer: PHCS Commercial |
$11,577.60
|
| Rate for Payer: United Healthcare All Payer |
$10,612.80
|
|
|
LINER EPOLY HI WALL 32*23
|
Facility
|
OP
|
$12,060.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,567.80 |
| Max. Negotiated Rate |
$11,577.60 |
| Rate for Payer: Aetna Commercial |
$9,286.20
|
| Rate for Payer: Anthem Medicaid |
$4,147.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,406.80
|
| Rate for Payer: Cash Price |
$6,030.00
|
| Rate for Payer: Cigna Commercial |
$10,009.80
|
| Rate for Payer: First Health Commercial |
$11,457.00
|
| Rate for Payer: Humana Commercial |
$10,251.00
|
| Rate for Payer: Humana KY Medicaid |
$4,147.43
|
| Rate for Payer: Kentucky WC Medicaid |
$4,189.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,889.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,900.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,618.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,230.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,612.80
|
| Rate for Payer: Ohio Health Group HMO |
$9,045.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,412.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,567.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,738.60
|
| Rate for Payer: PHCS Commercial |
$11,577.60
|
| Rate for Payer: United Healthcare All Payer |
$10,612.80
|
|
|
LINER FREEDOM 10^ SZ 24
|
Facility
|
IP
|
$16,274.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,115.67 |
| Max. Negotiated Rate |
$15,623.42 |
| Rate for Payer: Aetna Commercial |
$12,531.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,694.03
|
| Rate for Payer: Cash Price |
$8,137.20
|
| Rate for Payer: Cigna Commercial |
$13,507.75
|
| Rate for Payer: First Health Commercial |
$15,460.68
|
| Rate for Payer: Humana Commercial |
$13,833.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,345.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,010.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,882.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,321.47
|
| Rate for Payer: Ohio Health Group HMO |
$12,205.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,254.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,115.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,045.06
|
| Rate for Payer: PHCS Commercial |
$15,623.42
|
| Rate for Payer: United Healthcare All Payer |
$14,321.47
|
|
|
LINER FREEDOM 10^ SZ 24
|
Facility
|
OP
|
$16,274.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,115.67 |
| Max. Negotiated Rate |
$15,623.42 |
| Rate for Payer: Aetna Commercial |
$12,531.29
|
| Rate for Payer: Anthem Medicaid |
$5,596.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,694.03
|
| Rate for Payer: Cash Price |
$8,137.20
|
| Rate for Payer: Cigna Commercial |
$13,507.75
|
| Rate for Payer: First Health Commercial |
$15,460.68
|
| Rate for Payer: Humana Commercial |
$13,833.24
|
| Rate for Payer: Humana KY Medicaid |
$5,596.77
|
| Rate for Payer: Kentucky WC Medicaid |
$5,653.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,345.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,010.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,882.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,709.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,321.47
|
| Rate for Payer: Ohio Health Group HMO |
$12,205.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,254.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,115.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,045.06
|
| Rate for Payer: PHCS Commercial |
$15,623.42
|
| Rate for Payer: United Healthcare All Payer |
$14,321.47
|
|
|
LINER FREEDOM 10^ SZ 25
|
Facility
|
IP
|
$16,274.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,115.67 |
| Max. Negotiated Rate |
$15,623.42 |
| Rate for Payer: Aetna Commercial |
$12,531.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,694.03
|
| Rate for Payer: Cash Price |
$8,137.20
|
| Rate for Payer: Cigna Commercial |
$13,507.75
|
| Rate for Payer: First Health Commercial |
$15,460.68
|
| Rate for Payer: Humana Commercial |
$13,833.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,345.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,010.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,882.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,321.47
|
| Rate for Payer: Ohio Health Group HMO |
$12,205.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,254.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,115.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,045.06
|
| Rate for Payer: PHCS Commercial |
$15,623.42
|
| Rate for Payer: United Healthcare All Payer |
$14,321.47
|
|
|
LINER FREEDOM 10^ SZ 25
|
Facility
|
OP
|
$16,274.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,115.67 |
| Max. Negotiated Rate |
$15,623.42 |
| Rate for Payer: Aetna Commercial |
$12,531.29
|
| Rate for Payer: Anthem Medicaid |
$5,596.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,694.03
|
| Rate for Payer: Cash Price |
$8,137.20
|
| Rate for Payer: Cigna Commercial |
$13,507.75
|
| Rate for Payer: First Health Commercial |
$15,460.68
|
| Rate for Payer: Humana Commercial |
$13,833.24
|
| Rate for Payer: Humana KY Medicaid |
$5,596.77
|
| Rate for Payer: Kentucky WC Medicaid |
$5,653.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,345.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,010.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,882.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,709.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,321.47
|
| Rate for Payer: Ohio Health Group HMO |
$12,205.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,254.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,115.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,045.06
|
| Rate for Payer: PHCS Commercial |
$15,623.42
|
| Rate for Payer: United Healthcare All Payer |
$14,321.47
|
|
|
LINER FREEDOM 10^ SZ 26
|
Facility
|
IP
|
$16,274.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,115.67 |
| Max. Negotiated Rate |
$15,623.42 |
| Rate for Payer: Aetna Commercial |
$12,531.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,694.03
|
| Rate for Payer: Cash Price |
$8,137.20
|
| Rate for Payer: Cigna Commercial |
$13,507.75
|
| Rate for Payer: First Health Commercial |
$15,460.68
|
| Rate for Payer: Humana Commercial |
$13,833.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,345.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,010.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,882.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,321.47
|
| Rate for Payer: Ohio Health Group HMO |
$12,205.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,254.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,115.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,045.06
|
| Rate for Payer: PHCS Commercial |
$15,623.42
|
| Rate for Payer: United Healthcare All Payer |
$14,321.47
|
|
|
LINER FREEDOM 10^ SZ 26
|
Facility
|
OP
|
$16,274.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,115.67 |
| Max. Negotiated Rate |
$15,623.42 |
| Rate for Payer: Aetna Commercial |
$12,531.29
|
| Rate for Payer: Anthem Medicaid |
$5,596.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,694.03
|
| Rate for Payer: Cash Price |
$8,137.20
|
| Rate for Payer: Cigna Commercial |
$13,507.75
|
| Rate for Payer: First Health Commercial |
$15,460.68
|
| Rate for Payer: Humana Commercial |
$13,833.24
|
| Rate for Payer: Humana KY Medicaid |
$5,596.77
|
| Rate for Payer: Kentucky WC Medicaid |
$5,653.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,345.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,010.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,882.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,709.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,321.47
|
| Rate for Payer: Ohio Health Group HMO |
$12,205.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,254.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,115.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,045.06
|
| Rate for Payer: PHCS Commercial |
$15,623.42
|
| Rate for Payer: United Healthcare All Payer |
$14,321.47
|
|
|
LINER FREEDOM 10^ SZ 27
|
Facility
|
OP
|
$16,274.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,115.67 |
| Max. Negotiated Rate |
$15,623.42 |
| Rate for Payer: Aetna Commercial |
$12,531.29
|
| Rate for Payer: Anthem Medicaid |
$5,596.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,694.03
|
| Rate for Payer: Cash Price |
$8,137.20
|
| Rate for Payer: Cigna Commercial |
$13,507.75
|
| Rate for Payer: First Health Commercial |
$15,460.68
|
| Rate for Payer: Humana Commercial |
$13,833.24
|
| Rate for Payer: Humana KY Medicaid |
$5,596.77
|
| Rate for Payer: Kentucky WC Medicaid |
$5,653.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,345.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,010.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,882.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,709.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,321.47
|
| Rate for Payer: Ohio Health Group HMO |
$12,205.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,254.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,115.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,045.06
|
| Rate for Payer: PHCS Commercial |
$15,623.42
|
| Rate for Payer: United Healthcare All Payer |
$14,321.47
|
|
|
LINER FREEDOM 10^ SZ 27
|
Facility
|
IP
|
$16,274.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,115.67 |
| Max. Negotiated Rate |
$15,623.42 |
| Rate for Payer: Aetna Commercial |
$12,531.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,694.03
|
| Rate for Payer: Cash Price |
$8,137.20
|
| Rate for Payer: Cigna Commercial |
$13,507.75
|
| Rate for Payer: First Health Commercial |
$15,460.68
|
| Rate for Payer: Humana Commercial |
$13,833.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,345.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,010.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,882.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,321.47
|
| Rate for Payer: Ohio Health Group HMO |
$12,205.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,254.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,115.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,045.06
|
| Rate for Payer: PHCS Commercial |
$15,623.42
|
| Rate for Payer: United Healthcare All Payer |
$14,321.47
|
|
|
LINER FREEDOM 10^ SZ 28
|
Facility
|
OP
|
$16,274.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,115.67 |
| Max. Negotiated Rate |
$15,623.42 |
| Rate for Payer: Aetna Commercial |
$12,531.29
|
| Rate for Payer: Anthem Medicaid |
$5,596.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,694.03
|
| Rate for Payer: Cash Price |
$8,137.20
|
| Rate for Payer: Cigna Commercial |
$13,507.75
|
| Rate for Payer: First Health Commercial |
$15,460.68
|
| Rate for Payer: Humana Commercial |
$13,833.24
|
| Rate for Payer: Humana KY Medicaid |
$5,596.77
|
| Rate for Payer: Kentucky WC Medicaid |
$5,653.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,345.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,010.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,882.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,709.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,321.47
|
| Rate for Payer: Ohio Health Group HMO |
$12,205.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,254.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,115.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,045.06
|
| Rate for Payer: PHCS Commercial |
$15,623.42
|
| Rate for Payer: United Healthcare All Payer |
$14,321.47
|
|
|
LINER FREEDOM 10^ SZ 28
|
Facility
|
IP
|
$16,274.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,115.67 |
| Max. Negotiated Rate |
$15,623.42 |
| Rate for Payer: Aetna Commercial |
$12,531.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,694.03
|
| Rate for Payer: Cash Price |
$8,137.20
|
| Rate for Payer: Cigna Commercial |
$13,507.75
|
| Rate for Payer: First Health Commercial |
$15,460.68
|
| Rate for Payer: Humana Commercial |
$13,833.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,345.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,010.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,882.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,321.47
|
| Rate for Payer: Ohio Health Group HMO |
$12,205.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,254.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,115.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,045.06
|
| Rate for Payer: PHCS Commercial |
$15,623.42
|
| Rate for Payer: United Healthcare All Payer |
$14,321.47
|
|
|
LINER FREEDOM CONST +5 SZ 23
|
Facility
|
OP
|
$21,452.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,788.86 |
| Max. Negotiated Rate |
$20,594.65 |
| Rate for Payer: Aetna Commercial |
$16,518.63
|
| Rate for Payer: Anthem Medicaid |
$7,377.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,733.15
|
| Rate for Payer: Cash Price |
$10,726.38
|
| Rate for Payer: Cigna Commercial |
$17,805.79
|
| Rate for Payer: First Health Commercial |
$20,380.12
|
| Rate for Payer: Humana Commercial |
$18,234.85
|
| Rate for Payer: Humana KY Medicaid |
$7,377.60
|
| Rate for Payer: Kentucky WC Medicaid |
$7,452.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,591.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,832.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,435.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,525.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,878.43
|
| Rate for Payer: Ohio Health Group HMO |
$16,089.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,290.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,788.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,650.36
|
| Rate for Payer: PHCS Commercial |
$20,594.65
|
| Rate for Payer: United Healthcare All Payer |
$18,878.43
|
|
|
LINER FREEDOM CONST +5 SZ 23
|
Facility
|
IP
|
$21,452.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,788.86 |
| Max. Negotiated Rate |
$20,594.65 |
| Rate for Payer: Aetna Commercial |
$16,518.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,733.15
|
| Rate for Payer: Cash Price |
$10,726.38
|
| Rate for Payer: Cigna Commercial |
$17,805.79
|
| Rate for Payer: First Health Commercial |
$20,380.12
|
| Rate for Payer: Humana Commercial |
$18,234.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,591.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,832.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,435.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,878.43
|
| Rate for Payer: Ohio Health Group HMO |
$16,089.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,290.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,788.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,650.36
|
| Rate for Payer: PHCS Commercial |
$20,594.65
|
| Rate for Payer: United Healthcare All Payer |
$18,878.43
|
|
|
LINER FREEDOM CONST +5 SZ 24
|
Facility
|
IP
|
$21,452.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,788.86 |
| Max. Negotiated Rate |
$20,594.65 |
| Rate for Payer: Aetna Commercial |
$16,518.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,733.15
|
| Rate for Payer: Cash Price |
$10,726.38
|
| Rate for Payer: Cigna Commercial |
$17,805.79
|
| Rate for Payer: First Health Commercial |
$20,380.12
|
| Rate for Payer: Humana Commercial |
$18,234.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,591.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,832.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,435.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,878.43
|
| Rate for Payer: Ohio Health Group HMO |
$16,089.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,290.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,788.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,650.36
|
| Rate for Payer: PHCS Commercial |
$20,594.65
|
| Rate for Payer: United Healthcare All Payer |
$18,878.43
|
|
