|
LINER G7 10^ E1 G 32MM
|
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 G7 10^ E1 G 36MM
|
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 G7 10^ E1 G 36MM
|
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 G7 10^ E1 G 40MM
|
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 G7 10^ E1 G 40MM
|
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 G7 10^ E1 H 32MM
|
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 G7 10^ E1 H 32MM
|
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 G7 10^ E1 H 36MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LINER G7 10^ E1 H 36MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LINER G7 10^ E1 H 40MM
|
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 G7 10^ E1 H 40MM
|
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 G7 10^ E1 H 44MM
|
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 G7 10^ E1 H 44MM
|
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 G7 10^ E1 I 36MM
|
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 G7 10^ E1 I 36MM
|
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 G7 10^ E1 I 40MM
|
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 G7 10^ E1 I 40MM
|
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 G7 10^ E1 I 44MM
|
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 G7 10^ E1 I 44MM
|
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 G7 10^ E1 J 36MM
|
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 G7 10^ E1 J 36MM
|
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 G7 10^ E1 J 40MM
|
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 G7 10^ E1 J 40MM
|
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 G7 5S SH SZ LNR SZ E
|
Facility
|
OP
|
$22,855.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,971.25 |
| Max. Negotiated Rate |
$21,941.52 |
| Rate for Payer: Aetna Commercial |
$17,598.93
|
| Rate for Payer: Anthem Medicaid |
$7,860.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,827.48
|
| Rate for Payer: Cash Price |
$11,427.87
|
| Rate for Payer: Cigna Commercial |
$18,970.27
|
| Rate for Payer: First Health Commercial |
$21,712.96
|
| Rate for Payer: Humana Commercial |
$19,427.39
|
| Rate for Payer: Humana KY Medicaid |
$7,860.09
|
| Rate for Payer: Kentucky WC Medicaid |
$7,940.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,741.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,867.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,856.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,017.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,113.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,141.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,571.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,971.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,085.28
|
| Rate for Payer: PHCS Commercial |
$21,941.52
|
| Rate for Payer: United Healthcare All Payer |
$20,113.06
|
|
|
LINER G7 5S SH SZ LNR SZ E
|
Facility
|
IP
|
$22,855.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,971.25 |
| Max. Negotiated Rate |
$21,941.52 |
| Rate for Payer: Aetna Commercial |
$17,598.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,827.48
|
| Rate for Payer: Cash Price |
$11,427.87
|
| Rate for Payer: Cigna Commercial |
$18,970.27
|
| Rate for Payer: First Health Commercial |
$21,712.96
|
| Rate for Payer: Humana Commercial |
$19,427.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,741.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,867.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,856.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,113.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,141.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,571.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,971.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,085.28
|
| Rate for Payer: PHCS Commercial |
$21,941.52
|
| Rate for Payer: United Healthcare All Payer |
$20,113.06
|
|
