|
LINER G7 FREEDOM CONST 36MM G
|
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 G7 FREEDOM CONST 36MM H
|
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 G7 FREEDOM CONST 36MM H
|
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 G7 FREEDOM CONST 36MM I
|
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 G7 FREEDOM CONST 36MM I
|
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 G7 FREEDOM CONST+5MM 32B
|
Facility
|
OP
|
$15,544.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.76 |
| Max. Negotiated Rate |
$14,922.55 |
| Rate for Payer: Aetna Commercial |
$11,969.13
|
| Rate for Payer: Anthem Medicaid |
$5,345.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,124.57
|
| Rate for Payer: Cash Price |
$7,772.16
|
| Rate for Payer: Cigna Commercial |
$12,901.79
|
| Rate for Payer: First Health Commercial |
$14,767.10
|
| Rate for Payer: Humana Commercial |
$13,212.67
|
| Rate for Payer: Humana KY Medicaid |
$5,345.69
|
| Rate for Payer: Kentucky WC Medicaid |
$5,400.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,746.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,471.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,663.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,452.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,679.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,658.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,108.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,020.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,818.74
|
| Rate for Payer: PHCS Commercial |
$14,922.55
|
| Rate for Payer: United Healthcare All Payer |
$13,679.00
|
|
|
LINER G7 FREEDOM CONST+5MM 32B
|
Facility
|
IP
|
$15,544.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.76 |
| Max. Negotiated Rate |
$14,922.55 |
| Rate for Payer: Aetna Commercial |
$11,969.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,124.57
|
| Rate for Payer: Cash Price |
$7,772.16
|
| Rate for Payer: Cigna Commercial |
$12,901.79
|
| Rate for Payer: First Health Commercial |
$14,767.10
|
| Rate for Payer: Humana Commercial |
$13,212.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,746.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,471.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,663.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,679.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,658.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,108.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,020.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,818.74
|
| Rate for Payer: PHCS Commercial |
$14,922.55
|
| Rate for Payer: United Healthcare All Payer |
$13,679.00
|
|
|
LINER G7 FREEDOM CONST+5MM 32C
|
Facility
|
IP
|
$15,544.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.76 |
| Max. Negotiated Rate |
$14,922.55 |
| Rate for Payer: Aetna Commercial |
$11,969.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,124.57
|
| Rate for Payer: Cash Price |
$7,772.16
|
| Rate for Payer: Cigna Commercial |
$12,901.79
|
| Rate for Payer: First Health Commercial |
$14,767.10
|
| Rate for Payer: Humana Commercial |
$13,212.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,746.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,471.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,663.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,679.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,658.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,108.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,020.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,818.74
|
| Rate for Payer: PHCS Commercial |
$14,922.55
|
| Rate for Payer: United Healthcare All Payer |
$13,679.00
|
|
|
LINER G7 FREEDOM CONST+5MM 32C
|
Facility
|
OP
|
$15,544.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.76 |
| Max. Negotiated Rate |
$14,922.55 |
| Rate for Payer: Aetna Commercial |
$11,969.13
|
| Rate for Payer: Anthem Medicaid |
$5,345.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,124.57
|
| Rate for Payer: Cash Price |
$7,772.16
|
| Rate for Payer: Cigna Commercial |
$12,901.79
|
| Rate for Payer: First Health Commercial |
$14,767.10
|
| Rate for Payer: Humana Commercial |
$13,212.67
|
| Rate for Payer: Humana KY Medicaid |
$5,345.69
|
| Rate for Payer: Kentucky WC Medicaid |
$5,400.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,746.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,471.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,663.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,452.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,679.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,658.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,108.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,020.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,818.74
|
| Rate for Payer: PHCS Commercial |
$14,922.55
|
| Rate for Payer: United Healthcare All Payer |
$13,679.00
|
|
|
LINER G7 FREEDOM CONST+5MM 36D
|
Facility
|
IP
|
$15,544.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.76 |
| Max. Negotiated Rate |
$14,922.55 |
| Rate for Payer: Aetna Commercial |
$11,969.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,124.57
|
| Rate for Payer: Cash Price |
$7,772.16
|
| Rate for Payer: Cigna Commercial |
$12,901.79
|
| Rate for Payer: First Health Commercial |
$14,767.10
|
| Rate for Payer: Humana Commercial |
$13,212.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,746.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,471.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,663.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,679.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,658.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,108.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,020.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,818.74
|
| Rate for Payer: PHCS Commercial |
$14,922.55
|
| Rate for Payer: United Healthcare All Payer |
$13,679.00
|
|
|
LINER G7 FREEDOM CONST+5MM 36D
|
Facility
|
OP
|
$15,544.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.76 |
| Max. Negotiated Rate |
$14,922.55 |
| Rate for Payer: Aetna Commercial |
$11,969.13
|
| Rate for Payer: Anthem Medicaid |
$5,345.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,124.57
|
| Rate for Payer: Cash Price |
$7,772.16
|
| Rate for Payer: Cigna Commercial |
$12,901.79
|
| Rate for Payer: First Health Commercial |
$14,767.10
|
| Rate for Payer: Humana Commercial |
$13,212.67
|
| Rate for Payer: Humana KY Medicaid |
$5,345.69
|
| Rate for Payer: Kentucky WC Medicaid |
$5,400.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,746.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,471.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,663.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,452.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,679.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,658.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,108.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,020.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,818.74
|
| Rate for Payer: PHCS Commercial |
$14,922.55
|
| Rate for Payer: United Healthcare All Payer |
$13,679.00
|
|
|
LINER G7 FREEDOM CONST+5MM 36E
|
Facility
|
OP
|
$15,544.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.76 |
| Max. Negotiated Rate |
$14,922.55 |
| Rate for Payer: Aetna Commercial |
$11,969.13
|
| Rate for Payer: Anthem Medicaid |
$5,345.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,124.57
|
| Rate for Payer: Cash Price |
$7,772.16
|
| Rate for Payer: Cigna Commercial |
$12,901.79
|
| Rate for Payer: First Health Commercial |
$14,767.10
|
| Rate for Payer: Humana Commercial |
$13,212.67
|
| Rate for Payer: Humana KY Medicaid |
$5,345.69
|
| Rate for Payer: Kentucky WC Medicaid |
$5,400.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,746.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,471.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,663.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,452.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,679.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,658.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,108.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,020.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,818.74
|
| Rate for Payer: PHCS Commercial |
$14,922.55
|
| Rate for Payer: United Healthcare All Payer |
$13,679.00
|
|
|
LINER G7 FREEDOM CONST+5MM 36E
|
Facility
|
IP
|
$15,544.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.76 |
| Max. Negotiated Rate |
$14,922.55 |
| Rate for Payer: Aetna Commercial |
$11,969.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,124.57
|
| Rate for Payer: Cash Price |
$7,772.16
|
| Rate for Payer: Cigna Commercial |
$12,901.79
|
| Rate for Payer: First Health Commercial |
$14,767.10
|
| Rate for Payer: Humana Commercial |
$13,212.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,746.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,471.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,663.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,679.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,658.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,108.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,020.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,818.74
|
| Rate for Payer: PHCS Commercial |
$14,922.55
|
| Rate for Payer: United Healthcare All Payer |
$13,679.00
|
|
|
LINER G7 FREEDOM CONST+5MM 36F
|
Facility
|
OP
|
$15,544.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.76 |
| Max. Negotiated Rate |
$14,922.55 |
| Rate for Payer: Aetna Commercial |
$11,969.13
|
| Rate for Payer: Anthem Medicaid |
$5,345.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,124.57
|
| Rate for Payer: Cash Price |
$7,772.16
|
| Rate for Payer: Cigna Commercial |
$12,901.79
|
| Rate for Payer: First Health Commercial |
$14,767.10
|
| Rate for Payer: Humana Commercial |
$13,212.67
|
| Rate for Payer: Humana KY Medicaid |
$5,345.69
|
| Rate for Payer: Kentucky WC Medicaid |
$5,400.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,746.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,471.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,663.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,452.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,679.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,658.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,108.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,020.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,818.74
|
| Rate for Payer: PHCS Commercial |
$14,922.55
|
| Rate for Payer: United Healthcare All Payer |
$13,679.00
|
|
|
LINER G7 FREEDOM CONST+5MM 36F
|
Facility
|
IP
|
$15,544.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.76 |
| Max. Negotiated Rate |
$14,922.55 |
| Rate for Payer: Aetna Commercial |
$11,969.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,124.57
|
| Rate for Payer: Cash Price |
$7,772.16
|
| Rate for Payer: Cigna Commercial |
$12,901.79
|
| Rate for Payer: First Health Commercial |
$14,767.10
|
| Rate for Payer: Humana Commercial |
$13,212.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,746.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,471.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,663.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,679.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,658.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,108.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,020.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,818.74
|
| Rate for Payer: PHCS Commercial |
$14,922.55
|
| Rate for Payer: United Healthcare All Payer |
$13,679.00
|
|
|
LINER G7 FREEDOM CONST+5MM 36G
|
Facility
|
OP
|
$15,544.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.76 |
| Max. Negotiated Rate |
$14,922.55 |
| Rate for Payer: Aetna Commercial |
$11,969.13
|
| Rate for Payer: Anthem Medicaid |
$5,345.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,124.57
|
| Rate for Payer: Cash Price |
$7,772.16
|
| Rate for Payer: Cigna Commercial |
$12,901.79
|
| Rate for Payer: First Health Commercial |
$14,767.10
|
| Rate for Payer: Humana Commercial |
$13,212.67
|
| Rate for Payer: Humana KY Medicaid |
$5,345.69
|
| Rate for Payer: Kentucky WC Medicaid |
$5,400.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,746.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,471.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,663.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,452.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,679.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,658.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,108.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,020.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,818.74
|
| Rate for Payer: PHCS Commercial |
$14,922.55
|
| Rate for Payer: United Healthcare All Payer |
$13,679.00
|
|
|
LINER G7 FREEDOM CONST+5MM 36G
|
Facility
|
IP
|
$15,544.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.76 |
| Max. Negotiated Rate |
$14,922.55 |
| Rate for Payer: Aetna Commercial |
$11,969.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,124.57
|
| Rate for Payer: Cash Price |
$7,772.16
|
| Rate for Payer: Cigna Commercial |
$12,901.79
|
| Rate for Payer: First Health Commercial |
$14,767.10
|
| Rate for Payer: Humana Commercial |
$13,212.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,746.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,471.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,663.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,679.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,658.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,108.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,020.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,818.74
|
| Rate for Payer: PHCS Commercial |
$14,922.55
|
| Rate for Payer: United Healthcare All Payer |
$13,679.00
|
|
|
LINER G7 FREEDOM CONST+5MM 36H
|
Facility
|
IP
|
$15,544.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.76 |
| Max. Negotiated Rate |
$14,922.55 |
| Rate for Payer: Aetna Commercial |
$11,969.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,124.57
|
| Rate for Payer: Cash Price |
$7,772.16
|
| Rate for Payer: Cigna Commercial |
$12,901.79
|
| Rate for Payer: First Health Commercial |
$14,767.10
|
| Rate for Payer: Humana Commercial |
$13,212.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,746.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,471.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,663.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,679.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,658.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,108.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,020.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,818.74
|
| Rate for Payer: PHCS Commercial |
$14,922.55
|
| Rate for Payer: United Healthcare All Payer |
$13,679.00
|
|
|
LINER G7 FREEDOM CONST+5MM 36H
|
Facility
|
OP
|
$15,544.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.76 |
| Max. Negotiated Rate |
$14,922.55 |
| Rate for Payer: Aetna Commercial |
$11,969.13
|
| Rate for Payer: Anthem Medicaid |
$5,345.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,124.57
|
| Rate for Payer: Cash Price |
$7,772.16
|
| Rate for Payer: Cigna Commercial |
$12,901.79
|
| Rate for Payer: First Health Commercial |
$14,767.10
|
| Rate for Payer: Humana Commercial |
$13,212.67
|
| Rate for Payer: Humana KY Medicaid |
$5,345.69
|
| Rate for Payer: Kentucky WC Medicaid |
$5,400.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,746.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,471.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,663.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,452.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,679.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,658.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,108.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,020.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,818.74
|
| Rate for Payer: PHCS Commercial |
$14,922.55
|
| Rate for Payer: United Healthcare All Payer |
$13,679.00
|
|
|
LINER G7 FREEDOM CONST+5MM 36I
|
Facility
|
OP
|
$15,544.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.76 |
| Max. Negotiated Rate |
$14,922.55 |
| Rate for Payer: Aetna Commercial |
$11,969.13
|
| Rate for Payer: Anthem Medicaid |
$5,345.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,124.57
|
| Rate for Payer: Cash Price |
$7,772.16
|
| Rate for Payer: Cigna Commercial |
$12,901.79
|
| Rate for Payer: First Health Commercial |
$14,767.10
|
| Rate for Payer: Humana Commercial |
$13,212.67
|
| Rate for Payer: Humana KY Medicaid |
$5,345.69
|
| Rate for Payer: Kentucky WC Medicaid |
$5,400.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,746.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,471.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,663.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,452.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,679.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,658.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,108.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,020.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,818.74
|
| Rate for Payer: PHCS Commercial |
$14,922.55
|
| Rate for Payer: United Healthcare All Payer |
$13,679.00
|
|
|
LINER G7 FREEDOM CONST+5MM 36I
|
Facility
|
IP
|
$15,544.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.76 |
| Max. Negotiated Rate |
$14,922.55 |
| Rate for Payer: Aetna Commercial |
$11,969.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,124.57
|
| Rate for Payer: Cash Price |
$7,772.16
|
| Rate for Payer: Cigna Commercial |
$12,901.79
|
| Rate for Payer: First Health Commercial |
$14,767.10
|
| Rate for Payer: Humana Commercial |
$13,212.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,746.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,471.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,663.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,679.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,658.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,108.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,020.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,818.74
|
| Rate for Payer: PHCS Commercial |
$14,922.55
|
| Rate for Payer: United Healthcare All Payer |
$13,679.00
|
|
|
LINER G7 FREEDOM CONST+5MM 36J
|
Facility
|
IP
|
$15,544.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.76 |
| Max. Negotiated Rate |
$14,922.55 |
| Rate for Payer: Aetna Commercial |
$11,969.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,124.57
|
| Rate for Payer: Cash Price |
$7,772.16
|
| Rate for Payer: Cigna Commercial |
$12,901.79
|
| Rate for Payer: First Health Commercial |
$14,767.10
|
| Rate for Payer: Humana Commercial |
$13,212.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,746.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,471.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,663.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,679.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,658.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,108.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,020.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,818.74
|
| Rate for Payer: PHCS Commercial |
$14,922.55
|
| Rate for Payer: United Healthcare All Payer |
$13,679.00
|
|
|
LINER G7 FREEDOM CONST+5MM 36J
|
Facility
|
OP
|
$15,544.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,020.76 |
| Max. Negotiated Rate |
$14,922.55 |
| Rate for Payer: Aetna Commercial |
$11,969.13
|
| Rate for Payer: Anthem Medicaid |
$5,345.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,124.57
|
| Rate for Payer: Cash Price |
$7,772.16
|
| Rate for Payer: Cigna Commercial |
$12,901.79
|
| Rate for Payer: First Health Commercial |
$14,767.10
|
| Rate for Payer: Humana Commercial |
$13,212.67
|
| Rate for Payer: Humana KY Medicaid |
$5,345.69
|
| Rate for Payer: Kentucky WC Medicaid |
$5,400.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,746.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,471.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,663.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,452.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,679.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,658.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,108.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,020.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,818.74
|
| Rate for Payer: PHCS Commercial |
$14,922.55
|
| Rate for Payer: United Healthcare All Payer |
$13,679.00
|
|
|
LINER G7 HI-WALL E1 28MM A
|
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 HI-WALL E1 28MM A
|
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
|
|
