|
LINER G7 HI-WALL E1 44MM H
|
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 44MM H
|
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 HI-WALL E1 44MM I
|
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 HI-WALL E1 44MM I
|
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 44MM J
|
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 44MM J
|
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 NEU ACE +5MM*28MM B
|
Facility
|
IP
|
$12,664.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.38 |
| Max. Negotiated Rate |
$12,157.86 |
| Rate for Payer: Aetna Commercial |
$9,751.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,878.26
|
| Rate for Payer: Cash Price |
$6,332.22
|
| Rate for Payer: Cigna Commercial |
$10,511.49
|
| Rate for Payer: First Health Commercial |
$12,031.22
|
| Rate for Payer: Humana Commercial |
$10,764.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,384.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,346.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,799.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,144.71
|
| Rate for Payer: Ohio Health Group HMO |
$9,498.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,532.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,925.98
|
| Rate for Payer: PHCS Commercial |
$12,157.86
|
| Rate for Payer: United Healthcare All Payer |
$11,144.71
|
|
|
LINER G7 NEU ACE +5MM*28MM B
|
Facility
|
OP
|
$12,664.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.38 |
| Max. Negotiated Rate |
$12,157.86 |
| Rate for Payer: Aetna Commercial |
$9,751.62
|
| Rate for Payer: Anthem Medicaid |
$4,355.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,878.26
|
| Rate for Payer: Cash Price |
$6,332.22
|
| Rate for Payer: Cigna Commercial |
$10,511.49
|
| Rate for Payer: First Health Commercial |
$12,031.22
|
| Rate for Payer: Humana Commercial |
$10,764.77
|
| Rate for Payer: Humana KY Medicaid |
$4,355.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,399.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,384.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,346.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,799.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,442.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,144.71
|
| Rate for Payer: Ohio Health Group HMO |
$9,498.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,532.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,925.98
|
| Rate for Payer: PHCS Commercial |
$12,157.86
|
| Rate for Payer: United Healthcare All Payer |
$11,144.71
|
|
|
LINER G7 NEU ACE +5MM*28MM C
|
Facility
|
OP
|
$12,664.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.38 |
| Max. Negotiated Rate |
$12,157.86 |
| Rate for Payer: Aetna Commercial |
$9,751.62
|
| Rate for Payer: Anthem Medicaid |
$4,355.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,878.26
|
| Rate for Payer: Cash Price |
$6,332.22
|
| Rate for Payer: Cigna Commercial |
$10,511.49
|
| Rate for Payer: First Health Commercial |
$12,031.22
|
| Rate for Payer: Humana Commercial |
$10,764.77
|
| Rate for Payer: Humana KY Medicaid |
$4,355.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,399.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,384.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,346.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,799.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,442.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,144.71
|
| Rate for Payer: Ohio Health Group HMO |
$9,498.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,532.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,925.98
|
| Rate for Payer: PHCS Commercial |
$12,157.86
|
| Rate for Payer: United Healthcare All Payer |
$11,144.71
|
|
|
LINER G7 NEU ACE +5MM*28MM C
|
Facility
|
IP
|
$12,664.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.38 |
| Max. Negotiated Rate |
$12,157.86 |
| Rate for Payer: Aetna Commercial |
$9,751.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,878.26
|
| Rate for Payer: Cash Price |
$6,332.22
|
| Rate for Payer: Cigna Commercial |
$10,511.49
|
| Rate for Payer: First Health Commercial |
$12,031.22
|
| Rate for Payer: Humana Commercial |
$10,764.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,384.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,346.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,799.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,144.71
|
| Rate for Payer: Ohio Health Group HMO |
$9,498.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,532.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,925.98
|
| Rate for Payer: PHCS Commercial |
$12,157.86
|
| Rate for Payer: United Healthcare All Payer |
$11,144.71
|
|
|
LINER G7 NEU ACE +5MM*28MM D
|
Facility
|
OP
|
$12,664.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.38 |
| Max. Negotiated Rate |
$12,157.86 |
| Rate for Payer: Aetna Commercial |
$9,751.62
|
| Rate for Payer: Anthem Medicaid |
$4,355.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,878.26
|
| Rate for Payer: Cash Price |
$6,332.22
|
| Rate for Payer: Cigna Commercial |
$10,511.49
|
| Rate for Payer: First Health Commercial |
$12,031.22
|
| Rate for Payer: Humana Commercial |
$10,764.77
|
| Rate for Payer: Humana KY Medicaid |
$4,355.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,399.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,384.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,346.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,799.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,442.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,144.71
|
| Rate for Payer: Ohio Health Group HMO |
$9,498.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,532.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,925.98
|
| Rate for Payer: PHCS Commercial |
$12,157.86
|
| Rate for Payer: United Healthcare All Payer |
$11,144.71
|
|
|
LINER G7 NEU ACE +5MM*28MM D
|
Facility
|
IP
|
$12,664.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.38 |
| Max. Negotiated Rate |
$12,157.86 |
| Rate for Payer: Aetna Commercial |
$9,751.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,878.26
|
| Rate for Payer: Cash Price |
$6,332.22
|
| Rate for Payer: Cigna Commercial |
$10,511.49
|
| Rate for Payer: First Health Commercial |
$12,031.22
|
| Rate for Payer: Humana Commercial |
$10,764.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,384.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,346.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,799.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,144.71
|
| Rate for Payer: Ohio Health Group HMO |
$9,498.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,532.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,925.98
|
| Rate for Payer: PHCS Commercial |
$12,157.86
|
| Rate for Payer: United Healthcare All Payer |
$11,144.71
|
|
|
LINER G7 NEU ACE +5MM*28MM E
|
Facility
|
IP
|
$12,664.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.38 |
| Max. Negotiated Rate |
$12,157.86 |
| Rate for Payer: Aetna Commercial |
$9,751.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,878.26
|
| Rate for Payer: Cash Price |
$6,332.22
|
| Rate for Payer: Cigna Commercial |
$10,511.49
|
| Rate for Payer: First Health Commercial |
$12,031.22
|
| Rate for Payer: Humana Commercial |
$10,764.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,384.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,346.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,799.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,144.71
|
| Rate for Payer: Ohio Health Group HMO |
$9,498.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,532.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,925.98
|
| Rate for Payer: PHCS Commercial |
$12,157.86
|
| Rate for Payer: United Healthcare All Payer |
$11,144.71
|
|
|
LINER G7 NEU ACE +5MM*28MM E
|
Facility
|
OP
|
$12,664.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.38 |
| Max. Negotiated Rate |
$12,157.86 |
| Rate for Payer: Aetna Commercial |
$9,751.62
|
| Rate for Payer: Anthem Medicaid |
$4,355.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,878.26
|
| Rate for Payer: Cash Price |
$6,332.22
|
| Rate for Payer: Cigna Commercial |
$10,511.49
|
| Rate for Payer: First Health Commercial |
$12,031.22
|
| Rate for Payer: Humana Commercial |
$10,764.77
|
| Rate for Payer: Humana KY Medicaid |
$4,355.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,399.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,384.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,346.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,799.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,442.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,144.71
|
| Rate for Payer: Ohio Health Group HMO |
$9,498.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,532.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,925.98
|
| Rate for Payer: PHCS Commercial |
$12,157.86
|
| Rate for Payer: United Healthcare All Payer |
$11,144.71
|
|
|
LINER G7 NEU ACE +5MM*28MM F
|
Facility
|
OP
|
$12,664.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.38 |
| Max. Negotiated Rate |
$12,157.86 |
| Rate for Payer: Aetna Commercial |
$9,751.62
|
| Rate for Payer: Anthem Medicaid |
$4,355.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,878.26
|
| Rate for Payer: Cash Price |
$6,332.22
|
| Rate for Payer: Cigna Commercial |
$10,511.49
|
| Rate for Payer: First Health Commercial |
$12,031.22
|
| Rate for Payer: Humana Commercial |
$10,764.77
|
| Rate for Payer: Humana KY Medicaid |
$4,355.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,399.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,384.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,346.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,799.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,442.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,144.71
|
| Rate for Payer: Ohio Health Group HMO |
$9,498.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,532.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,925.98
|
| Rate for Payer: PHCS Commercial |
$12,157.86
|
| Rate for Payer: United Healthcare All Payer |
$11,144.71
|
|
|
LINER G7 NEU ACE +5MM*28MM F
|
Facility
|
IP
|
$12,664.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.38 |
| Max. Negotiated Rate |
$12,157.86 |
| Rate for Payer: Aetna Commercial |
$9,751.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,878.26
|
| Rate for Payer: Cash Price |
$6,332.22
|
| Rate for Payer: Cigna Commercial |
$10,511.49
|
| Rate for Payer: First Health Commercial |
$12,031.22
|
| Rate for Payer: Humana Commercial |
$10,764.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,384.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,346.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,799.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,144.71
|
| Rate for Payer: Ohio Health Group HMO |
$9,498.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,532.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,925.98
|
| Rate for Payer: PHCS Commercial |
$12,157.86
|
| Rate for Payer: United Healthcare All Payer |
$11,144.71
|
|
|
LINER G7 NEU ACE +5MM*28MM G
|
Facility
|
OP
|
$12,664.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.38 |
| Max. Negotiated Rate |
$12,157.86 |
| Rate for Payer: Aetna Commercial |
$9,751.62
|
| Rate for Payer: Anthem Medicaid |
$4,355.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,878.26
|
| Rate for Payer: Cash Price |
$6,332.22
|
| Rate for Payer: Cigna Commercial |
$10,511.49
|
| Rate for Payer: First Health Commercial |
$12,031.22
|
| Rate for Payer: Humana Commercial |
$10,764.77
|
| Rate for Payer: Humana KY Medicaid |
$4,355.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,399.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,384.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,346.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,799.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,442.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,144.71
|
| Rate for Payer: Ohio Health Group HMO |
$9,498.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,532.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,925.98
|
| Rate for Payer: PHCS Commercial |
$12,157.86
|
| Rate for Payer: United Healthcare All Payer |
$11,144.71
|
|
|
LINER G7 NEU ACE +5MM*28MM G
|
Facility
|
IP
|
$12,664.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.38 |
| Max. Negotiated Rate |
$12,157.86 |
| Rate for Payer: Aetna Commercial |
$9,751.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,878.26
|
| Rate for Payer: Cash Price |
$6,332.22
|
| Rate for Payer: Cigna Commercial |
$10,511.49
|
| Rate for Payer: First Health Commercial |
$12,031.22
|
| Rate for Payer: Humana Commercial |
$10,764.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,384.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,346.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,799.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,144.71
|
| Rate for Payer: Ohio Health Group HMO |
$9,498.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,532.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,925.98
|
| Rate for Payer: PHCS Commercial |
$12,157.86
|
| Rate for Payer: United Healthcare All Payer |
$11,144.71
|
|
|
LINER G7 NEU ACE +5MM*32MM B
|
Facility
|
IP
|
$12,664.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.38 |
| Max. Negotiated Rate |
$12,157.86 |
| Rate for Payer: Aetna Commercial |
$9,751.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,878.26
|
| Rate for Payer: Cash Price |
$6,332.22
|
| Rate for Payer: Cigna Commercial |
$10,511.49
|
| Rate for Payer: First Health Commercial |
$12,031.22
|
| Rate for Payer: Humana Commercial |
$10,764.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,384.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,346.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,799.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,144.71
|
| Rate for Payer: Ohio Health Group HMO |
$9,498.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,532.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,925.98
|
| Rate for Payer: PHCS Commercial |
$12,157.86
|
| Rate for Payer: United Healthcare All Payer |
$11,144.71
|
|
|
LINER G7 NEU ACE +5MM*32MM B
|
Facility
|
OP
|
$12,664.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.38 |
| Max. Negotiated Rate |
$12,157.86 |
| Rate for Payer: Aetna Commercial |
$9,751.62
|
| Rate for Payer: Anthem Medicaid |
$4,355.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,878.26
|
| Rate for Payer: Cash Price |
$6,332.22
|
| Rate for Payer: Cigna Commercial |
$10,511.49
|
| Rate for Payer: First Health Commercial |
$12,031.22
|
| Rate for Payer: Humana Commercial |
$10,764.77
|
| Rate for Payer: Humana KY Medicaid |
$4,355.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,399.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,384.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,346.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,799.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,442.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,144.71
|
| Rate for Payer: Ohio Health Group HMO |
$9,498.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,532.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,925.98
|
| Rate for Payer: PHCS Commercial |
$12,157.86
|
| Rate for Payer: United Healthcare All Payer |
$11,144.71
|
|
|
LINER G7 NEU ACE +5MM*32MM C
|
Facility
|
IP
|
$12,664.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.38 |
| Max. Negotiated Rate |
$12,157.86 |
| Rate for Payer: Aetna Commercial |
$9,751.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,878.26
|
| Rate for Payer: Cash Price |
$6,332.22
|
| Rate for Payer: Cigna Commercial |
$10,511.49
|
| Rate for Payer: First Health Commercial |
$12,031.22
|
| Rate for Payer: Humana Commercial |
$10,764.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,384.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,346.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,799.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,144.71
|
| Rate for Payer: Ohio Health Group HMO |
$9,498.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,532.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,925.98
|
| Rate for Payer: PHCS Commercial |
$12,157.86
|
| Rate for Payer: United Healthcare All Payer |
$11,144.71
|
|
|
LINER G7 NEU ACE +5MM*32MM C
|
Facility
|
OP
|
$12,664.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.38 |
| Max. Negotiated Rate |
$12,157.86 |
| Rate for Payer: Aetna Commercial |
$9,751.62
|
| Rate for Payer: Anthem Medicaid |
$4,355.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,878.26
|
| Rate for Payer: Cash Price |
$6,332.22
|
| Rate for Payer: Cigna Commercial |
$10,511.49
|
| Rate for Payer: First Health Commercial |
$12,031.22
|
| Rate for Payer: Humana Commercial |
$10,764.77
|
| Rate for Payer: Humana KY Medicaid |
$4,355.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,399.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,384.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,346.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,799.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,442.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,144.71
|
| Rate for Payer: Ohio Health Group HMO |
$9,498.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,532.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,925.98
|
| Rate for Payer: PHCS Commercial |
$12,157.86
|
| Rate for Payer: United Healthcare All Payer |
$11,144.71
|
|
|
LINER G7 NEU ACE +5MM*32MM D
|
Facility
|
OP
|
$12,664.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.38 |
| Max. Negotiated Rate |
$12,157.86 |
| Rate for Payer: Aetna Commercial |
$9,751.62
|
| Rate for Payer: Anthem Medicaid |
$4,355.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,878.26
|
| Rate for Payer: Cash Price |
$6,332.22
|
| Rate for Payer: Cigna Commercial |
$10,511.49
|
| Rate for Payer: First Health Commercial |
$12,031.22
|
| Rate for Payer: Humana Commercial |
$10,764.77
|
| Rate for Payer: Humana KY Medicaid |
$4,355.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,399.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,384.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,346.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,799.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,442.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,144.71
|
| Rate for Payer: Ohio Health Group HMO |
$9,498.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,532.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,925.98
|
| Rate for Payer: PHCS Commercial |
$12,157.86
|
| Rate for Payer: United Healthcare All Payer |
$11,144.71
|
|
|
LINER G7 NEU ACE +5MM*32MM D
|
Facility
|
IP
|
$12,664.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.38 |
| Max. Negotiated Rate |
$12,157.86 |
| Rate for Payer: Aetna Commercial |
$9,751.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,878.26
|
| Rate for Payer: Cash Price |
$6,332.22
|
| Rate for Payer: Cigna Commercial |
$10,511.49
|
| Rate for Payer: First Health Commercial |
$12,031.22
|
| Rate for Payer: Humana Commercial |
$10,764.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,384.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,346.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,799.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,144.71
|
| Rate for Payer: Ohio Health Group HMO |
$9,498.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,532.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,925.98
|
| Rate for Payer: PHCS Commercial |
$12,157.86
|
| Rate for Payer: United Healthcare All Payer |
$11,144.71
|
|
|
LINER G7 NEU ACE +5MM*32MM E
|
Facility
|
OP
|
$12,664.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.38 |
| Max. Negotiated Rate |
$12,157.86 |
| Rate for Payer: Aetna Commercial |
$9,751.62
|
| Rate for Payer: Anthem Medicaid |
$4,355.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,878.26
|
| Rate for Payer: Cash Price |
$6,332.22
|
| Rate for Payer: Cigna Commercial |
$10,511.49
|
| Rate for Payer: First Health Commercial |
$12,031.22
|
| Rate for Payer: Humana Commercial |
$10,764.77
|
| Rate for Payer: Humana KY Medicaid |
$4,355.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4,399.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,384.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,346.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,799.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,442.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,144.71
|
| Rate for Payer: Ohio Health Group HMO |
$9,498.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,532.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,925.98
|
| Rate for Payer: PHCS Commercial |
$12,157.86
|
| Rate for Payer: United Healthcare All Payer |
$11,144.71
|
|
