|
LINER FREEDOM CONST +5 SZ28
|
Facility
|
IP
|
$22,109.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,632.70 |
| Max. Negotiated Rate |
$21,224.64 |
| Rate for Payer: Aetna Commercial |
$17,023.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,245.02
|
| Rate for Payer: Cash Price |
$11,054.50
|
| Rate for Payer: Cigna Commercial |
$18,350.47
|
| Rate for Payer: First Health Commercial |
$21,003.55
|
| Rate for Payer: Humana Commercial |
$18,792.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,129.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,316.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,632.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,455.92
|
| Rate for Payer: Ohio Health Group HMO |
$16,581.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,687.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,234.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,255.21
|
| Rate for Payer: PHCS Commercial |
$21,224.64
|
| Rate for Payer: United Healthcare All Payer |
$19,455.92
|
|
|
LINER FREEDOM CONST SZ 24
|
Facility
|
OP
|
$16,809.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,042.94 |
| Max. Negotiated Rate |
$16,137.41 |
| Rate for Payer: Aetna Commercial |
$12,943.55
|
| Rate for Payer: Anthem Medicaid |
$5,780.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,111.64
|
| Rate for Payer: Cash Price |
$8,404.90
|
| Rate for Payer: Cigna Commercial |
$13,952.13
|
| Rate for Payer: First Health Commercial |
$15,969.31
|
| Rate for Payer: Humana Commercial |
$14,288.33
|
| Rate for Payer: Humana KY Medicaid |
$5,780.89
|
| Rate for Payer: Kentucky WC Medicaid |
$5,839.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,784.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,405.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,042.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,896.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,792.62
|
| Rate for Payer: Ohio Health Group HMO |
$12,607.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,447.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,624.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,598.76
|
| Rate for Payer: PHCS Commercial |
$16,137.41
|
| Rate for Payer: United Healthcare All Payer |
$14,792.62
|
|
|
LINER FREEDOM CONST SZ 24
|
Facility
|
IP
|
$16,809.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,042.94 |
| Max. Negotiated Rate |
$16,137.41 |
| Rate for Payer: Aetna Commercial |
$12,943.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,111.64
|
| Rate for Payer: Cash Price |
$8,404.90
|
| Rate for Payer: Cigna Commercial |
$13,952.13
|
| Rate for Payer: First Health Commercial |
$15,969.31
|
| Rate for Payer: Humana Commercial |
$14,288.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,784.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,405.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,042.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,792.62
|
| Rate for Payer: Ohio Health Group HMO |
$12,607.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,447.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,624.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,598.76
|
| Rate for Payer: PHCS Commercial |
$16,137.41
|
| Rate for Payer: United Healthcare All Payer |
$14,792.62
|
|
|
LINER FREEDOM CONST SZ 25
|
Facility
|
IP
|
$16,809.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,042.94 |
| Max. Negotiated Rate |
$16,137.41 |
| Rate for Payer: Aetna Commercial |
$12,943.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,111.64
|
| Rate for Payer: Cash Price |
$8,404.90
|
| Rate for Payer: Cigna Commercial |
$13,952.13
|
| Rate for Payer: First Health Commercial |
$15,969.31
|
| Rate for Payer: Humana Commercial |
$14,288.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,784.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,405.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,042.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,792.62
|
| Rate for Payer: Ohio Health Group HMO |
$12,607.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,447.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,624.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,598.76
|
| Rate for Payer: PHCS Commercial |
$16,137.41
|
| Rate for Payer: United Healthcare All Payer |
$14,792.62
|
|
|
LINER FREEDOM CONST SZ 25
|
Facility
|
OP
|
$16,809.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,042.94 |
| Max. Negotiated Rate |
$16,137.41 |
| Rate for Payer: Aetna Commercial |
$12,943.55
|
| Rate for Payer: Anthem Medicaid |
$5,780.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,111.64
|
| Rate for Payer: Cash Price |
$8,404.90
|
| Rate for Payer: Cigna Commercial |
$13,952.13
|
| Rate for Payer: First Health Commercial |
$15,969.31
|
| Rate for Payer: Humana Commercial |
$14,288.33
|
| Rate for Payer: Humana KY Medicaid |
$5,780.89
|
| Rate for Payer: Kentucky WC Medicaid |
$5,839.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,784.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,405.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,042.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,896.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,792.62
|
| Rate for Payer: Ohio Health Group HMO |
$12,607.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,447.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,624.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,598.76
|
| Rate for Payer: PHCS Commercial |
$16,137.41
|
| Rate for Payer: United Healthcare All Payer |
$14,792.62
|
|
|
LINER FREEDOM CONST SZ 26
|
Facility
|
OP
|
$16,809.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,042.94 |
| Max. Negotiated Rate |
$16,137.41 |
| Rate for Payer: Aetna Commercial |
$12,943.55
|
| Rate for Payer: Anthem Medicaid |
$5,780.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,111.64
|
| Rate for Payer: Cash Price |
$8,404.90
|
| Rate for Payer: Cigna Commercial |
$13,952.13
|
| Rate for Payer: First Health Commercial |
$15,969.31
|
| Rate for Payer: Humana Commercial |
$14,288.33
|
| Rate for Payer: Humana KY Medicaid |
$5,780.89
|
| Rate for Payer: Kentucky WC Medicaid |
$5,839.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,784.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,405.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,042.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,896.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,792.62
|
| Rate for Payer: Ohio Health Group HMO |
$12,607.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,447.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,624.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,598.76
|
| Rate for Payer: PHCS Commercial |
$16,137.41
|
| Rate for Payer: United Healthcare All Payer |
$14,792.62
|
|
|
LINER FREEDOM CONST SZ 26
|
Facility
|
IP
|
$16,809.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,042.94 |
| Max. Negotiated Rate |
$16,137.41 |
| Rate for Payer: Aetna Commercial |
$12,943.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,111.64
|
| Rate for Payer: Cash Price |
$8,404.90
|
| Rate for Payer: Cigna Commercial |
$13,952.13
|
| Rate for Payer: First Health Commercial |
$15,969.31
|
| Rate for Payer: Humana Commercial |
$14,288.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,784.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,405.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,042.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,792.62
|
| Rate for Payer: Ohio Health Group HMO |
$12,607.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,447.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,624.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,598.76
|
| Rate for Payer: PHCS Commercial |
$16,137.41
|
| Rate for Payer: United Healthcare All Payer |
$14,792.62
|
|
|
LINER FREEDOM CONST SZ 27
|
Facility
|
IP
|
$16,809.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,042.94 |
| Max. Negotiated Rate |
$16,137.41 |
| Rate for Payer: Aetna Commercial |
$12,943.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,111.64
|
| Rate for Payer: Cash Price |
$8,404.90
|
| Rate for Payer: Cigna Commercial |
$13,952.13
|
| Rate for Payer: First Health Commercial |
$15,969.31
|
| Rate for Payer: Humana Commercial |
$14,288.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,784.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,405.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,042.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,792.62
|
| Rate for Payer: Ohio Health Group HMO |
$12,607.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,447.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,624.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,598.76
|
| Rate for Payer: PHCS Commercial |
$16,137.41
|
| Rate for Payer: United Healthcare All Payer |
$14,792.62
|
|
|
LINER FREEDOM CONST SZ 27
|
Facility
|
OP
|
$16,809.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,042.94 |
| Max. Negotiated Rate |
$16,137.41 |
| Rate for Payer: Aetna Commercial |
$12,943.55
|
| Rate for Payer: Anthem Medicaid |
$5,780.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,111.64
|
| Rate for Payer: Cash Price |
$8,404.90
|
| Rate for Payer: Cigna Commercial |
$13,952.13
|
| Rate for Payer: First Health Commercial |
$15,969.31
|
| Rate for Payer: Humana Commercial |
$14,288.33
|
| Rate for Payer: Humana KY Medicaid |
$5,780.89
|
| Rate for Payer: Kentucky WC Medicaid |
$5,839.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,784.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,405.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,042.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,896.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,792.62
|
| Rate for Payer: Ohio Health Group HMO |
$12,607.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,447.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,624.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,598.76
|
| Rate for Payer: PHCS Commercial |
$16,137.41
|
| Rate for Payer: United Healthcare All Payer |
$14,792.62
|
|
|
LINER FREEDOM CONST SZ 28
|
Facility
|
OP
|
$16,809.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,042.94 |
| Max. Negotiated Rate |
$16,137.41 |
| Rate for Payer: Aetna Commercial |
$12,943.55
|
| Rate for Payer: Anthem Medicaid |
$5,780.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,111.64
|
| Rate for Payer: Cash Price |
$8,404.90
|
| Rate for Payer: Cigna Commercial |
$13,952.13
|
| Rate for Payer: First Health Commercial |
$15,969.31
|
| Rate for Payer: Humana Commercial |
$14,288.33
|
| Rate for Payer: Humana KY Medicaid |
$5,780.89
|
| Rate for Payer: Kentucky WC Medicaid |
$5,839.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,784.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,405.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,042.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,896.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,792.62
|
| Rate for Payer: Ohio Health Group HMO |
$12,607.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,447.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,624.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,598.76
|
| Rate for Payer: PHCS Commercial |
$16,137.41
|
| Rate for Payer: United Healthcare All Payer |
$14,792.62
|
|
|
LINER FREEDOM CONST SZ 28
|
Facility
|
IP
|
$16,809.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,042.94 |
| Max. Negotiated Rate |
$16,137.41 |
| Rate for Payer: Aetna Commercial |
$12,943.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,111.64
|
| Rate for Payer: Cash Price |
$8,404.90
|
| Rate for Payer: Cigna Commercial |
$13,952.13
|
| Rate for Payer: First Health Commercial |
$15,969.31
|
| Rate for Payer: Humana Commercial |
$14,288.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,784.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,405.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,042.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,792.62
|
| Rate for Payer: Ohio Health Group HMO |
$12,607.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,447.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,624.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,598.76
|
| Rate for Payer: PHCS Commercial |
$16,137.41
|
| Rate for Payer: United Healthcare All Payer |
$14,792.62
|
|
|
LINER G7 10^ E1 A 28MM
|
Facility
|
IP
|
$12,308.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,692.40 |
| Max. Negotiated Rate |
$11,815.68 |
| Rate for Payer: Aetna Commercial |
$9,477.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,600.24
|
| Rate for Payer: Cash Price |
$6,154.00
|
| Rate for Payer: Cigna Commercial |
$10,215.64
|
| Rate for Payer: First Health Commercial |
$11,692.60
|
| Rate for Payer: Humana Commercial |
$10,461.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,092.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,083.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,692.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,831.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,231.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,846.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,707.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,492.52
|
| Rate for Payer: PHCS Commercial |
$11,815.68
|
| Rate for Payer: United Healthcare All Payer |
$10,831.04
|
|
|
LINER G7 10^ E1 A 28MM
|
Facility
|
OP
|
$12,308.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,692.40 |
| Max. Negotiated Rate |
$11,815.68 |
| Rate for Payer: Aetna Commercial |
$9,477.16
|
| Rate for Payer: Anthem Medicaid |
$4,232.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,600.24
|
| Rate for Payer: Cash Price |
$6,154.00
|
| Rate for Payer: Cigna Commercial |
$10,215.64
|
| Rate for Payer: First Health Commercial |
$11,692.60
|
| Rate for Payer: Humana Commercial |
$10,461.80
|
| Rate for Payer: Humana KY Medicaid |
$4,232.72
|
| Rate for Payer: Kentucky WC Medicaid |
$4,275.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,092.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,083.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,692.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,317.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,831.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,231.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,846.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,707.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,492.52
|
| Rate for Payer: PHCS Commercial |
$11,815.68
|
| Rate for Payer: United Healthcare All Payer |
$10,831.04
|
|
|
LINER G7 10^ E1 B 28MM
|
Facility
|
IP
|
$12,308.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,692.40 |
| Max. Negotiated Rate |
$11,815.68 |
| Rate for Payer: Aetna Commercial |
$9,477.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,600.24
|
| Rate for Payer: Cash Price |
$6,154.00
|
| Rate for Payer: Cigna Commercial |
$10,215.64
|
| Rate for Payer: First Health Commercial |
$11,692.60
|
| Rate for Payer: Humana Commercial |
$10,461.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,092.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,083.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,692.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,831.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,231.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,846.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,707.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,492.52
|
| Rate for Payer: PHCS Commercial |
$11,815.68
|
| Rate for Payer: United Healthcare All Payer |
$10,831.04
|
|
|
LINER G7 10^ E1 B 28MM
|
Facility
|
OP
|
$12,308.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,692.40 |
| Max. Negotiated Rate |
$11,815.68 |
| Rate for Payer: Aetna Commercial |
$9,477.16
|
| Rate for Payer: Anthem Medicaid |
$4,232.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,600.24
|
| Rate for Payer: Cash Price |
$6,154.00
|
| Rate for Payer: Cigna Commercial |
$10,215.64
|
| Rate for Payer: First Health Commercial |
$11,692.60
|
| Rate for Payer: Humana Commercial |
$10,461.80
|
| Rate for Payer: Humana KY Medicaid |
$4,232.72
|
| Rate for Payer: Kentucky WC Medicaid |
$4,275.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,092.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,083.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,692.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,317.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,831.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,231.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,846.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,707.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,492.52
|
| Rate for Payer: PHCS Commercial |
$11,815.68
|
| Rate for Payer: United Healthcare All Payer |
$10,831.04
|
|
|
LINER G7 10^ E1 B 32MM
|
Facility
|
IP
|
$12,308.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,692.40 |
| Max. Negotiated Rate |
$11,815.68 |
| Rate for Payer: Aetna Commercial |
$9,477.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,600.24
|
| Rate for Payer: Cash Price |
$6,154.00
|
| Rate for Payer: Cigna Commercial |
$10,215.64
|
| Rate for Payer: First Health Commercial |
$11,692.60
|
| Rate for Payer: Humana Commercial |
$10,461.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,092.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,083.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,692.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,831.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,231.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,846.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,707.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,492.52
|
| Rate for Payer: PHCS Commercial |
$11,815.68
|
| Rate for Payer: United Healthcare All Payer |
$10,831.04
|
|
|
LINER G7 10^ E1 B 32MM
|
Facility
|
OP
|
$12,308.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,692.40 |
| Max. Negotiated Rate |
$11,815.68 |
| Rate for Payer: Aetna Commercial |
$9,477.16
|
| Rate for Payer: Anthem Medicaid |
$4,232.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,600.24
|
| Rate for Payer: Cash Price |
$6,154.00
|
| Rate for Payer: Cigna Commercial |
$10,215.64
|
| Rate for Payer: First Health Commercial |
$11,692.60
|
| Rate for Payer: Humana Commercial |
$10,461.80
|
| Rate for Payer: Humana KY Medicaid |
$4,232.72
|
| Rate for Payer: Kentucky WC Medicaid |
$4,275.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,092.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,083.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,692.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,317.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,831.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,231.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,846.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,707.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,492.52
|
| Rate for Payer: PHCS Commercial |
$11,815.68
|
| Rate for Payer: United Healthcare All Payer |
$10,831.04
|
|
|
LINER G7 10^ E1 C 32MM
|
Facility
|
OP
|
$12,308.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,692.40 |
| Max. Negotiated Rate |
$11,815.68 |
| Rate for Payer: Aetna Commercial |
$9,477.16
|
| Rate for Payer: Anthem Medicaid |
$4,232.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,600.24
|
| Rate for Payer: Cash Price |
$6,154.00
|
| Rate for Payer: Cigna Commercial |
$10,215.64
|
| Rate for Payer: First Health Commercial |
$11,692.60
|
| Rate for Payer: Humana Commercial |
$10,461.80
|
| Rate for Payer: Humana KY Medicaid |
$4,232.72
|
| Rate for Payer: Kentucky WC Medicaid |
$4,275.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,092.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,083.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,692.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,317.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,831.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,231.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,846.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,707.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,492.52
|
| Rate for Payer: PHCS Commercial |
$11,815.68
|
| Rate for Payer: United Healthcare All Payer |
$10,831.04
|
|
|
LINER G7 10^ E1 C 32MM
|
Facility
|
IP
|
$12,308.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,692.40 |
| Max. Negotiated Rate |
$11,815.68 |
| Rate for Payer: Aetna Commercial |
$9,477.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,600.24
|
| Rate for Payer: Cash Price |
$6,154.00
|
| Rate for Payer: Cigna Commercial |
$10,215.64
|
| Rate for Payer: First Health Commercial |
$11,692.60
|
| Rate for Payer: Humana Commercial |
$10,461.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,092.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,083.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,692.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,831.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,231.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,846.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,707.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,492.52
|
| Rate for Payer: PHCS Commercial |
$11,815.68
|
| Rate for Payer: United Healthcare All Payer |
$10,831.04
|
|
|
LINER G7 10^ E1 D 28MM
|
Facility
|
IP
|
$12,308.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,692.40 |
| Max. Negotiated Rate |
$11,815.68 |
| Rate for Payer: Aetna Commercial |
$9,477.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,600.24
|
| Rate for Payer: Cash Price |
$6,154.00
|
| Rate for Payer: Cigna Commercial |
$10,215.64
|
| Rate for Payer: First Health Commercial |
$11,692.60
|
| Rate for Payer: Humana Commercial |
$10,461.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,092.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,083.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,692.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,831.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,231.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,846.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,707.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,492.52
|
| Rate for Payer: PHCS Commercial |
$11,815.68
|
| Rate for Payer: United Healthcare All Payer |
$10,831.04
|
|
|
LINER G7 10^ E1 D 28MM
|
Facility
|
OP
|
$12,308.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,692.40 |
| Max. Negotiated Rate |
$11,815.68 |
| Rate for Payer: Aetna Commercial |
$9,477.16
|
| Rate for Payer: Anthem Medicaid |
$4,232.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,600.24
|
| Rate for Payer: Cash Price |
$6,154.00
|
| Rate for Payer: Cigna Commercial |
$10,215.64
|
| Rate for Payer: First Health Commercial |
$11,692.60
|
| Rate for Payer: Humana Commercial |
$10,461.80
|
| Rate for Payer: Humana KY Medicaid |
$4,232.72
|
| Rate for Payer: Kentucky WC Medicaid |
$4,275.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,092.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,083.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,692.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,317.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,831.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,231.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,846.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,707.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,492.52
|
| Rate for Payer: PHCS Commercial |
$11,815.68
|
| Rate for Payer: United Healthcare All Payer |
$10,831.04
|
|
|
LINER G7 10^ E1 D 32MM
|
Facility
|
OP
|
$12,308.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,692.40 |
| Max. Negotiated Rate |
$11,815.68 |
| Rate for Payer: Aetna Commercial |
$9,477.16
|
| Rate for Payer: Anthem Medicaid |
$4,232.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,600.24
|
| Rate for Payer: Cash Price |
$6,154.00
|
| Rate for Payer: Cigna Commercial |
$10,215.64
|
| Rate for Payer: First Health Commercial |
$11,692.60
|
| Rate for Payer: Humana Commercial |
$10,461.80
|
| Rate for Payer: Humana KY Medicaid |
$4,232.72
|
| Rate for Payer: Kentucky WC Medicaid |
$4,275.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,092.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,083.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,692.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,317.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,831.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,231.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,846.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,707.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,492.52
|
| Rate for Payer: PHCS Commercial |
$11,815.68
|
| Rate for Payer: United Healthcare All Payer |
$10,831.04
|
|
|
LINER G7 10^ E1 D 32MM
|
Facility
|
IP
|
$12,308.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,692.40 |
| Max. Negotiated Rate |
$11,815.68 |
| Rate for Payer: Aetna Commercial |
$9,477.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,600.24
|
| Rate for Payer: Cash Price |
$6,154.00
|
| Rate for Payer: Cigna Commercial |
$10,215.64
|
| Rate for Payer: First Health Commercial |
$11,692.60
|
| Rate for Payer: Humana Commercial |
$10,461.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,092.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,083.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,692.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,831.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,231.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,846.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,707.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,492.52
|
| Rate for Payer: PHCS Commercial |
$11,815.68
|
| Rate for Payer: United Healthcare All Payer |
$10,831.04
|
|
|
LINER G7 10^ E1 D 36MM
|
Facility
|
OP
|
$12,308.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,692.40 |
| Max. Negotiated Rate |
$11,815.68 |
| Rate for Payer: Aetna Commercial |
$9,477.16
|
| Rate for Payer: Anthem Medicaid |
$4,232.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,600.24
|
| Rate for Payer: Cash Price |
$6,154.00
|
| Rate for Payer: Cigna Commercial |
$10,215.64
|
| Rate for Payer: First Health Commercial |
$11,692.60
|
| Rate for Payer: Humana Commercial |
$10,461.80
|
| Rate for Payer: Humana KY Medicaid |
$4,232.72
|
| Rate for Payer: Kentucky WC Medicaid |
$4,275.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,092.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,083.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,692.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,317.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,831.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,231.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,846.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,707.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,492.52
|
| Rate for Payer: PHCS Commercial |
$11,815.68
|
| Rate for Payer: United Healthcare All Payer |
$10,831.04
|
|
|
LINER G7 10^ E1 D 36MM
|
Facility
|
IP
|
$12,308.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,692.40 |
| Max. Negotiated Rate |
$11,815.68 |
| Rate for Payer: Aetna Commercial |
$9,477.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,600.24
|
| Rate for Payer: Cash Price |
$6,154.00
|
| Rate for Payer: Cigna Commercial |
$10,215.64
|
| Rate for Payer: First Health Commercial |
$11,692.60
|
| Rate for Payer: Humana Commercial |
$10,461.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,092.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,083.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,692.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,831.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,231.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,846.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,707.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,492.52
|
| Rate for Payer: PHCS Commercial |
$11,815.68
|
| Rate for Payer: United Healthcare All Payer |
$10,831.04
|
|
