|
LINER G7 FREEDOM CONST 10^ 36F
|
Facility
|
OP
|
$16,059.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,817.83 |
| Max. Negotiated Rate |
$15,417.06 |
| Rate for Payer: Aetna Commercial |
$12,365.77
|
| Rate for Payer: Anthem Medicaid |
$5,522.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,526.36
|
| Rate for Payer: Cash Price |
$8,029.72
|
| Rate for Payer: Cigna Commercial |
$13,329.34
|
| Rate for Payer: First Health Commercial |
$15,256.47
|
| Rate for Payer: Humana Commercial |
$13,650.52
|
| Rate for Payer: Humana KY Medicaid |
$5,522.84
|
| Rate for Payer: Kentucky WC Medicaid |
$5,579.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,168.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,851.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,817.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,633.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,132.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,044.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,847.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,971.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,081.01
|
| Rate for Payer: PHCS Commercial |
$15,417.06
|
| Rate for Payer: United Healthcare All Payer |
$14,132.31
|
|
|
LINER G7 FREEDOM CONST 10^ 36F
|
Facility
|
IP
|
$16,059.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,817.83 |
| Max. Negotiated Rate |
$15,417.06 |
| Rate for Payer: Aetna Commercial |
$12,365.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,526.36
|
| Rate for Payer: Cash Price |
$8,029.72
|
| Rate for Payer: Cigna Commercial |
$13,329.34
|
| Rate for Payer: First Health Commercial |
$15,256.47
|
| Rate for Payer: Humana Commercial |
$13,650.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,168.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,851.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,817.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,132.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,044.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,847.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,971.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,081.01
|
| Rate for Payer: PHCS Commercial |
$15,417.06
|
| Rate for Payer: United Healthcare All Payer |
$14,132.31
|
|
|
LINER G7 FREEDOM CONST 10^ 36G
|
Facility
|
IP
|
$16,059.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,817.83 |
| Max. Negotiated Rate |
$15,417.06 |
| Rate for Payer: Aetna Commercial |
$12,365.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,526.36
|
| Rate for Payer: Cash Price |
$8,029.72
|
| Rate for Payer: Cigna Commercial |
$13,329.34
|
| Rate for Payer: First Health Commercial |
$15,256.47
|
| Rate for Payer: Humana Commercial |
$13,650.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,168.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,851.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,817.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,132.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,044.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,847.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,971.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,081.01
|
| Rate for Payer: PHCS Commercial |
$15,417.06
|
| Rate for Payer: United Healthcare All Payer |
$14,132.31
|
|
|
LINER G7 FREEDOM CONST 10^ 36G
|
Facility
|
OP
|
$16,059.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,817.83 |
| Max. Negotiated Rate |
$15,417.06 |
| Rate for Payer: Aetna Commercial |
$12,365.77
|
| Rate for Payer: Anthem Medicaid |
$5,522.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,526.36
|
| Rate for Payer: Cash Price |
$8,029.72
|
| Rate for Payer: Cigna Commercial |
$13,329.34
|
| Rate for Payer: First Health Commercial |
$15,256.47
|
| Rate for Payer: Humana Commercial |
$13,650.52
|
| Rate for Payer: Humana KY Medicaid |
$5,522.84
|
| Rate for Payer: Kentucky WC Medicaid |
$5,579.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,168.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,851.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,817.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,633.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,132.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,044.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,847.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,971.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,081.01
|
| Rate for Payer: PHCS Commercial |
$15,417.06
|
| Rate for Payer: United Healthcare All Payer |
$14,132.31
|
|
|
LINER G7 FREEDOM CONST 10^ 36H
|
Facility
|
IP
|
$16,059.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,817.83 |
| Max. Negotiated Rate |
$15,417.06 |
| Rate for Payer: Aetna Commercial |
$12,365.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,526.36
|
| Rate for Payer: Cash Price |
$8,029.72
|
| Rate for Payer: Cigna Commercial |
$13,329.34
|
| Rate for Payer: First Health Commercial |
$15,256.47
|
| Rate for Payer: Humana Commercial |
$13,650.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,168.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,851.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,817.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,132.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,044.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,847.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,971.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,081.01
|
| Rate for Payer: PHCS Commercial |
$15,417.06
|
| Rate for Payer: United Healthcare All Payer |
$14,132.31
|
|
|
LINER G7 FREEDOM CONST 10^ 36H
|
Facility
|
OP
|
$16,059.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,817.83 |
| Max. Negotiated Rate |
$15,417.06 |
| Rate for Payer: Aetna Commercial |
$12,365.77
|
| Rate for Payer: Anthem Medicaid |
$5,522.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,526.36
|
| Rate for Payer: Cash Price |
$8,029.72
|
| Rate for Payer: Cigna Commercial |
$13,329.34
|
| Rate for Payer: First Health Commercial |
$15,256.47
|
| Rate for Payer: Humana Commercial |
$13,650.52
|
| Rate for Payer: Humana KY Medicaid |
$5,522.84
|
| Rate for Payer: Kentucky WC Medicaid |
$5,579.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,168.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,851.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,817.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,633.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,132.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,044.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,847.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,971.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,081.01
|
| Rate for Payer: PHCS Commercial |
$15,417.06
|
| Rate for Payer: United Healthcare All Payer |
$14,132.31
|
|
|
LINER G7 FREEDOM CONST 10^ 36I
|
Facility
|
OP
|
$16,059.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,817.83 |
| Max. Negotiated Rate |
$15,417.06 |
| Rate for Payer: Aetna Commercial |
$12,365.77
|
| Rate for Payer: Anthem Medicaid |
$5,522.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,526.36
|
| Rate for Payer: Cash Price |
$8,029.72
|
| Rate for Payer: Cigna Commercial |
$13,329.34
|
| Rate for Payer: First Health Commercial |
$15,256.47
|
| Rate for Payer: Humana Commercial |
$13,650.52
|
| Rate for Payer: Humana KY Medicaid |
$5,522.84
|
| Rate for Payer: Kentucky WC Medicaid |
$5,579.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,168.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,851.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,817.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,633.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,132.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,044.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,847.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,971.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,081.01
|
| Rate for Payer: PHCS Commercial |
$15,417.06
|
| Rate for Payer: United Healthcare All Payer |
$14,132.31
|
|
|
LINER G7 FREEDOM CONST 10^ 36I
|
Facility
|
IP
|
$16,059.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,817.83 |
| Max. Negotiated Rate |
$15,417.06 |
| Rate for Payer: Aetna Commercial |
$12,365.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,526.36
|
| Rate for Payer: Cash Price |
$8,029.72
|
| Rate for Payer: Cigna Commercial |
$13,329.34
|
| Rate for Payer: First Health Commercial |
$15,256.47
|
| Rate for Payer: Humana Commercial |
$13,650.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,168.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,851.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,817.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,132.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,044.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,847.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,971.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,081.01
|
| Rate for Payer: PHCS Commercial |
$15,417.06
|
| Rate for Payer: United Healthcare All Payer |
$14,132.31
|
|
|
LINER G7 FREEDOM CONST 10^ 36J
|
Facility
|
IP
|
$16,059.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,817.83 |
| Max. Negotiated Rate |
$15,417.06 |
| Rate for Payer: Aetna Commercial |
$12,365.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,526.36
|
| Rate for Payer: Cash Price |
$8,029.72
|
| Rate for Payer: Cigna Commercial |
$13,329.34
|
| Rate for Payer: First Health Commercial |
$15,256.47
|
| Rate for Payer: Humana Commercial |
$13,650.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,168.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,851.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,817.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,132.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,044.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,847.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,971.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,081.01
|
| Rate for Payer: PHCS Commercial |
$15,417.06
|
| Rate for Payer: United Healthcare All Payer |
$14,132.31
|
|
|
LINER G7 FREEDOM CONST 10^ 36J
|
Facility
|
OP
|
$16,059.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,817.83 |
| Max. Negotiated Rate |
$15,417.06 |
| Rate for Payer: Aetna Commercial |
$12,365.77
|
| Rate for Payer: Anthem Medicaid |
$5,522.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,526.36
|
| Rate for Payer: Cash Price |
$8,029.72
|
| Rate for Payer: Cigna Commercial |
$13,329.34
|
| Rate for Payer: First Health Commercial |
$15,256.47
|
| Rate for Payer: Humana Commercial |
$13,650.52
|
| Rate for Payer: Humana KY Medicaid |
$5,522.84
|
| Rate for Payer: Kentucky WC Medicaid |
$5,579.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,168.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,851.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,817.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,633.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,132.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,044.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,847.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,971.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,081.01
|
| Rate for Payer: PHCS Commercial |
$15,417.06
|
| Rate for Payer: United Healthcare All Payer |
$14,132.31
|
|
|
LINER G7 FREEDOM CONST 32MM B
|
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 G7 FREEDOM CONST 32MM B
|
Facility
|
OP
|
$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 Medicaid |
$7,603.29
|
| 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: Humana KY Medicaid |
$7,603.29
|
| Rate for Payer: Kentucky WC Medicaid |
$7,680.67
|
| 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: Molina Healthcare Medicaid |
$7,755.84
|
| 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 G7 FREEDOM CONST 32MM C
|
Facility
|
OP
|
$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 Medicaid |
$7,603.29
|
| 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: Humana KY Medicaid |
$7,603.29
|
| Rate for Payer: Kentucky WC Medicaid |
$7,680.67
|
| 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: Molina Healthcare Medicaid |
$7,755.84
|
| 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 G7 FREEDOM CONST 32MM C
|
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 G7 FREEDOM CONST 36MM D
|
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 G7 FREEDOM CONST 36MM D
|
Facility
|
OP
|
$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 Medicaid |
$7,603.29
|
| 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: Humana KY Medicaid |
$7,603.29
|
| Rate for Payer: Kentucky WC Medicaid |
$7,680.67
|
| 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: Molina Healthcare Medicaid |
$7,755.84
|
| 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 G7 FREEDOM CONST 36MM G
|
Facility
|
OP
|
$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 Medicaid |
$7,603.29
|
| 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: Humana KY Medicaid |
$7,603.29
|
| Rate for Payer: Kentucky WC Medicaid |
$7,680.67
|
| 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: Molina Healthcare Medicaid |
$7,755.84
|
| 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 G7 FREEDOM CONST 36MM G
|
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 G7 FREEDOM CONST 36MM H
|
Facility
|
OP
|
$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 Medicaid |
$7,603.29
|
| 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: Humana KY Medicaid |
$7,603.29
|
| Rate for Payer: Kentucky WC Medicaid |
$7,680.67
|
| 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: Molina Healthcare Medicaid |
$7,755.84
|
| 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 G7 FREEDOM CONST 36MM H
|
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 G7 FREEDOM CONST 36MM I
|
Facility
|
OP
|
$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 Medicaid |
$7,603.29
|
| 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: Humana KY Medicaid |
$7,603.29
|
| Rate for Payer: Kentucky WC Medicaid |
$7,680.67
|
| 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: Molina Healthcare Medicaid |
$7,755.84
|
| 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 G7 FREEDOM CONST 36MM I
|
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 G7 FREEDOM CONST+5MM 32B
|
Facility
|
IP
|
$16,059.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,817.83 |
| Max. Negotiated Rate |
$15,417.06 |
| Rate for Payer: Aetna Commercial |
$12,365.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,526.36
|
| Rate for Payer: Cash Price |
$8,029.72
|
| Rate for Payer: Cigna Commercial |
$13,329.34
|
| Rate for Payer: First Health Commercial |
$15,256.47
|
| Rate for Payer: Humana Commercial |
$13,650.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,168.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,851.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,817.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,132.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,044.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,847.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,971.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,081.01
|
| Rate for Payer: PHCS Commercial |
$15,417.06
|
| Rate for Payer: United Healthcare All Payer |
$14,132.31
|
|
|
LINER G7 FREEDOM CONST+5MM 32B
|
Facility
|
OP
|
$16,059.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,817.83 |
| Max. Negotiated Rate |
$15,417.06 |
| Rate for Payer: Aetna Commercial |
$12,365.77
|
| Rate for Payer: Anthem Medicaid |
$5,522.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,526.36
|
| Rate for Payer: Cash Price |
$8,029.72
|
| Rate for Payer: Cigna Commercial |
$13,329.34
|
| Rate for Payer: First Health Commercial |
$15,256.47
|
| Rate for Payer: Humana Commercial |
$13,650.52
|
| Rate for Payer: Humana KY Medicaid |
$5,522.84
|
| Rate for Payer: Kentucky WC Medicaid |
$5,579.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,168.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,851.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,817.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,633.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,132.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,044.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,847.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,971.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,081.01
|
| Rate for Payer: PHCS Commercial |
$15,417.06
|
| Rate for Payer: United Healthcare All Payer |
$14,132.31
|
|
|
LINER G7 FREEDOM CONST+5MM 32C
|
Facility
|
IP
|
$16,059.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,817.83 |
| Max. Negotiated Rate |
$15,417.06 |
| Rate for Payer: Aetna Commercial |
$12,365.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,526.36
|
| Rate for Payer: Cash Price |
$8,029.72
|
| Rate for Payer: Cigna Commercial |
$13,329.34
|
| Rate for Payer: First Health Commercial |
$15,256.47
|
| Rate for Payer: Humana Commercial |
$13,650.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,168.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,851.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,817.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,132.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,044.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,847.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,971.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,081.01
|
| Rate for Payer: PHCS Commercial |
$15,417.06
|
| Rate for Payer: United Healthcare All Payer |
$14,132.31
|
|
