|
LINER G7 HI-WALL E1 36MM G
|
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 HI-WALL E1 36MM H
|
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 HI-WALL E1 36MM H
|
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 HI-WALL E1 36MM I
|
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 HI-WALL E1 36MM I
|
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 HI-WALL E1 36MM J
|
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 HI-WALL E1 36MM J
|
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 HI-WALL E1 40MM F
|
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 HI-WALL E1 40MM F
|
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 HI-WALL E1 40MM G
|
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 HI-WALL E1 40MM G
|
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 HI-WALL E1 40MM H
|
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 HI-WALL E1 40MM H
|
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 HI-WALL E1 40MM I
|
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 HI-WALL E1 40MM I
|
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 HI-WALL E1 40MM J
|
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 HI-WALL E1 40MM J
|
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 HI-WALL E1 44MM H
|
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 HI-WALL E1 44MM H
|
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 HI-WALL E1 44MM I
|
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 HI-WALL E1 44MM I
|
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 HI-WALL E1 44MM J
|
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 HI-WALL E1 44MM J
|
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 NEU ACE +5MM*28MM B
|
Facility
|
OP
|
$12,915.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,874.72 |
| Max. Negotiated Rate |
$12,399.12 |
| Rate for Payer: Aetna Commercial |
$9,945.13
|
| Rate for Payer: Anthem Medicaid |
$4,441.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,074.28
|
| Rate for Payer: Cash Price |
$6,457.88
|
| Rate for Payer: Cigna Commercial |
$10,720.07
|
| Rate for Payer: First Health Commercial |
$12,269.96
|
| Rate for Payer: Humana Commercial |
$10,978.39
|
| Rate for Payer: Humana KY Medicaid |
$4,441.73
|
| Rate for Payer: Kentucky WC Medicaid |
$4,486.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,590.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,531.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,874.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,530.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,365.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,686.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,332.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,236.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,911.87
|
| Rate for Payer: PHCS Commercial |
$12,399.12
|
| Rate for Payer: United Healthcare All Payer |
$11,365.86
|
|
|
LINER G7 NEU ACE +5MM*28MM B
|
Facility
|
IP
|
$12,915.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,874.72 |
| Max. Negotiated Rate |
$12,399.12 |
| Rate for Payer: Aetna Commercial |
$9,945.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,074.28
|
| Rate for Payer: Cash Price |
$6,457.88
|
| Rate for Payer: Cigna Commercial |
$10,720.07
|
| Rate for Payer: First Health Commercial |
$12,269.96
|
| Rate for Payer: Humana Commercial |
$10,978.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,590.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,531.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,874.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,365.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,686.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,332.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,236.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,911.87
|
| Rate for Payer: PHCS Commercial |
$12,399.12
|
| Rate for Payer: United Healthcare All Payer |
$11,365.86
|
|
