|
LINER MDM 36MM C
|
Facility
|
OP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem Medicaid |
$3,821.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Humana KY Medicaid |
$3,821.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,859.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,897.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
LINER MDM 36MM C
|
Facility
|
IP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
LINER MDM 38MM D
|
Facility
|
OP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem Medicaid |
$3,821.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Humana KY Medicaid |
$3,821.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,859.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,897.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
LINER MDM 38MM D
|
Facility
|
IP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
LINER MDM 42MM E
|
Facility
|
OP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem Medicaid |
$3,821.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Humana KY Medicaid |
$3,821.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,859.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,897.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
LINER MDM 42MM E
|
Facility
|
IP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
LINER MDM 46MM F
|
Facility
|
IP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
LINER MDM 46MM F
|
Facility
|
OP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem Medicaid |
$3,821.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Humana KY Medicaid |
$3,821.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,859.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,897.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
LINER MDM 48MM G
|
Facility
|
OP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem Medicaid |
$3,821.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Humana KY Medicaid |
$3,821.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,859.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,897.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
LINER MDM 48MM G
|
Facility
|
IP
|
$11,111.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,444.43 |
| Max. Negotiated Rate |
$10,666.56 |
| Rate for Payer: Aetna Commercial |
$8,555.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.58
|
| Rate for Payer: Cash Price |
$5,555.50
|
| Rate for Payer: Cigna Commercial |
$9,222.13
|
| Rate for Payer: First Health Commercial |
$10,555.45
|
| Rate for Payer: Humana Commercial |
$9,444.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,111.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.68
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,222.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,444.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,444.41
|
| Rate for Payer: PHCS Commercial |
$10,666.56
|
| Rate for Payer: United Healthcare All Payer |
$9,777.68
|
|
|
LINER R3 0^ +4 XLPE ACE 44*60
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
LINER R3 0^ +4 XLPE ACE 44*60
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
LINER R3 0^ +4 XLPE ACE 44*62
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
LINER R3 0^ +4 XLPE ACE 44*62
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
LINER R3 0^ +4 XLPE ACE 44*64
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
LINER R3 0^ +4 XLPE ACE 44*64
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
LINER R3 0 +4 XLPE ACET 40*56
|
Facility
|
IP
|
$13,294.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,728.29 |
| Max. Negotiated Rate |
$12,762.76 |
| Rate for Payer: Aetna Commercial |
$10,236.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,369.74
|
| Rate for Payer: Cash Price |
$6,647.27
|
| Rate for Payer: Cigna Commercial |
$11,034.47
|
| Rate for Payer: First Health Commercial |
$12,629.81
|
| Rate for Payer: Humana Commercial |
$11,300.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,901.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,811.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,988.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,699.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,970.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,658.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,728.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,121.31
|
| Rate for Payer: PHCS Commercial |
$12,762.76
|
| Rate for Payer: United Healthcare All Payer |
$11,699.20
|
|
|
LINER R3 0 +4 XLPE ACET 40*56
|
Facility
|
OP
|
$13,294.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,728.29 |
| Max. Negotiated Rate |
$12,762.76 |
| Rate for Payer: Aetna Commercial |
$10,236.80
|
| Rate for Payer: Anthem Medicaid |
$4,571.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,369.74
|
| Rate for Payer: Cash Price |
$6,647.27
|
| Rate for Payer: Cigna Commercial |
$11,034.47
|
| Rate for Payer: First Health Commercial |
$12,629.81
|
| Rate for Payer: Humana Commercial |
$11,300.36
|
| Rate for Payer: Humana KY Medicaid |
$4,571.99
|
| Rate for Payer: Kentucky WC Medicaid |
$4,618.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,901.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,811.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,988.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,663.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,699.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,970.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,658.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,728.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,121.31
|
| Rate for Payer: PHCS Commercial |
$12,762.76
|
| Rate for Payer: United Healthcare All Payer |
$11,699.20
|
|
|
LINER R3 0 +4 XLPE ACET 40*58
|
Facility
|
OP
|
$13,294.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,728.29 |
| Max. Negotiated Rate |
$12,762.76 |
| Rate for Payer: Aetna Commercial |
$10,236.80
|
| Rate for Payer: Anthem Medicaid |
$4,571.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,369.74
|
| Rate for Payer: Cash Price |
$6,647.27
|
| Rate for Payer: Cigna Commercial |
$11,034.47
|
| Rate for Payer: First Health Commercial |
$12,629.81
|
| Rate for Payer: Humana Commercial |
$11,300.36
|
| Rate for Payer: Humana KY Medicaid |
$4,571.99
|
| Rate for Payer: Kentucky WC Medicaid |
$4,618.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,901.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,811.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,988.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,663.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,699.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,970.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,658.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,728.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,121.31
|
| Rate for Payer: PHCS Commercial |
$12,762.76
|
| Rate for Payer: United Healthcare All Payer |
$11,699.20
|
|
|
LINER R3 0 +4 XLPE ACET 40*58
|
Facility
|
IP
|
$13,294.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,728.29 |
| Max. Negotiated Rate |
$12,762.76 |
| Rate for Payer: Aetna Commercial |
$10,236.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,369.74
|
| Rate for Payer: Cash Price |
$6,647.27
|
| Rate for Payer: Cigna Commercial |
$11,034.47
|
| Rate for Payer: First Health Commercial |
$12,629.81
|
| Rate for Payer: Humana Commercial |
$11,300.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,901.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,811.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,988.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,699.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,970.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,658.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,728.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,121.31
|
| Rate for Payer: PHCS Commercial |
$12,762.76
|
| Rate for Payer: United Healthcare All Payer |
$11,699.20
|
|
|
LINER R3 0 +4 XLPE ACET 40*60
|
Facility
|
OP
|
$13,294.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,728.29 |
| Max. Negotiated Rate |
$12,762.76 |
| Rate for Payer: Aetna Commercial |
$10,236.80
|
| Rate for Payer: Anthem Medicaid |
$4,571.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,369.74
|
| Rate for Payer: Cash Price |
$6,647.27
|
| Rate for Payer: Cigna Commercial |
$11,034.47
|
| Rate for Payer: First Health Commercial |
$12,629.81
|
| Rate for Payer: Humana Commercial |
$11,300.36
|
| Rate for Payer: Humana KY Medicaid |
$4,571.99
|
| Rate for Payer: Kentucky WC Medicaid |
$4,618.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,901.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,811.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,988.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,663.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,699.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,970.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,658.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,728.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,121.31
|
| Rate for Payer: PHCS Commercial |
$12,762.76
|
| Rate for Payer: United Healthcare All Payer |
$11,699.20
|
|
|
LINER R3 0 +4 XLPE ACET 40*60
|
Facility
|
IP
|
$13,294.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,728.29 |
| Max. Negotiated Rate |
$12,762.76 |
| Rate for Payer: Aetna Commercial |
$10,236.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,369.74
|
| Rate for Payer: Cash Price |
$6,647.27
|
| Rate for Payer: Cigna Commercial |
$11,034.47
|
| Rate for Payer: First Health Commercial |
$12,629.81
|
| Rate for Payer: Humana Commercial |
$11,300.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,901.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,811.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,988.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,699.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,970.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,658.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,728.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,121.31
|
| Rate for Payer: PHCS Commercial |
$12,762.76
|
| Rate for Payer: United Healthcare All Payer |
$11,699.20
|
|
|
LINER R3 0 +4 XLPE ACET 40*62
|
Facility
|
OP
|
$13,294.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,728.29 |
| Max. Negotiated Rate |
$12,762.76 |
| Rate for Payer: Aetna Commercial |
$10,236.80
|
| Rate for Payer: Anthem Medicaid |
$4,571.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,369.74
|
| Rate for Payer: Cash Price |
$6,647.27
|
| Rate for Payer: Cigna Commercial |
$11,034.47
|
| Rate for Payer: First Health Commercial |
$12,629.81
|
| Rate for Payer: Humana Commercial |
$11,300.36
|
| Rate for Payer: Humana KY Medicaid |
$4,571.99
|
| Rate for Payer: Kentucky WC Medicaid |
$4,618.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,901.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,811.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,988.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,663.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,699.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,970.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,658.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,728.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,121.31
|
| Rate for Payer: PHCS Commercial |
$12,762.76
|
| Rate for Payer: United Healthcare All Payer |
$11,699.20
|
|
|
LINER R3 0 +4 XLPE ACET 40*62
|
Facility
|
IP
|
$13,294.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,728.29 |
| Max. Negotiated Rate |
$12,762.76 |
| Rate for Payer: Aetna Commercial |
$10,236.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,369.74
|
| Rate for Payer: Cash Price |
$6,647.27
|
| Rate for Payer: Cigna Commercial |
$11,034.47
|
| Rate for Payer: First Health Commercial |
$12,629.81
|
| Rate for Payer: Humana Commercial |
$11,300.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,901.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,811.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,988.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,699.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,970.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,658.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,728.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,121.31
|
| Rate for Payer: PHCS Commercial |
$12,762.76
|
| Rate for Payer: United Healthcare All Payer |
$11,699.20
|
|
|
LINER R3 0 +4 XLPE ACET 40*64
|
Facility
|
OP
|
$13,294.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,728.29 |
| Max. Negotiated Rate |
$12,762.76 |
| Rate for Payer: Aetna Commercial |
$10,236.80
|
| Rate for Payer: Anthem Medicaid |
$4,571.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,369.74
|
| Rate for Payer: Cash Price |
$6,647.27
|
| Rate for Payer: Cigna Commercial |
$11,034.47
|
| Rate for Payer: First Health Commercial |
$12,629.81
|
| Rate for Payer: Humana Commercial |
$11,300.36
|
| Rate for Payer: Humana KY Medicaid |
$4,571.99
|
| Rate for Payer: Kentucky WC Medicaid |
$4,618.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,901.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,811.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,988.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,663.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,699.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,970.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,658.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,728.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,121.31
|
| Rate for Payer: PHCS Commercial |
$12,762.76
|
| Rate for Payer: United Healthcare All Payer |
$11,699.20
|
|
