|
LINER G7 NEUTRAL 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 NEUTRAL 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 NEUTRAL 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 NEUTRAL 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 NEUTRAL 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 NEUTRAL 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 NEUTRAL 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 NEUTRAL 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 NEUTRAL 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 NEUTRAL 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 NEUTRAL 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 NEUTRAL 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 NEUTRAL 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 NEUTRAL 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 NEUTRAL 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 NEUTRAL 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 NEUTRAL 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 NEUTRAL 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 HUMERAL L/42+3
|
Facility
|
IP
|
$6,704.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.42 |
| Max. Negotiated Rate |
$6,436.56 |
| Rate for Payer: Aetna Commercial |
$5,162.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,229.70
|
| Rate for Payer: Cash Price |
$3,352.38
|
| Rate for Payer: Cigna Commercial |
$5,564.94
|
| Rate for Payer: First Health Commercial |
$6,369.51
|
| Rate for Payer: Humana Commercial |
$5,699.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,497.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,028.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,363.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,833.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,626.28
|
| Rate for Payer: PHCS Commercial |
$6,436.56
|
| Rate for Payer: United Healthcare All Payer |
$5,900.18
|
|
|
LINER HUMERAL L/42+3
|
Facility
|
OP
|
$6,704.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.42 |
| Max. Negotiated Rate |
$6,436.56 |
| Rate for Payer: Aetna Commercial |
$5,162.66
|
| Rate for Payer: Anthem Medicaid |
$2,305.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,229.70
|
| Rate for Payer: Cash Price |
$3,352.38
|
| Rate for Payer: Cigna Commercial |
$5,564.94
|
| Rate for Payer: First Health Commercial |
$6,369.51
|
| Rate for Payer: Humana Commercial |
$5,699.04
|
| Rate for Payer: Humana KY Medicaid |
$2,305.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,329.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,497.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,352.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,028.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,363.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,833.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,626.28
|
| Rate for Payer: PHCS Commercial |
$6,436.56
|
| Rate for Payer: United Healthcare All Payer |
$5,900.18
|
|
|
LINER HUMERAL L/42+3 CONST
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LINER HUMERAL L/42+3 CONST
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LINER HUMERAL L/42+6
|
Facility
|
IP
|
$6,704.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.42 |
| Max. Negotiated Rate |
$6,436.56 |
| Rate for Payer: Aetna Commercial |
$5,162.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,229.70
|
| Rate for Payer: Cash Price |
$3,352.38
|
| Rate for Payer: Cigna Commercial |
$5,564.94
|
| Rate for Payer: First Health Commercial |
$6,369.51
|
| Rate for Payer: Humana Commercial |
$5,699.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,497.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,028.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,363.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,833.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,626.28
|
| Rate for Payer: PHCS Commercial |
$6,436.56
|
| Rate for Payer: United Healthcare All Payer |
$5,900.18
|
|
|
LINER HUMERAL L/42+6
|
Facility
|
OP
|
$6,704.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.42 |
| Max. Negotiated Rate |
$6,436.56 |
| Rate for Payer: Aetna Commercial |
$5,162.66
|
| Rate for Payer: Anthem Medicaid |
$2,305.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,229.70
|
| Rate for Payer: Cash Price |
$3,352.38
|
| Rate for Payer: Cigna Commercial |
$5,564.94
|
| Rate for Payer: First Health Commercial |
$6,369.51
|
| Rate for Payer: Humana Commercial |
$5,699.04
|
| Rate for Payer: Humana KY Medicaid |
$2,305.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,329.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,497.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,352.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,028.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,363.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,833.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,626.28
|
| Rate for Payer: PHCS Commercial |
$6,436.56
|
| Rate for Payer: United Healthcare All Payer |
$5,900.18
|
|
|
LINER HUMERAL L/42+6 CONST
|
Facility
|
IP
|
$6,704.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.42 |
| Max. Negotiated Rate |
$6,436.56 |
| Rate for Payer: Aetna Commercial |
$5,162.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,229.70
|
| Rate for Payer: Cash Price |
$3,352.38
|
| Rate for Payer: Cigna Commercial |
$5,564.94
|
| Rate for Payer: First Health Commercial |
$6,369.51
|
| Rate for Payer: Humana Commercial |
$5,699.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,497.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,028.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,363.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,833.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,626.28
|
| Rate for Payer: PHCS Commercial |
$6,436.56
|
| Rate for Payer: United Healthcare All Payer |
$5,900.18
|
|
