|
LINER R3 CONST ACET 52MM
|
Facility
|
OP
|
$17,880.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,324.40 |
| Max. Negotiated Rate |
$17,164.80 |
| Rate for Payer: Aetna Commercial |
$13,767.60
|
| Rate for Payer: Anthem Medicaid |
$6,148.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,946.40
|
| Rate for Payer: Cash Price |
$8,940.00
|
| Rate for Payer: Cigna Commercial |
$14,840.40
|
| Rate for Payer: First Health Commercial |
$16,986.00
|
| Rate for Payer: Humana Commercial |
$15,198.00
|
| Rate for Payer: Humana KY Medicaid |
$6,148.93
|
| Rate for Payer: Kentucky WC Medicaid |
$6,211.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,661.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,195.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,364.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,272.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,734.40
|
| Rate for Payer: Ohio Health Group HMO |
$13,410.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,576.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,324.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,542.80
|
| Rate for Payer: PHCS Commercial |
$17,164.80
|
| Rate for Payer: United Healthcare All Payer |
$15,734.40
|
|
|
LINER R3 CONST ACET 52MM
|
Facility
|
IP
|
$17,880.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,324.40 |
| Max. Negotiated Rate |
$17,164.80 |
| Rate for Payer: Aetna Commercial |
$13,767.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,946.40
|
| Rate for Payer: Cash Price |
$8,940.00
|
| Rate for Payer: Cigna Commercial |
$14,840.40
|
| Rate for Payer: First Health Commercial |
$16,986.00
|
| Rate for Payer: Humana Commercial |
$15,198.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,661.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,195.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,364.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,734.40
|
| Rate for Payer: Ohio Health Group HMO |
$13,410.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,576.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,324.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,542.80
|
| Rate for Payer: PHCS Commercial |
$17,164.80
|
| Rate for Payer: United Healthcare All Payer |
$15,734.40
|
|
|
LINER R3 CONST ACET 54MM
|
Facility
|
OP
|
$17,880.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,324.40 |
| Max. Negotiated Rate |
$17,164.80 |
| Rate for Payer: Aetna Commercial |
$13,767.60
|
| Rate for Payer: Anthem Medicaid |
$6,148.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,946.40
|
| Rate for Payer: Cash Price |
$8,940.00
|
| Rate for Payer: Cigna Commercial |
$14,840.40
|
| Rate for Payer: First Health Commercial |
$16,986.00
|
| Rate for Payer: Humana Commercial |
$15,198.00
|
| Rate for Payer: Humana KY Medicaid |
$6,148.93
|
| Rate for Payer: Kentucky WC Medicaid |
$6,211.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,661.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,195.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,364.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,272.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,734.40
|
| Rate for Payer: Ohio Health Group HMO |
$13,410.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,576.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,324.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,542.80
|
| Rate for Payer: PHCS Commercial |
$17,164.80
|
| Rate for Payer: United Healthcare All Payer |
$15,734.40
|
|
|
LINER R3 CONST ACET 54MM
|
Facility
|
IP
|
$17,880.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,324.40 |
| Max. Negotiated Rate |
$17,164.80 |
| Rate for Payer: Aetna Commercial |
$13,767.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,946.40
|
| Rate for Payer: Cash Price |
$8,940.00
|
| Rate for Payer: Cigna Commercial |
$14,840.40
|
| Rate for Payer: First Health Commercial |
$16,986.00
|
| Rate for Payer: Humana Commercial |
$15,198.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,661.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,195.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,364.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,734.40
|
| Rate for Payer: Ohio Health Group HMO |
$13,410.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,576.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,324.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,542.80
|
| Rate for Payer: PHCS Commercial |
$17,164.80
|
| Rate for Payer: United Healthcare All Payer |
$15,734.40
|
|
|
LINER R3 CONST ACET 56MM
|
Facility
|
OP
|
$17,880.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,324.40 |
| Max. Negotiated Rate |
$17,164.80 |
| Rate for Payer: Aetna Commercial |
$13,767.60
|
| Rate for Payer: Anthem Medicaid |
$6,148.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,946.40
|
| Rate for Payer: Cash Price |
$8,940.00
|
| Rate for Payer: Cigna Commercial |
$14,840.40
|
| Rate for Payer: First Health Commercial |
$16,986.00
|
| Rate for Payer: Humana Commercial |
$15,198.00
|
| Rate for Payer: Humana KY Medicaid |
$6,148.93
|
| Rate for Payer: Kentucky WC Medicaid |
$6,211.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,661.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,195.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,364.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,272.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,734.40
|
| Rate for Payer: Ohio Health Group HMO |
$13,410.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,576.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,324.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,542.80
|
| Rate for Payer: PHCS Commercial |
$17,164.80
|
| Rate for Payer: United Healthcare All Payer |
$15,734.40
|
|
|
LINER R3 CONST ACET 56MM
|
Facility
|
IP
|
$17,880.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,324.40 |
| Max. Negotiated Rate |
$17,164.80 |
| Rate for Payer: Aetna Commercial |
$13,767.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,946.40
|
| Rate for Payer: Cash Price |
$8,940.00
|
| Rate for Payer: Cigna Commercial |
$14,840.40
|
| Rate for Payer: First Health Commercial |
$16,986.00
|
| Rate for Payer: Humana Commercial |
$15,198.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,661.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,195.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,364.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,734.40
|
| Rate for Payer: Ohio Health Group HMO |
$13,410.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,576.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,324.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,542.80
|
| Rate for Payer: PHCS Commercial |
$17,164.80
|
| Rate for Payer: United Healthcare All Payer |
$15,734.40
|
|
|
LINER R3 CONST ACET 58MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| 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 |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LINER R3 CONST ACET 58MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| 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 |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LINER R3 CONST ACET 60MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| 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 |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LINER R3 CONST ACET 60MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| 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 |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LINER R3 CONST ACET 62MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| 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 |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LINER R3 CONST ACET 62MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| 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 |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LINER R3 CONST ACET 64MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| 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 |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LINER R3 CONST ACET 64MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| 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 |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LINER R3 CONST ACET 66/70MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| 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 |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LINER R3 CONST ACET 66/70MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| 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 |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LINER SMALL CLEAR 32
|
Facility
|
OP
|
$554.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$532.55 |
| Rate for Payer: Aetna Commercial |
$427.15
|
| Rate for Payer: Anthem Medicaid |
$190.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$432.70
|
| Rate for Payer: Cash Price |
$277.37
|
| Rate for Payer: Cigna Commercial |
$460.43
|
| Rate for Payer: First Health Commercial |
$527.00
|
| Rate for Payer: Humana Commercial |
$471.53
|
| Rate for Payer: Humana KY Medicaid |
$190.78
|
| Rate for Payer: Kentucky WC Medicaid |
$192.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$454.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$409.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$166.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$194.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$488.17
|
| Rate for Payer: Ohio Health Group HMO |
$416.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$171.97
|
| Rate for Payer: PHCS Commercial |
$532.55
|
| Rate for Payer: United Healthcare All Payer |
$488.17
|
|
|
LINER SMALL CLEAR 32
|
Facility
|
IP
|
$554.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$532.55 |
| Rate for Payer: Aetna Commercial |
$427.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$432.70
|
| Rate for Payer: Cash Price |
$277.37
|
| Rate for Payer: Cigna Commercial |
$460.43
|
| Rate for Payer: First Health Commercial |
$527.00
|
| Rate for Payer: Humana Commercial |
$471.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$454.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$409.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$166.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$488.17
|
| Rate for Payer: Ohio Health Group HMO |
$416.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$171.97
|
| Rate for Payer: PHCS Commercial |
$532.55
|
| Rate for Payer: United Healthcare All Payer |
$488.17
|
|
|
LINER TM REV 10^ OBLIQUE 28*48
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| 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 |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LINER TM REV 10^ OBLIQUE 28*48
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| 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 |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LINER TM REV 10^ OBLIQUE 28*50
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| 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 |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LINER TM REV 10^ OBLIQUE 28*50
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| 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 |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LINER TM REV 10^ OBLIQUE 28*52
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| 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 |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LINER TM REV 10^ OBLIQUE 28*52
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| 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 |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LINER TM REV 10^ OBLIQUE 28*54
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| 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 |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
