|
LINER ALTRX +4 10DEG 44*66
|
Facility
|
IP
|
$17,977.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,337.04 |
| Max. Negotiated Rate |
$17,258.11 |
| Rate for Payer: Aetna Commercial |
$13,842.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,022.22
|
| Rate for Payer: Cash Price |
$8,988.60
|
| Rate for Payer: Cigna Commercial |
$14,921.08
|
| Rate for Payer: First Health Commercial |
$17,078.34
|
| Rate for Payer: Humana Commercial |
$15,280.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,741.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,267.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,393.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,819.94
|
| Rate for Payer: Ohio Health Group HMO |
$13,482.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,595.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,337.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,572.93
|
| Rate for Payer: PHCS Commercial |
$17,258.11
|
| Rate for Payer: United Healthcare All Payer |
$15,819.94
|
|
|
LINER ALTRX +4 10DEG 44*66
|
Facility
|
OP
|
$17,977.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,337.04 |
| Max. Negotiated Rate |
$17,258.11 |
| Rate for Payer: Aetna Commercial |
$13,842.44
|
| Rate for Payer: Anthem Medicaid |
$6,182.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,022.22
|
| Rate for Payer: Cash Price |
$8,988.60
|
| Rate for Payer: Cigna Commercial |
$14,921.08
|
| Rate for Payer: First Health Commercial |
$17,078.34
|
| Rate for Payer: Humana Commercial |
$15,280.62
|
| Rate for Payer: Humana KY Medicaid |
$6,182.36
|
| Rate for Payer: Kentucky WC Medicaid |
$6,245.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,741.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,267.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,393.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,306.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,819.94
|
| Rate for Payer: Ohio Health Group HMO |
$13,482.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,595.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,337.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,572.93
|
| Rate for Payer: PHCS Commercial |
$17,258.11
|
| Rate for Payer: United Healthcare All Payer |
$15,819.94
|
|
|
LINER ALTRX +4 10DEG 44*68
|
Facility
|
OP
|
$17,977.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,337.04 |
| Max. Negotiated Rate |
$17,258.11 |
| Rate for Payer: Aetna Commercial |
$13,842.44
|
| Rate for Payer: Anthem Medicaid |
$6,182.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,022.22
|
| Rate for Payer: Cash Price |
$8,988.60
|
| Rate for Payer: Cigna Commercial |
$14,921.08
|
| Rate for Payer: First Health Commercial |
$17,078.34
|
| Rate for Payer: Humana Commercial |
$15,280.62
|
| Rate for Payer: Humana KY Medicaid |
$6,182.36
|
| Rate for Payer: Kentucky WC Medicaid |
$6,245.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,741.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,267.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,393.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,306.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,819.94
|
| Rate for Payer: Ohio Health Group HMO |
$13,482.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,595.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,337.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,572.93
|
| Rate for Payer: PHCS Commercial |
$17,258.11
|
| Rate for Payer: United Healthcare All Payer |
$15,819.94
|
|
|
LINER ALTRX +4 10DEG 44*68
|
Facility
|
IP
|
$17,977.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,337.04 |
| Max. Negotiated Rate |
$17,258.11 |
| Rate for Payer: Aetna Commercial |
$13,842.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,022.22
|
| Rate for Payer: Cash Price |
$8,988.60
|
| Rate for Payer: Cigna Commercial |
$14,921.08
|
| Rate for Payer: First Health Commercial |
$17,078.34
|
| Rate for Payer: Humana Commercial |
$15,280.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,741.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,267.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,393.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,819.94
|
| Rate for Payer: Ohio Health Group HMO |
$13,482.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,595.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,337.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,572.93
|
| Rate for Payer: PHCS Commercial |
$17,258.11
|
| Rate for Payer: United Healthcare All Payer |
$15,819.94
|
|
|
LINER ALTRX +4 10DEG 48*70
|
Facility
|
IP
|
$17,977.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,337.04 |
| Max. Negotiated Rate |
$17,258.11 |
| Rate for Payer: Aetna Commercial |
$13,842.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,022.22
|
| Rate for Payer: Cash Price |
$8,988.60
|
| Rate for Payer: Cigna Commercial |
$14,921.08
|
| Rate for Payer: First Health Commercial |
$17,078.34
|
| Rate for Payer: Humana Commercial |
$15,280.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,741.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,267.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,393.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,819.94
|
| Rate for Payer: Ohio Health Group HMO |
$13,482.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,595.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,337.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,572.93
|
| Rate for Payer: PHCS Commercial |
$17,258.11
|
| Rate for Payer: United Healthcare All Payer |
$15,819.94
|
|
|
LINER ALTRX +4 10DEG 48*70
|
Facility
|
OP
|
$17,977.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,337.04 |
| Max. Negotiated Rate |
$17,258.11 |
| Rate for Payer: Aetna Commercial |
$13,842.44
|
| Rate for Payer: Anthem Medicaid |
$6,182.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,022.22
|
| Rate for Payer: Cash Price |
$8,988.60
|
| Rate for Payer: Cigna Commercial |
$14,921.08
|
| Rate for Payer: First Health Commercial |
$17,078.34
|
| Rate for Payer: Humana Commercial |
$15,280.62
|
| Rate for Payer: Humana KY Medicaid |
$6,182.36
|
| Rate for Payer: Kentucky WC Medicaid |
$6,245.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,741.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,267.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,393.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,306.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,819.94
|
| Rate for Payer: Ohio Health Group HMO |
$13,482.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,595.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,337.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,572.93
|
| Rate for Payer: PHCS Commercial |
$17,258.11
|
| Rate for Payer: United Healthcare All Payer |
$15,819.94
|
|
|
LINER ALTRX +4 10DEG 48*72
|
Facility
|
OP
|
$17,977.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,337.04 |
| Max. Negotiated Rate |
$17,258.11 |
| Rate for Payer: Aetna Commercial |
$13,842.44
|
| Rate for Payer: Anthem Medicaid |
$6,182.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,022.22
|
| Rate for Payer: Cash Price |
$8,988.60
|
| Rate for Payer: Cigna Commercial |
$14,921.08
|
| Rate for Payer: First Health Commercial |
$17,078.34
|
| Rate for Payer: Humana Commercial |
$15,280.62
|
| Rate for Payer: Humana KY Medicaid |
$6,182.36
|
| Rate for Payer: Kentucky WC Medicaid |
$6,245.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,741.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,267.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,393.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,306.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,819.94
|
| Rate for Payer: Ohio Health Group HMO |
$13,482.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,595.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,337.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,572.93
|
| Rate for Payer: PHCS Commercial |
$17,258.11
|
| Rate for Payer: United Healthcare All Payer |
$15,819.94
|
|
|
LINER ALTRX +4 10DEG 48*72
|
Facility
|
IP
|
$17,977.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,337.04 |
| Max. Negotiated Rate |
$17,258.11 |
| Rate for Payer: Aetna Commercial |
$13,842.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,022.22
|
| Rate for Payer: Cash Price |
$8,988.60
|
| Rate for Payer: Cigna Commercial |
$14,921.08
|
| Rate for Payer: First Health Commercial |
$17,078.34
|
| Rate for Payer: Humana Commercial |
$15,280.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,741.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,267.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,393.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,819.94
|
| Rate for Payer: Ohio Health Group HMO |
$13,482.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,595.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,337.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,572.93
|
| Rate for Payer: PHCS Commercial |
$17,258.11
|
| Rate for Payer: United Healthcare All Payer |
$15,819.94
|
|
|
LINER ALTRX +4 10DEG 48*74
|
Facility
|
IP
|
$17,977.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,337.04 |
| Max. Negotiated Rate |
$17,258.11 |
| Rate for Payer: Aetna Commercial |
$13,842.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,022.22
|
| Rate for Payer: Cash Price |
$8,988.60
|
| Rate for Payer: Cigna Commercial |
$14,921.08
|
| Rate for Payer: First Health Commercial |
$17,078.34
|
| Rate for Payer: Humana Commercial |
$15,280.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,741.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,267.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,393.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,819.94
|
| Rate for Payer: Ohio Health Group HMO |
$13,482.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,595.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,337.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,572.93
|
| Rate for Payer: PHCS Commercial |
$17,258.11
|
| Rate for Payer: United Healthcare All Payer |
$15,819.94
|
|
|
LINER ALTRX +4 10DEG 48*74
|
Facility
|
OP
|
$17,977.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,337.04 |
| Max. Negotiated Rate |
$17,258.11 |
| Rate for Payer: Aetna Commercial |
$13,842.44
|
| Rate for Payer: Anthem Medicaid |
$6,182.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,022.22
|
| Rate for Payer: Cash Price |
$8,988.60
|
| Rate for Payer: Cigna Commercial |
$14,921.08
|
| Rate for Payer: First Health Commercial |
$17,078.34
|
| Rate for Payer: Humana Commercial |
$15,280.62
|
| Rate for Payer: Humana KY Medicaid |
$6,182.36
|
| Rate for Payer: Kentucky WC Medicaid |
$6,245.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,741.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,267.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,393.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,306.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,819.94
|
| Rate for Payer: Ohio Health Group HMO |
$13,482.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,595.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,337.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,572.93
|
| Rate for Payer: PHCS Commercial |
$17,258.11
|
| Rate for Payer: United Healthcare All Payer |
$15,819.94
|
|
|
LINER ALTRX +4 10DEG 48*76
|
Facility
|
OP
|
$17,977.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,337.04 |
| Max. Negotiated Rate |
$17,258.11 |
| Rate for Payer: Aetna Commercial |
$13,842.44
|
| Rate for Payer: Anthem Medicaid |
$6,182.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,022.22
|
| Rate for Payer: Cash Price |
$8,988.60
|
| Rate for Payer: Cigna Commercial |
$14,921.08
|
| Rate for Payer: First Health Commercial |
$17,078.34
|
| Rate for Payer: Humana Commercial |
$15,280.62
|
| Rate for Payer: Humana KY Medicaid |
$6,182.36
|
| Rate for Payer: Kentucky WC Medicaid |
$6,245.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,741.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,267.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,393.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,306.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,819.94
|
| Rate for Payer: Ohio Health Group HMO |
$13,482.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,595.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,337.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,572.93
|
| Rate for Payer: PHCS Commercial |
$17,258.11
|
| Rate for Payer: United Healthcare All Payer |
$15,819.94
|
|
|
LINER ALTRX +4 10DEG 48*76
|
Facility
|
IP
|
$17,977.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,337.04 |
| Max. Negotiated Rate |
$17,258.11 |
| Rate for Payer: Aetna Commercial |
$13,842.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,022.22
|
| Rate for Payer: Cash Price |
$8,988.60
|
| Rate for Payer: Cigna Commercial |
$14,921.08
|
| Rate for Payer: First Health Commercial |
$17,078.34
|
| Rate for Payer: Humana Commercial |
$15,280.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,741.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,267.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,393.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,819.94
|
| Rate for Payer: Ohio Health Group HMO |
$13,482.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,595.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,337.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,572.93
|
| Rate for Payer: PHCS Commercial |
$17,258.11
|
| Rate for Payer: United Healthcare All Payer |
$15,819.94
|
|
|
LINER ALTRX +4 NEUT 40*56
|
Facility
|
OP
|
$11,201.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.20 |
| Max. Negotiated Rate |
$10,753.46 |
| Rate for Payer: Aetna Commercial |
$8,625.17
|
| Rate for Payer: Anthem Medicaid |
$3,852.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,737.19
|
| Rate for Payer: Cash Price |
$5,600.76
|
| Rate for Payer: Cigna Commercial |
$9,297.26
|
| Rate for Payer: First Health Commercial |
$10,641.44
|
| Rate for Payer: Humana Commercial |
$9,521.29
|
| Rate for Payer: Humana KY Medicaid |
$3,852.20
|
| Rate for Payer: Kentucky WC Medicaid |
$3,891.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,185.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,266.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,360.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,929.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,857.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,401.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,240.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,456.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,472.47
|
| Rate for Payer: PHCS Commercial |
$10,753.46
|
| Rate for Payer: United Healthcare All Payer |
$9,857.34
|
|
|
LINER ALTRX +4 NEUT 40*56
|
Facility
|
IP
|
$11,201.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.20 |
| Max. Negotiated Rate |
$10,753.46 |
| Rate for Payer: Aetna Commercial |
$8,625.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,737.19
|
| Rate for Payer: Cash Price |
$5,600.76
|
| Rate for Payer: Cigna Commercial |
$9,297.26
|
| Rate for Payer: First Health Commercial |
$10,641.44
|
| Rate for Payer: Humana Commercial |
$9,521.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,185.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,266.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,360.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,857.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,401.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,240.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,456.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,472.47
|
| Rate for Payer: PHCS Commercial |
$10,753.46
|
| Rate for Payer: United Healthcare All Payer |
$9,857.34
|
|
|
LINER ALTRX +4 NEUT40*58
|
Facility
|
IP
|
$11,201.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.20 |
| Max. Negotiated Rate |
$10,753.46 |
| Rate for Payer: Aetna Commercial |
$8,625.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,737.19
|
| Rate for Payer: Cash Price |
$5,600.76
|
| Rate for Payer: Cigna Commercial |
$9,297.26
|
| Rate for Payer: First Health Commercial |
$10,641.44
|
| Rate for Payer: Humana Commercial |
$9,521.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,185.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,266.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,360.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,857.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,401.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,240.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,456.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,472.47
|
| Rate for Payer: PHCS Commercial |
$10,753.46
|
| Rate for Payer: United Healthcare All Payer |
$9,857.34
|
|
|
LINER ALTRX +4 NEUT40*58
|
Facility
|
OP
|
$11,201.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.20 |
| Max. Negotiated Rate |
$10,753.46 |
| Rate for Payer: Aetna Commercial |
$8,625.17
|
| Rate for Payer: Anthem Medicaid |
$3,852.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,737.19
|
| Rate for Payer: Cash Price |
$5,600.76
|
| Rate for Payer: Cigna Commercial |
$9,297.26
|
| Rate for Payer: First Health Commercial |
$10,641.44
|
| Rate for Payer: Humana Commercial |
$9,521.29
|
| Rate for Payer: Humana KY Medicaid |
$3,852.20
|
| Rate for Payer: Kentucky WC Medicaid |
$3,891.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,185.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,266.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,360.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,929.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,857.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,401.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,240.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,456.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,472.47
|
| Rate for Payer: PHCS Commercial |
$10,753.46
|
| Rate for Payer: United Healthcare All Payer |
$9,857.34
|
|
|
LINER ALTRX +4 NEUT 40*60
|
Facility
|
OP
|
$11,201.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.20 |
| Max. Negotiated Rate |
$10,753.46 |
| Rate for Payer: Aetna Commercial |
$8,625.17
|
| Rate for Payer: Anthem Medicaid |
$3,852.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,737.19
|
| Rate for Payer: Cash Price |
$5,600.76
|
| Rate for Payer: Cigna Commercial |
$9,297.26
|
| Rate for Payer: First Health Commercial |
$10,641.44
|
| Rate for Payer: Humana Commercial |
$9,521.29
|
| Rate for Payer: Humana KY Medicaid |
$3,852.20
|
| Rate for Payer: Kentucky WC Medicaid |
$3,891.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,185.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,266.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,360.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,929.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,857.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,401.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,240.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,456.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,472.47
|
| Rate for Payer: PHCS Commercial |
$10,753.46
|
| Rate for Payer: United Healthcare All Payer |
$9,857.34
|
|
|
LINER ALTRX +4 NEUT 40*60
|
Facility
|
IP
|
$11,201.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.20 |
| Max. Negotiated Rate |
$10,753.46 |
| Rate for Payer: Aetna Commercial |
$8,625.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,737.19
|
| Rate for Payer: Cash Price |
$5,600.76
|
| Rate for Payer: Cigna Commercial |
$9,297.26
|
| Rate for Payer: First Health Commercial |
$10,641.44
|
| Rate for Payer: Humana Commercial |
$9,521.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,185.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,266.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,360.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,857.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,401.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,240.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,456.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,472.47
|
| Rate for Payer: PHCS Commercial |
$10,753.46
|
| Rate for Payer: United Healthcare All Payer |
$9,857.34
|
|
|
LINER ALTRX +4 NEUT 40*62
|
Facility
|
OP
|
$11,201.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.20 |
| Max. Negotiated Rate |
$10,753.46 |
| Rate for Payer: Aetna Commercial |
$8,625.17
|
| Rate for Payer: Anthem Medicaid |
$3,852.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,737.19
|
| Rate for Payer: Cash Price |
$5,600.76
|
| Rate for Payer: Cigna Commercial |
$9,297.26
|
| Rate for Payer: First Health Commercial |
$10,641.44
|
| Rate for Payer: Humana Commercial |
$9,521.29
|
| Rate for Payer: Humana KY Medicaid |
$3,852.20
|
| Rate for Payer: Kentucky WC Medicaid |
$3,891.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,185.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,266.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,360.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,929.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,857.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,401.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,240.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,456.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,472.47
|
| Rate for Payer: PHCS Commercial |
$10,753.46
|
| Rate for Payer: United Healthcare All Payer |
$9,857.34
|
|
|
LINER ALTRX +4 NEUT 40*62
|
Facility
|
IP
|
$11,201.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.20 |
| Max. Negotiated Rate |
$10,753.46 |
| Rate for Payer: Aetna Commercial |
$8,625.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,737.19
|
| Rate for Payer: Cash Price |
$5,600.76
|
| Rate for Payer: Cigna Commercial |
$9,297.26
|
| Rate for Payer: First Health Commercial |
$10,641.44
|
| Rate for Payer: Humana Commercial |
$9,521.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,185.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,266.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,360.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,857.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,401.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,240.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,456.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,472.47
|
| Rate for Payer: PHCS Commercial |
$10,753.46
|
| Rate for Payer: United Healthcare All Payer |
$9,857.34
|
|
|
LINER ALTRX +4 NEUT 40*64
|
Facility
|
OP
|
$11,201.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.20 |
| Max. Negotiated Rate |
$10,753.46 |
| Rate for Payer: Aetna Commercial |
$8,625.17
|
| Rate for Payer: Anthem Medicaid |
$3,852.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,737.19
|
| Rate for Payer: Cash Price |
$5,600.76
|
| Rate for Payer: Cigna Commercial |
$9,297.26
|
| Rate for Payer: First Health Commercial |
$10,641.44
|
| Rate for Payer: Humana Commercial |
$9,521.29
|
| Rate for Payer: Humana KY Medicaid |
$3,852.20
|
| Rate for Payer: Kentucky WC Medicaid |
$3,891.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,185.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,266.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,360.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,929.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,857.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,401.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,240.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,456.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,472.47
|
| Rate for Payer: PHCS Commercial |
$10,753.46
|
| Rate for Payer: United Healthcare All Payer |
$9,857.34
|
|
|
LINER ALTRX +4 NEUT 40*64
|
Facility
|
IP
|
$11,201.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.20 |
| Max. Negotiated Rate |
$10,753.46 |
| Rate for Payer: Aetna Commercial |
$8,625.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,737.19
|
| Rate for Payer: Cash Price |
$5,600.76
|
| Rate for Payer: Cigna Commercial |
$9,297.26
|
| Rate for Payer: First Health Commercial |
$10,641.44
|
| Rate for Payer: Humana Commercial |
$9,521.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,185.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,266.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,360.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,857.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,401.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,240.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,456.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,472.47
|
| Rate for Payer: PHCS Commercial |
$10,753.46
|
| Rate for Payer: United Healthcare All Payer |
$9,857.34
|
|
|
LINER ALTRX +4 NEUT 40*66
|
Facility
|
OP
|
$11,201.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.20 |
| Max. Negotiated Rate |
$10,753.46 |
| Rate for Payer: Aetna Commercial |
$8,625.17
|
| Rate for Payer: Anthem Medicaid |
$3,852.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,737.19
|
| Rate for Payer: Cash Price |
$5,600.76
|
| Rate for Payer: Cigna Commercial |
$9,297.26
|
| Rate for Payer: First Health Commercial |
$10,641.44
|
| Rate for Payer: Humana Commercial |
$9,521.29
|
| Rate for Payer: Humana KY Medicaid |
$3,852.20
|
| Rate for Payer: Kentucky WC Medicaid |
$3,891.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,185.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,266.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,360.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,929.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,857.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,401.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,240.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,456.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,472.47
|
| Rate for Payer: PHCS Commercial |
$10,753.46
|
| Rate for Payer: United Healthcare All Payer |
$9,857.34
|
|
|
LINER ALTRX +4 NEUT 40*66
|
Facility
|
IP
|
$11,201.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.20 |
| Max. Negotiated Rate |
$10,753.46 |
| Rate for Payer: Aetna Commercial |
$8,625.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,737.19
|
| Rate for Payer: Cash Price |
$5,600.76
|
| Rate for Payer: Cigna Commercial |
$9,297.26
|
| Rate for Payer: First Health Commercial |
$10,641.44
|
| Rate for Payer: Humana Commercial |
$9,521.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,185.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,266.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,360.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,857.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,401.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,240.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,456.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,472.47
|
| Rate for Payer: PHCS Commercial |
$10,753.46
|
| Rate for Payer: United Healthcare All Payer |
$9,857.34
|
|
|
LINER ALTRX +4 NEUT 44*62
|
Facility
|
IP
|
$11,488.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,493.49 |
| Max. Negotiated Rate |
$11,028.87 |
| Rate for Payer: Aetna Commercial |
$8,846.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,960.96
|
| Rate for Payer: Cash Price |
$5,744.20
|
| Rate for Payer: Cigna Commercial |
$9,535.38
|
| Rate for Payer: First Health Commercial |
$10,913.99
|
| Rate for Payer: Humana Commercial |
$9,765.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,420.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,478.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,446.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,109.80
|
| Rate for Payer: Ohio Health Group HMO |
$8,616.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,297.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,493.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,561.41
|
| Rate for Payer: PHCS Commercial |
$11,028.87
|
| Rate for Payer: United Healthcare All Payer |
$10,109.80
|
|
