|
LINER ALTRX NEUTRAL 40*58
|
Facility
|
OP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$604.50 |
| Max. Negotiated Rate |
$4,464.00 |
| Rate for Payer: Aetna Commercial |
$3,580.50
|
| Rate for Payer: Anthem Medicaid |
$1,599.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,627.00
|
| Rate for Payer: Cash Price |
$2,325.00
|
| Rate for Payer: Cigna Commercial |
$3,859.50
|
| Rate for Payer: First Health Commercial |
$4,417.50
|
| Rate for Payer: Humana Commercial |
$3,952.50
|
| Rate for Payer: Humana KY Medicaid |
$1,599.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,615.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,813.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,431.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,395.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,631.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,092.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$930.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$604.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,441.50
|
| Rate for Payer: PHCS Commercial |
$4,464.00
|
| Rate for Payer: United Healthcare All Payer |
$4,092.00
|
|
|
LINER ALTRX NEUTRAL 40*58
|
Facility
|
IP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$604.50 |
| Max. Negotiated Rate |
$4,464.00 |
| Rate for Payer: Aetna Commercial |
$3,580.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,627.00
|
| Rate for Payer: Cash Price |
$2,325.00
|
| Rate for Payer: Cigna Commercial |
$3,859.50
|
| Rate for Payer: First Health Commercial |
$4,417.50
|
| Rate for Payer: Humana Commercial |
$3,952.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,813.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,431.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,395.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,092.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$930.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$604.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,441.50
|
| Rate for Payer: PHCS Commercial |
$4,464.00
|
| Rate for Payer: United Healthcare All Payer |
$4,092.00
|
|
|
LINER ALTRX NEUTRAL 40*60
|
Facility
|
OP
|
$19,403.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,522.47 |
| Max. Negotiated Rate |
$18,627.50 |
| Rate for Payer: Aetna Commercial |
$14,940.81
|
| Rate for Payer: Anthem Medicaid |
$6,672.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,134.85
|
| Rate for Payer: Cash Price |
$9,701.83
|
| Rate for Payer: Cigna Commercial |
$16,105.03
|
| Rate for Payer: First Health Commercial |
$18,433.47
|
| Rate for Payer: Humana Commercial |
$16,493.10
|
| Rate for Payer: Humana KY Medicaid |
$6,672.92
|
| Rate for Payer: Kentucky WC Medicaid |
$6,740.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,910.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,319.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,821.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,806.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,075.21
|
| Rate for Payer: Ohio Health Group HMO |
$14,552.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,522.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,015.13
|
| Rate for Payer: PHCS Commercial |
$18,627.50
|
| Rate for Payer: United Healthcare All Payer |
$17,075.21
|
|
|
LINER ALTRX NEUTRAL 40*60
|
Facility
|
IP
|
$19,403.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,522.47 |
| Max. Negotiated Rate |
$18,627.50 |
| Rate for Payer: Aetna Commercial |
$14,940.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,134.85
|
| Rate for Payer: Cash Price |
$9,701.83
|
| Rate for Payer: Cigna Commercial |
$16,105.03
|
| Rate for Payer: First Health Commercial |
$18,433.47
|
| Rate for Payer: Humana Commercial |
$16,493.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,910.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,319.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,821.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,075.21
|
| Rate for Payer: Ohio Health Group HMO |
$14,552.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,522.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,015.13
|
| Rate for Payer: PHCS Commercial |
$18,627.50
|
| Rate for Payer: United Healthcare All Payer |
$17,075.21
|
|
|
LINER ALTRX NEUTRAL 40*62
|
Facility
|
IP
|
$19,403.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,522.47 |
| Max. Negotiated Rate |
$18,627.50 |
| Rate for Payer: Aetna Commercial |
$14,940.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,134.85
|
| Rate for Payer: Cash Price |
$9,701.83
|
| Rate for Payer: Cigna Commercial |
$16,105.03
|
| Rate for Payer: First Health Commercial |
$18,433.47
|
| Rate for Payer: Humana Commercial |
$16,493.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,910.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,319.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,821.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,075.21
|
| Rate for Payer: Ohio Health Group HMO |
$14,552.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,522.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,015.13
|
| Rate for Payer: PHCS Commercial |
$18,627.50
|
| Rate for Payer: United Healthcare All Payer |
$17,075.21
|
|
|
LINER ALTRX NEUTRAL 40*62
|
Facility
|
OP
|
$19,403.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,522.47 |
| Max. Negotiated Rate |
$18,627.50 |
| Rate for Payer: Aetna Commercial |
$14,940.81
|
| Rate for Payer: Anthem Medicaid |
$6,672.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,134.85
|
| Rate for Payer: Cash Price |
$9,701.83
|
| Rate for Payer: Cigna Commercial |
$16,105.03
|
| Rate for Payer: First Health Commercial |
$18,433.47
|
| Rate for Payer: Humana Commercial |
$16,493.10
|
| Rate for Payer: Humana KY Medicaid |
$6,672.92
|
| Rate for Payer: Kentucky WC Medicaid |
$6,740.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,910.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,319.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,821.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,806.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,075.21
|
| Rate for Payer: Ohio Health Group HMO |
$14,552.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,522.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,015.13
|
| Rate for Payer: PHCS Commercial |
$18,627.50
|
| Rate for Payer: United Healthcare All Payer |
$17,075.21
|
|
|
LINER ALTRX NEUTRAL 40*64
|
Facility
|
OP
|
$19,403.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,522.47 |
| Max. Negotiated Rate |
$18,627.50 |
| Rate for Payer: Aetna Commercial |
$14,940.81
|
| Rate for Payer: Anthem Medicaid |
$6,672.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,134.85
|
| Rate for Payer: Cash Price |
$9,701.83
|
| Rate for Payer: Cigna Commercial |
$16,105.03
|
| Rate for Payer: First Health Commercial |
$18,433.47
|
| Rate for Payer: Humana Commercial |
$16,493.10
|
| Rate for Payer: Humana KY Medicaid |
$6,672.92
|
| Rate for Payer: Kentucky WC Medicaid |
$6,740.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,910.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,319.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,821.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,806.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,075.21
|
| Rate for Payer: Ohio Health Group HMO |
$14,552.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,522.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,015.13
|
| Rate for Payer: PHCS Commercial |
$18,627.50
|
| Rate for Payer: United Healthcare All Payer |
$17,075.21
|
|
|
LINER ALTRX NEUTRAL 40*64
|
Facility
|
IP
|
$19,403.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,522.47 |
| Max. Negotiated Rate |
$18,627.50 |
| Rate for Payer: Aetna Commercial |
$14,940.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,134.85
|
| Rate for Payer: Cash Price |
$9,701.83
|
| Rate for Payer: Cigna Commercial |
$16,105.03
|
| Rate for Payer: First Health Commercial |
$18,433.47
|
| Rate for Payer: Humana Commercial |
$16,493.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,910.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,319.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,821.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,075.21
|
| Rate for Payer: Ohio Health Group HMO |
$14,552.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,522.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,015.13
|
| Rate for Payer: PHCS Commercial |
$18,627.50
|
| Rate for Payer: United Healthcare All Payer |
$17,075.21
|
|
|
LINER ALTRX NEUTRAL 40*66
|
Facility
|
OP
|
$19,403.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,522.47 |
| Max. Negotiated Rate |
$18,627.50 |
| Rate for Payer: Aetna Commercial |
$14,940.81
|
| Rate for Payer: Anthem Medicaid |
$6,672.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,134.85
|
| Rate for Payer: Cash Price |
$9,701.83
|
| Rate for Payer: Cigna Commercial |
$16,105.03
|
| Rate for Payer: First Health Commercial |
$18,433.47
|
| Rate for Payer: Humana Commercial |
$16,493.10
|
| Rate for Payer: Humana KY Medicaid |
$6,672.92
|
| Rate for Payer: Kentucky WC Medicaid |
$6,740.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,910.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,319.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,821.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,806.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,075.21
|
| Rate for Payer: Ohio Health Group HMO |
$14,552.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,522.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,015.13
|
| Rate for Payer: PHCS Commercial |
$18,627.50
|
| Rate for Payer: United Healthcare All Payer |
$17,075.21
|
|
|
LINER ALTRX NEUTRAL 40*66
|
Facility
|
IP
|
$19,403.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,522.47 |
| Max. Negotiated Rate |
$18,627.50 |
| Rate for Payer: Aetna Commercial |
$14,940.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,134.85
|
| Rate for Payer: Cash Price |
$9,701.83
|
| Rate for Payer: Cigna Commercial |
$16,105.03
|
| Rate for Payer: First Health Commercial |
$18,433.47
|
| Rate for Payer: Humana Commercial |
$16,493.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,910.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,319.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,821.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,075.21
|
| Rate for Payer: Ohio Health Group HMO |
$14,552.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,522.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,015.13
|
| Rate for Payer: PHCS Commercial |
$18,627.50
|
| Rate for Payer: United Healthcare All Payer |
$17,075.21
|
|
|
LINER ALUM CER 28ID 46-48 OD
|
Facility
|
IP
|
$9,023.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,173.07 |
| Max. Negotiated Rate |
$8,662.67 |
| Rate for Payer: Aetna Commercial |
$6,948.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,038.42
|
| Rate for Payer: Cash Price |
$4,511.81
|
| Rate for Payer: Cigna Commercial |
$7,489.60
|
| Rate for Payer: First Health Commercial |
$8,572.43
|
| Rate for Payer: Humana Commercial |
$7,670.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,399.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,659.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,707.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,940.78
|
| Rate for Payer: Ohio Health Group HMO |
$6,767.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,804.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,173.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,797.32
|
| Rate for Payer: PHCS Commercial |
$8,662.67
|
| Rate for Payer: United Healthcare All Payer |
$7,940.78
|
|
|
LINER ALUM CER 28ID 46-48 OD
|
Facility
|
OP
|
$9,023.61
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,173.07 |
| Max. Negotiated Rate |
$8,662.67 |
| Rate for Payer: Aetna Commercial |
$6,948.18
|
| Rate for Payer: Anthem Medicaid |
$3,103.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,038.42
|
| Rate for Payer: Cash Price |
$4,511.81
|
| Rate for Payer: Cigna Commercial |
$7,489.60
|
| Rate for Payer: First Health Commercial |
$8,572.43
|
| Rate for Payer: Humana Commercial |
$7,670.07
|
| Rate for Payer: Humana KY Medicaid |
$3,103.22
|
| Rate for Payer: Kentucky WC Medicaid |
$3,134.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,399.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,659.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,707.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,165.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,940.78
|
| Rate for Payer: Ohio Health Group HMO |
$6,767.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,804.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,173.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,797.32
|
| Rate for Payer: PHCS Commercial |
$8,662.67
|
| Rate for Payer: United Healthcare All Payer |
$7,940.78
|
|
|
LINER ALUM CER 32ID 50-54 OD
|
Facility
|
OP
|
$7,193.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$935.11 |
| Max. Negotiated Rate |
$6,905.41 |
| Rate for Payer: Aetna Commercial |
$5,538.72
|
| Rate for Payer: Anthem Medicaid |
$2,473.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,610.65
|
| Rate for Payer: Cash Price |
$3,596.57
|
| Rate for Payer: Cigna Commercial |
$5,970.31
|
| Rate for Payer: First Health Commercial |
$6,833.48
|
| Rate for Payer: Humana Commercial |
$6,114.17
|
| Rate for Payer: Humana KY Medicaid |
$2,473.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,498.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,898.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,308.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,157.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,523.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,329.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,394.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,438.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$935.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,229.87
|
| Rate for Payer: PHCS Commercial |
$6,905.41
|
| Rate for Payer: United Healthcare All Payer |
$6,329.96
|
|
|
LINER ALUM CER 32ID 50-54 OD
|
Facility
|
IP
|
$7,193.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$935.11 |
| Max. Negotiated Rate |
$6,905.41 |
| Rate for Payer: Aetna Commercial |
$5,538.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,610.65
|
| Rate for Payer: Cash Price |
$3,596.57
|
| Rate for Payer: Cigna Commercial |
$5,970.31
|
| Rate for Payer: First Health Commercial |
$6,833.48
|
| Rate for Payer: Humana Commercial |
$6,114.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,898.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,308.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,157.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,329.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,394.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,438.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$935.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,229.87
|
| Rate for Payer: PHCS Commercial |
$6,905.41
|
| Rate for Payer: United Healthcare All Payer |
$6,329.96
|
|
|
LINER ALUM CER 32ID 56-66 OD
|
Facility
|
IP
|
$7,193.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$935.11 |
| Max. Negotiated Rate |
$6,905.41 |
| Rate for Payer: Aetna Commercial |
$5,538.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,610.65
|
| Rate for Payer: Cash Price |
$3,596.57
|
| Rate for Payer: Cigna Commercial |
$5,970.31
|
| Rate for Payer: First Health Commercial |
$6,833.48
|
| Rate for Payer: Humana Commercial |
$6,114.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,898.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,308.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,157.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,329.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,394.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,438.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$935.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,229.87
|
| Rate for Payer: PHCS Commercial |
$6,905.41
|
| Rate for Payer: United Healthcare All Payer |
$6,329.96
|
|
|
LINER ALUM CER 32ID 56-66 OD
|
Facility
|
OP
|
$7,193.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$935.11 |
| Max. Negotiated Rate |
$6,905.41 |
| Rate for Payer: Aetna Commercial |
$5,538.72
|
| Rate for Payer: Anthem Medicaid |
$2,473.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,610.65
|
| Rate for Payer: Cash Price |
$3,596.57
|
| Rate for Payer: Cigna Commercial |
$5,970.31
|
| Rate for Payer: First Health Commercial |
$6,833.48
|
| Rate for Payer: Humana Commercial |
$6,114.17
|
| Rate for Payer: Humana KY Medicaid |
$2,473.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,498.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,898.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,308.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,157.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,523.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,329.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,394.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,438.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$935.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,229.87
|
| Rate for Payer: PHCS Commercial |
$6,905.41
|
| Rate for Payer: United Healthcare All Payer |
$6,329.96
|
|
|
LINER ALUM CER SAM 32 50-54
|
Facility
|
IP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
|
LINER ALUM CER SAM 32 50-54
|
Facility
|
OP
|
$2,050.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.03 |
| Rate for Payer: Aetna Commercial |
$1,578.52
|
| Rate for Payer: Anthem Medicaid |
$705.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.02
|
| Rate for Payer: Cash Price |
$1,025.02
|
| Rate for Payer: Cigna Commercial |
$1,701.52
|
| Rate for Payer: First Health Commercial |
$1,947.53
|
| Rate for Payer: Humana Commercial |
$1,742.53
|
| Rate for Payer: Humana KY Medicaid |
$705.01
|
| Rate for Payer: Kentucky WC Medicaid |
$712.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.51
|
| Rate for Payer: PHCS Commercial |
$1,968.03
|
| Rate for Payer: United Healthcare All Payer |
$1,804.03
|
|
|
LINER ANTEV XLPE 20^ +4 32X48
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
LINER ANTEV XLPE 20^ +4 32X48
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
LINER ANTEV XLPE 20^ +4 32X50
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
LINER ANTEV XLPE 20^ +4 32X50
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
LINER ANTEV XLPE 20^ +4 36X52
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
LINER ANTEV XLPE 20^ +4 36X52
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
LINER ANTEV XLPE 20^ +4 36X54
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
