|
LG DRES/OR DETRI BURN W/O ANES
|
Facility
|
OP
|
$179.00
|
|
| Hospital Charge Code |
45000332
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$53.70 |
| Max. Negotiated Rate |
$171.84 |
| Rate for Payer: Aetna Commercial |
$137.83
|
| Rate for Payer: Anthem Medicaid |
$61.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139.62
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cigna Commercial |
$148.57
|
| Rate for Payer: First Health Commercial |
$170.05
|
| Rate for Payer: Humana Commercial |
$152.15
|
| Rate for Payer: Humana KY Medicaid |
$61.56
|
| Rate for Payer: Kentucky WC Medicaid |
$62.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$146.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$62.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$157.52
|
| Rate for Payer: Ohio Health Group HMO |
$134.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$143.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$155.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$123.51
|
| Rate for Payer: PHCS Commercial |
$171.84
|
| Rate for Payer: United Healthcare All Payer |
$157.52
|
|
|
LG DRES/OR DETRI BURN W/O ANES
|
Facility
|
IP
|
$179.00
|
|
| Hospital Charge Code |
45000332
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$53.70 |
| Max. Negotiated Rate |
$171.84 |
| Rate for Payer: Aetna Commercial |
$137.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139.62
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cigna Commercial |
$148.57
|
| Rate for Payer: First Health Commercial |
$170.05
|
| Rate for Payer: Humana Commercial |
$152.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$146.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$157.52
|
| Rate for Payer: Ohio Health Group HMO |
$134.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$143.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$155.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$123.51
|
| Rate for Payer: PHCS Commercial |
$171.84
|
| Rate for Payer: United Healthcare All Payer |
$157.52
|
|
|
LG DRES/OR DETRI BURN W/O ANES
|
Facility
|
IP
|
$172.00
|
|
| Hospital Charge Code |
76102560
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$165.12 |
| Rate for Payer: Aetna Commercial |
$132.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$134.16
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna Commercial |
$142.76
|
| Rate for Payer: First Health Commercial |
$163.40
|
| Rate for Payer: Humana Commercial |
$146.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$141.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$151.36
|
| Rate for Payer: Ohio Health Group HMO |
$129.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$137.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.68
|
| Rate for Payer: PHCS Commercial |
$165.12
|
| Rate for Payer: United Healthcare All Payer |
$151.36
|
|
|
LGN HG FLX XLPE SZ3-4 *11MM
|
Facility
|
IP
|
$8,404.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,521.32 |
| Max. Negotiated Rate |
$8,068.23 |
| Rate for Payer: Aetna Commercial |
$6,471.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,555.44
|
| Rate for Payer: Cash Price |
$4,202.20
|
| Rate for Payer: Cigna Commercial |
$6,975.66
|
| Rate for Payer: First Health Commercial |
$7,984.19
|
| Rate for Payer: Humana Commercial |
$7,143.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,891.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,202.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,521.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,395.88
|
| Rate for Payer: Ohio Health Group HMO |
$6,303.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,723.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,311.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,799.04
|
| Rate for Payer: PHCS Commercial |
$8,068.23
|
| Rate for Payer: United Healthcare All Payer |
$7,395.88
|
|
|
LGN HG FLX XLPE SZ3-4 *11MM
|
Facility
|
OP
|
$8,404.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,521.32 |
| Max. Negotiated Rate |
$8,068.23 |
| Rate for Payer: Aetna Commercial |
$6,471.40
|
| Rate for Payer: Anthem Medicaid |
$2,890.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,555.44
|
| Rate for Payer: Cash Price |
$4,202.20
|
| Rate for Payer: Cigna Commercial |
$6,975.66
|
| Rate for Payer: First Health Commercial |
$7,984.19
|
| Rate for Payer: Humana Commercial |
$7,143.75
|
| Rate for Payer: Humana KY Medicaid |
$2,890.28
|
| Rate for Payer: Kentucky WC Medicaid |
$2,919.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,891.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,202.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,521.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,948.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,395.88
|
| Rate for Payer: Ohio Health Group HMO |
$6,303.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,723.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,311.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,799.04
|
| Rate for Payer: PHCS Commercial |
$8,068.23
|
| Rate for Payer: United Healthcare All Payer |
$7,395.88
|
|
|
LGN POR CR HA FEM SZ 8 LT
|
Facility
|
IP
|
$20,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,168.75 |
| Max. Negotiated Rate |
$19,740.00 |
| Rate for Payer: Aetna Commercial |
$15,833.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,038.75
|
| Rate for Payer: Cash Price |
$10,281.25
|
| Rate for Payer: Cigna Commercial |
$17,066.88
|
| Rate for Payer: First Health Commercial |
$19,534.38
|
| Rate for Payer: Humana Commercial |
$17,478.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,861.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,175.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,168.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,095.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,421.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,889.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,188.12
|
| Rate for Payer: PHCS Commercial |
$19,740.00
|
| Rate for Payer: United Healthcare All Payer |
$18,095.00
|
|
|
LGN POR CR HA FEM SZ 8 LT
|
Facility
|
OP
|
$20,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,168.75 |
| Max. Negotiated Rate |
$19,740.00 |
| Rate for Payer: Aetna Commercial |
$15,833.12
|
| Rate for Payer: Anthem Medicaid |
$7,071.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,038.75
|
| Rate for Payer: Cash Price |
$10,281.25
|
| Rate for Payer: Cigna Commercial |
$17,066.88
|
| Rate for Payer: First Health Commercial |
$19,534.38
|
| Rate for Payer: Humana Commercial |
$17,478.12
|
| Rate for Payer: Humana KY Medicaid |
$7,071.44
|
| Rate for Payer: Kentucky WC Medicaid |
$7,143.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,861.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,175.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,168.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,213.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,095.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,421.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,889.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,188.12
|
| Rate for Payer: PHCS Commercial |
$19,740.00
|
| Rate for Payer: United Healthcare All Payer |
$18,095.00
|
|
|
LGN POROUS CR FEM SZ 2 L
|
Facility
|
IP
|
$25,231.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,569.38 |
| Max. Negotiated Rate |
$24,222.00 |
| Rate for Payer: Aetna Commercial |
$19,428.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,680.38
|
| Rate for Payer: Cash Price |
$12,615.62
|
| Rate for Payer: Cigna Commercial |
$20,941.94
|
| Rate for Payer: First Health Commercial |
$23,969.69
|
| Rate for Payer: Humana Commercial |
$21,446.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,689.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,620.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,569.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,203.50
|
| Rate for Payer: Ohio Health Group HMO |
$18,923.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,185.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,951.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,409.56
|
| Rate for Payer: PHCS Commercial |
$24,222.00
|
| Rate for Payer: United Healthcare All Payer |
$22,203.50
|
|
|
LGN POROUS CR FEM SZ 2 L
|
Facility
|
OP
|
$25,231.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,569.38 |
| Max. Negotiated Rate |
$24,222.00 |
| Rate for Payer: Aetna Commercial |
$19,428.06
|
| Rate for Payer: Anthem Medicaid |
$8,677.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,680.38
|
| Rate for Payer: Cash Price |
$12,615.62
|
| Rate for Payer: Cigna Commercial |
$20,941.94
|
| Rate for Payer: First Health Commercial |
$23,969.69
|
| Rate for Payer: Humana Commercial |
$21,446.56
|
| Rate for Payer: Humana KY Medicaid |
$8,677.03
|
| Rate for Payer: Kentucky WC Medicaid |
$8,765.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,689.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,620.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,569.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,851.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,203.50
|
| Rate for Payer: Ohio Health Group HMO |
$18,923.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,185.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,951.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,409.56
|
| Rate for Payer: PHCS Commercial |
$24,222.00
|
| Rate for Payer: United Healthcare All Payer |
$22,203.50
|
|
|
LGN POROUS CR FEM SZ 2 LT
|
Facility
|
OP
|
$20,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,168.75 |
| Max. Negotiated Rate |
$19,740.00 |
| Rate for Payer: Aetna Commercial |
$15,833.12
|
| Rate for Payer: Anthem Medicaid |
$7,071.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,038.75
|
| Rate for Payer: Cash Price |
$10,281.25
|
| Rate for Payer: Cigna Commercial |
$17,066.88
|
| Rate for Payer: First Health Commercial |
$19,534.38
|
| Rate for Payer: Humana Commercial |
$17,478.12
|
| Rate for Payer: Humana KY Medicaid |
$7,071.44
|
| Rate for Payer: Kentucky WC Medicaid |
$7,143.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,861.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,175.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,168.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,213.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,095.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,421.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,889.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,188.12
|
| Rate for Payer: PHCS Commercial |
$19,740.00
|
| Rate for Payer: United Healthcare All Payer |
$18,095.00
|
|
|
LGN POROUS CR FEM SZ 2 LT
|
Facility
|
IP
|
$20,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,168.75 |
| Max. Negotiated Rate |
$19,740.00 |
| Rate for Payer: Aetna Commercial |
$15,833.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,038.75
|
| Rate for Payer: Cash Price |
$10,281.25
|
| Rate for Payer: Cigna Commercial |
$17,066.88
|
| Rate for Payer: First Health Commercial |
$19,534.38
|
| Rate for Payer: Humana Commercial |
$17,478.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,861.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,175.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,168.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,095.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,421.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,889.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,188.12
|
| Rate for Payer: PHCS Commercial |
$19,740.00
|
| Rate for Payer: United Healthcare All Payer |
$18,095.00
|
|
|
LGN POROUS CR FEM SZ 2 R
|
Facility
|
IP
|
$25,231.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,569.38 |
| Max. Negotiated Rate |
$24,222.00 |
| Rate for Payer: Aetna Commercial |
$19,428.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,680.38
|
| Rate for Payer: Cash Price |
$12,615.62
|
| Rate for Payer: Cigna Commercial |
$20,941.94
|
| Rate for Payer: First Health Commercial |
$23,969.69
|
| Rate for Payer: Humana Commercial |
$21,446.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,689.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,620.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,569.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,203.50
|
| Rate for Payer: Ohio Health Group HMO |
$18,923.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,185.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,951.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,409.56
|
| Rate for Payer: PHCS Commercial |
$24,222.00
|
| Rate for Payer: United Healthcare All Payer |
$22,203.50
|
|
|
LGN POROUS CR FEM SZ 2 R
|
Facility
|
OP
|
$25,231.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,569.38 |
| Max. Negotiated Rate |
$24,222.00 |
| Rate for Payer: Aetna Commercial |
$19,428.06
|
| Rate for Payer: Anthem Medicaid |
$8,677.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,680.38
|
| Rate for Payer: Cash Price |
$12,615.62
|
| Rate for Payer: Cigna Commercial |
$20,941.94
|
| Rate for Payer: First Health Commercial |
$23,969.69
|
| Rate for Payer: Humana Commercial |
$21,446.56
|
| Rate for Payer: Humana KY Medicaid |
$8,677.03
|
| Rate for Payer: Kentucky WC Medicaid |
$8,765.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,689.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,620.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,569.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,851.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,203.50
|
| Rate for Payer: Ohio Health Group HMO |
$18,923.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,185.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,951.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,409.56
|
| Rate for Payer: PHCS Commercial |
$24,222.00
|
| Rate for Payer: United Healthcare All Payer |
$22,203.50
|
|
|
LGN POROUS CR FEM SZ 3 L
|
Facility
|
IP
|
$25,231.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,569.38 |
| Max. Negotiated Rate |
$24,222.00 |
| Rate for Payer: Aetna Commercial |
$19,428.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,680.38
|
| Rate for Payer: Cash Price |
$12,615.62
|
| Rate for Payer: Cigna Commercial |
$20,941.94
|
| Rate for Payer: First Health Commercial |
$23,969.69
|
| Rate for Payer: Humana Commercial |
$21,446.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,689.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,620.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,569.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,203.50
|
| Rate for Payer: Ohio Health Group HMO |
$18,923.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,185.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,951.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,409.56
|
| Rate for Payer: PHCS Commercial |
$24,222.00
|
| Rate for Payer: United Healthcare All Payer |
$22,203.50
|
|
|
LGN POROUS CR FEM SZ 3 L
|
Facility
|
OP
|
$25,231.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,569.38 |
| Max. Negotiated Rate |
$24,222.00 |
| Rate for Payer: Aetna Commercial |
$19,428.06
|
| Rate for Payer: Anthem Medicaid |
$8,677.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,680.38
|
| Rate for Payer: Cash Price |
$12,615.62
|
| Rate for Payer: Cigna Commercial |
$20,941.94
|
| Rate for Payer: First Health Commercial |
$23,969.69
|
| Rate for Payer: Humana Commercial |
$21,446.56
|
| Rate for Payer: Humana KY Medicaid |
$8,677.03
|
| Rate for Payer: Kentucky WC Medicaid |
$8,765.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,689.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,620.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,569.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,851.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,203.50
|
| Rate for Payer: Ohio Health Group HMO |
$18,923.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,185.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,951.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,409.56
|
| Rate for Payer: PHCS Commercial |
$24,222.00
|
| Rate for Payer: United Healthcare All Payer |
$22,203.50
|
|
|
LGN POROUS CR FEM SZ 3 LT
|
Facility
|
IP
|
$20,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,168.75 |
| Max. Negotiated Rate |
$19,740.00 |
| Rate for Payer: Aetna Commercial |
$15,833.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,038.75
|
| Rate for Payer: Cash Price |
$10,281.25
|
| Rate for Payer: Cigna Commercial |
$17,066.88
|
| Rate for Payer: First Health Commercial |
$19,534.38
|
| Rate for Payer: Humana Commercial |
$17,478.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,861.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,175.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,168.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,095.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,421.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,889.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,188.12
|
| Rate for Payer: PHCS Commercial |
$19,740.00
|
| Rate for Payer: United Healthcare All Payer |
$18,095.00
|
|
|
LGN POROUS CR FEM SZ 3 LT
|
Facility
|
OP
|
$20,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,168.75 |
| Max. Negotiated Rate |
$19,740.00 |
| Rate for Payer: Aetna Commercial |
$15,833.12
|
| Rate for Payer: Anthem Medicaid |
$7,071.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,038.75
|
| Rate for Payer: Cash Price |
$10,281.25
|
| Rate for Payer: Cigna Commercial |
$17,066.88
|
| Rate for Payer: First Health Commercial |
$19,534.38
|
| Rate for Payer: Humana Commercial |
$17,478.12
|
| Rate for Payer: Humana KY Medicaid |
$7,071.44
|
| Rate for Payer: Kentucky WC Medicaid |
$7,143.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,861.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,175.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,168.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,213.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,095.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,421.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,889.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,188.12
|
| Rate for Payer: PHCS Commercial |
$19,740.00
|
| Rate for Payer: United Healthcare All Payer |
$18,095.00
|
|
|
LGN POROUS CR FEM SZ 3 R
|
Facility
|
OP
|
$25,231.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,569.38 |
| Max. Negotiated Rate |
$24,222.00 |
| Rate for Payer: Aetna Commercial |
$19,428.06
|
| Rate for Payer: Anthem Medicaid |
$8,677.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,680.38
|
| Rate for Payer: Cash Price |
$12,615.62
|
| Rate for Payer: Cigna Commercial |
$20,941.94
|
| Rate for Payer: First Health Commercial |
$23,969.69
|
| Rate for Payer: Humana Commercial |
$21,446.56
|
| Rate for Payer: Humana KY Medicaid |
$8,677.03
|
| Rate for Payer: Kentucky WC Medicaid |
$8,765.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,689.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,620.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,569.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,851.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,203.50
|
| Rate for Payer: Ohio Health Group HMO |
$18,923.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,185.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,951.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,409.56
|
| Rate for Payer: PHCS Commercial |
$24,222.00
|
| Rate for Payer: United Healthcare All Payer |
$22,203.50
|
|
|
LGN POROUS CR FEM SZ 3 R
|
Facility
|
IP
|
$25,231.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,569.38 |
| Max. Negotiated Rate |
$24,222.00 |
| Rate for Payer: Aetna Commercial |
$19,428.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,680.38
|
| Rate for Payer: Cash Price |
$12,615.62
|
| Rate for Payer: Cigna Commercial |
$20,941.94
|
| Rate for Payer: First Health Commercial |
$23,969.69
|
| Rate for Payer: Humana Commercial |
$21,446.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,689.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,620.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,569.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,203.50
|
| Rate for Payer: Ohio Health Group HMO |
$18,923.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,185.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,951.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,409.56
|
| Rate for Payer: PHCS Commercial |
$24,222.00
|
| Rate for Payer: United Healthcare All Payer |
$22,203.50
|
|
|
LGN POROUS CR FEM SZ 4 L
|
Facility
|
OP
|
$25,231.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,569.38 |
| Max. Negotiated Rate |
$24,222.00 |
| Rate for Payer: Aetna Commercial |
$19,428.06
|
| Rate for Payer: Anthem Medicaid |
$8,677.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,680.38
|
| Rate for Payer: Cash Price |
$12,615.62
|
| Rate for Payer: Cigna Commercial |
$20,941.94
|
| Rate for Payer: First Health Commercial |
$23,969.69
|
| Rate for Payer: Humana Commercial |
$21,446.56
|
| Rate for Payer: Humana KY Medicaid |
$8,677.03
|
| Rate for Payer: Kentucky WC Medicaid |
$8,765.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,689.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,620.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,569.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,851.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,203.50
|
| Rate for Payer: Ohio Health Group HMO |
$18,923.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,185.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,951.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,409.56
|
| Rate for Payer: PHCS Commercial |
$24,222.00
|
| Rate for Payer: United Healthcare All Payer |
$22,203.50
|
|
|
LGN POROUS CR FEM SZ 4 L
|
Facility
|
IP
|
$25,231.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,569.38 |
| Max. Negotiated Rate |
$24,222.00 |
| Rate for Payer: Aetna Commercial |
$19,428.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,680.38
|
| Rate for Payer: Cash Price |
$12,615.62
|
| Rate for Payer: Cigna Commercial |
$20,941.94
|
| Rate for Payer: First Health Commercial |
$23,969.69
|
| Rate for Payer: Humana Commercial |
$21,446.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,689.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,620.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,569.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,203.50
|
| Rate for Payer: Ohio Health Group HMO |
$18,923.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,185.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,951.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,409.56
|
| Rate for Payer: PHCS Commercial |
$24,222.00
|
| Rate for Payer: United Healthcare All Payer |
$22,203.50
|
|
|
LGN POROUS CR FEM SZ 4 LT
|
Facility
|
IP
|
$20,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,168.75 |
| Max. Negotiated Rate |
$19,740.00 |
| Rate for Payer: Aetna Commercial |
$15,833.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,038.75
|
| Rate for Payer: Cash Price |
$10,281.25
|
| Rate for Payer: Cigna Commercial |
$17,066.88
|
| Rate for Payer: First Health Commercial |
$19,534.38
|
| Rate for Payer: Humana Commercial |
$17,478.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,861.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,175.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,168.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,095.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,421.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,889.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,188.12
|
| Rate for Payer: PHCS Commercial |
$19,740.00
|
| Rate for Payer: United Healthcare All Payer |
$18,095.00
|
|
|
LGN POROUS CR FEM SZ 4 LT
|
Facility
|
OP
|
$20,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,168.75 |
| Max. Negotiated Rate |
$19,740.00 |
| Rate for Payer: Aetna Commercial |
$15,833.12
|
| Rate for Payer: Anthem Medicaid |
$7,071.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,038.75
|
| Rate for Payer: Cash Price |
$10,281.25
|
| Rate for Payer: Cigna Commercial |
$17,066.88
|
| Rate for Payer: First Health Commercial |
$19,534.38
|
| Rate for Payer: Humana Commercial |
$17,478.12
|
| Rate for Payer: Humana KY Medicaid |
$7,071.44
|
| Rate for Payer: Kentucky WC Medicaid |
$7,143.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,861.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,175.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,168.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,213.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,095.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,421.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,889.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,188.12
|
| Rate for Payer: PHCS Commercial |
$19,740.00
|
| Rate for Payer: United Healthcare All Payer |
$18,095.00
|
|
|
LGN POROUS CR FEM SZ 4 R
|
Facility
|
IP
|
$25,231.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,569.38 |
| Max. Negotiated Rate |
$24,222.00 |
| Rate for Payer: Aetna Commercial |
$19,428.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,680.38
|
| Rate for Payer: Cash Price |
$12,615.62
|
| Rate for Payer: Cigna Commercial |
$20,941.94
|
| Rate for Payer: First Health Commercial |
$23,969.69
|
| Rate for Payer: Humana Commercial |
$21,446.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,689.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,620.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,569.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,203.50
|
| Rate for Payer: Ohio Health Group HMO |
$18,923.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,185.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,951.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,409.56
|
| Rate for Payer: PHCS Commercial |
$24,222.00
|
| Rate for Payer: United Healthcare All Payer |
$22,203.50
|
|
|
LGN POROUS CR FEM SZ 4 R
|
Facility
|
OP
|
$25,231.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,569.38 |
| Max. Negotiated Rate |
$24,222.00 |
| Rate for Payer: Aetna Commercial |
$19,428.06
|
| Rate for Payer: Anthem Medicaid |
$8,677.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,680.38
|
| Rate for Payer: Cash Price |
$12,615.62
|
| Rate for Payer: Cigna Commercial |
$20,941.94
|
| Rate for Payer: First Health Commercial |
$23,969.69
|
| Rate for Payer: Humana Commercial |
$21,446.56
|
| Rate for Payer: Humana KY Medicaid |
$8,677.03
|
| Rate for Payer: Kentucky WC Medicaid |
$8,765.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,689.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,620.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,569.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,851.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,203.50
|
| Rate for Payer: Ohio Health Group HMO |
$18,923.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,185.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,951.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,409.56
|
| Rate for Payer: PHCS Commercial |
$24,222.00
|
| Rate for Payer: United Healthcare All Payer |
$22,203.50
|
|
