|
LINEAR ST 8 CONT TRIAL LD 70CM
|
Facility
|
OP
|
$8,022.40
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,406.72 |
| Max. Negotiated Rate |
$7,701.50 |
| Rate for Payer: Aetna Commercial |
$6,177.25
|
| Rate for Payer: Anthem Medicaid |
$2,758.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,257.47
|
| Rate for Payer: Cash Price |
$4,011.20
|
| Rate for Payer: Cigna Commercial |
$6,658.59
|
| Rate for Payer: First Health Commercial |
$7,621.28
|
| Rate for Payer: Humana Commercial |
$6,819.04
|
| Rate for Payer: Humana KY Medicaid |
$2,758.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,786.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,578.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,920.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,406.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,814.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,059.71
|
| Rate for Payer: Ohio Health Group HMO |
$6,016.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,417.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,979.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,535.46
|
| Rate for Payer: PHCS Commercial |
$7,701.50
|
| Rate for Payer: United Healthcare All Payer |
$7,059.71
|
|
|
LINEAR ST 8 CONT TRIAL LD 70CM
|
Facility
|
IP
|
$8,022.40
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,406.72 |
| Max. Negotiated Rate |
$7,701.50 |
| Rate for Payer: Aetna Commercial |
$6,177.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,257.47
|
| Rate for Payer: Cash Price |
$4,011.20
|
| Rate for Payer: Cigna Commercial |
$6,658.59
|
| Rate for Payer: First Health Commercial |
$7,621.28
|
| Rate for Payer: Humana Commercial |
$6,819.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,578.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,920.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,406.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,059.71
|
| Rate for Payer: Ohio Health Group HMO |
$6,016.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,417.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,979.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,535.46
|
| Rate for Payer: PHCS Commercial |
$7,701.50
|
| Rate for Payer: United Healthcare All Payer |
$7,059.71
|
|
|
LINE PLACEMENT UNDER FLUORO(P
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 77001
|
| Hospital Charge Code |
320P0222
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$157.68 |
| Rate for Payer: Aetna Commercial |
$157.68
|
| Rate for Payer: Ambetter Exchange |
$87.04
|
| Rate for Payer: Anthem Medicaid |
$57.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$87.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$87.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$104.45
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$142.16
|
| Rate for Payer: Healthspan PPO |
$147.75
|
| Rate for Payer: Humana Medicaid |
$57.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$24.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$87.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$58.78
|
| Rate for Payer: Molina Healthcare Passport |
$57.63
|
| Rate for Payer: Multiplan PHCS |
$132.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$113.15
|
| Rate for Payer: UHCCP Medicaid |
$77.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$58.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$87.04
|
|
|
LINE PLACEMENT UNDER FLUORO(T
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 77001
|
| Hospital Charge Code |
320T0222
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
LINE PLACEMENT UNDER FLUORO(T
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 77001
|
| Hospital Charge Code |
320T0222
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Humana KY Medicaid |
$257.93
|
| Rate for Payer: Kentucky WC Medicaid |
$260.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
LINER ACE COCR 40MMID 52MM OD
|
Facility
|
OP
|
$20,618.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,185.62 |
| Max. Negotiated Rate |
$19,794.00 |
| Rate for Payer: Aetna Commercial |
$15,876.44
|
| Rate for Payer: Anthem Medicaid |
$7,090.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,082.62
|
| Rate for Payer: Cash Price |
$10,309.38
|
| Rate for Payer: Cigna Commercial |
$17,113.56
|
| Rate for Payer: First Health Commercial |
$19,587.81
|
| Rate for Payer: Humana Commercial |
$17,525.94
|
| Rate for Payer: Humana KY Medicaid |
$7,090.79
|
| Rate for Payer: Kentucky WC Medicaid |
$7,162.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,907.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,216.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,185.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,233.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,144.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,464.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,495.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,938.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,226.94
|
| Rate for Payer: PHCS Commercial |
$19,794.00
|
| Rate for Payer: United Healthcare All Payer |
$18,144.50
|
|
|
LINER ACE COCR 40MMID 52MM OD
|
Facility
|
IP
|
$20,618.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,185.62 |
| Max. Negotiated Rate |
$19,794.00 |
| Rate for Payer: Aetna Commercial |
$15,876.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,082.62
|
| Rate for Payer: Cash Price |
$10,309.38
|
| Rate for Payer: Cigna Commercial |
$17,113.56
|
| Rate for Payer: First Health Commercial |
$19,587.81
|
| Rate for Payer: Humana Commercial |
$17,525.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,907.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,216.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,185.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,144.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,464.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,495.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,938.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,226.94
|
| Rate for Payer: PHCS Commercial |
$19,794.00
|
| Rate for Payer: United Healthcare All Payer |
$18,144.50
|
|
|
LINER ACE COCR 42MMID 54MM OD
|
Facility
|
IP
|
$23,375.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,012.50 |
| Max. Negotiated Rate |
$22,440.00 |
| Rate for Payer: Aetna Commercial |
$17,998.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,232.50
|
| Rate for Payer: Cash Price |
$11,687.50
|
| Rate for Payer: Cigna Commercial |
$19,401.25
|
| Rate for Payer: First Health Commercial |
$22,206.25
|
| Rate for Payer: Humana Commercial |
$19,868.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,167.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,250.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,012.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,570.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,531.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,336.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,128.75
|
| Rate for Payer: PHCS Commercial |
$22,440.00
|
| Rate for Payer: United Healthcare All Payer |
$20,570.00
|
|
|
LINER ACE COCR 42MMID 54MM OD
|
Facility
|
OP
|
$23,375.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,012.50 |
| Max. Negotiated Rate |
$22,440.00 |
| Rate for Payer: Aetna Commercial |
$17,998.75
|
| Rate for Payer: Anthem Medicaid |
$8,038.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,232.50
|
| Rate for Payer: Cash Price |
$11,687.50
|
| Rate for Payer: Cigna Commercial |
$19,401.25
|
| Rate for Payer: First Health Commercial |
$22,206.25
|
| Rate for Payer: Humana Commercial |
$19,868.75
|
| Rate for Payer: Humana KY Medicaid |
$8,038.66
|
| Rate for Payer: Kentucky WC Medicaid |
$8,120.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,167.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,250.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,012.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,199.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,570.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,531.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,336.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,128.75
|
| Rate for Payer: PHCS Commercial |
$22,440.00
|
| Rate for Payer: United Healthcare All Payer |
$20,570.00
|
|
|
LINER ALTRX +4 10 DEG 40*56
|
Facility
|
OP
|
$11,444.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,433.45 |
| Max. Negotiated Rate |
$10,987.03 |
| Rate for Payer: Aetna Commercial |
$8,812.51
|
| Rate for Payer: Anthem Medicaid |
$3,935.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,926.96
|
| Rate for Payer: Cash Price |
$5,722.41
|
| Rate for Payer: Cigna Commercial |
$9,499.20
|
| Rate for Payer: First Health Commercial |
$10,872.58
|
| Rate for Payer: Humana Commercial |
$9,728.10
|
| Rate for Payer: Humana KY Medicaid |
$3,935.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,975.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,384.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,446.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,433.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,014.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,071.44
|
| Rate for Payer: Ohio Health Group HMO |
$8,583.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,155.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,956.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,896.93
|
| Rate for Payer: PHCS Commercial |
$10,987.03
|
| Rate for Payer: United Healthcare All Payer |
$10,071.44
|
|
|
LINER ALTRX +4 10 DEG 40*56
|
Facility
|
IP
|
$11,444.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,433.45 |
| Max. Negotiated Rate |
$10,987.03 |
| Rate for Payer: Aetna Commercial |
$8,812.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,926.96
|
| Rate for Payer: Cash Price |
$5,722.41
|
| Rate for Payer: Cigna Commercial |
$9,499.20
|
| Rate for Payer: First Health Commercial |
$10,872.58
|
| Rate for Payer: Humana Commercial |
$9,728.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,384.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,446.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,433.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,071.44
|
| Rate for Payer: Ohio Health Group HMO |
$8,583.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,155.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,956.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,896.93
|
| Rate for Payer: PHCS Commercial |
$10,987.03
|
| Rate for Payer: United Healthcare All Payer |
$10,071.44
|
|
|
LINER ALTRX +4 10 DEG 40*58
|
Facility
|
IP
|
$11,444.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,433.45 |
| Max. Negotiated Rate |
$10,987.03 |
| Rate for Payer: Aetna Commercial |
$8,812.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,926.96
|
| Rate for Payer: Cash Price |
$5,722.41
|
| Rate for Payer: Cigna Commercial |
$9,499.20
|
| Rate for Payer: First Health Commercial |
$10,872.58
|
| Rate for Payer: Humana Commercial |
$9,728.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,384.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,446.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,433.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,071.44
|
| Rate for Payer: Ohio Health Group HMO |
$8,583.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,155.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,956.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,896.93
|
| Rate for Payer: PHCS Commercial |
$10,987.03
|
| Rate for Payer: United Healthcare All Payer |
$10,071.44
|
|
|
LINER ALTRX +4 10 DEG 40*58
|
Facility
|
OP
|
$11,444.82
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,433.45 |
| Max. Negotiated Rate |
$10,987.03 |
| Rate for Payer: Aetna Commercial |
$8,812.51
|
| Rate for Payer: Anthem Medicaid |
$3,935.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,926.96
|
| Rate for Payer: Cash Price |
$5,722.41
|
| Rate for Payer: Cigna Commercial |
$9,499.20
|
| Rate for Payer: First Health Commercial |
$10,872.58
|
| Rate for Payer: Humana Commercial |
$9,728.10
|
| Rate for Payer: Humana KY Medicaid |
$3,935.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,975.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,384.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,446.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,433.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,014.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,071.44
|
| Rate for Payer: Ohio Health Group HMO |
$8,583.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,155.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,956.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,896.93
|
| Rate for Payer: PHCS Commercial |
$10,987.03
|
| Rate for Payer: United Healthcare All Payer |
$10,071.44
|
|
|
LINER ALTRX +4 10DEG 44*62
|
Facility
|
OP
|
$11,733.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,519.98 |
| Max. Negotiated Rate |
$11,263.95 |
| Rate for Payer: Aetna Commercial |
$9,034.63
|
| Rate for Payer: Anthem Medicaid |
$4,035.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,151.96
|
| Rate for Payer: Cash Price |
$5,866.64
|
| Rate for Payer: Cigna Commercial |
$9,738.62
|
| Rate for Payer: First Health Commercial |
$11,146.62
|
| Rate for Payer: Humana Commercial |
$9,973.29
|
| Rate for Payer: Humana KY Medicaid |
$4,035.07
|
| Rate for Payer: Kentucky WC Medicaid |
$4,076.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,621.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,659.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,519.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,116.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,325.29
|
| Rate for Payer: Ohio Health Group HMO |
$8,799.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,386.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,207.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,095.96
|
| Rate for Payer: PHCS Commercial |
$11,263.95
|
| Rate for Payer: United Healthcare All Payer |
$10,325.29
|
|
|
LINER ALTRX +4 10DEG 44*62
|
Facility
|
IP
|
$11,733.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,519.98 |
| Max. Negotiated Rate |
$11,263.95 |
| Rate for Payer: Aetna Commercial |
$9,034.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,151.96
|
| Rate for Payer: Cash Price |
$5,866.64
|
| Rate for Payer: Cigna Commercial |
$9,738.62
|
| Rate for Payer: First Health Commercial |
$11,146.62
|
| Rate for Payer: Humana Commercial |
$9,973.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,621.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,659.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,519.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,325.29
|
| Rate for Payer: Ohio Health Group HMO |
$8,799.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,386.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,207.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,095.96
|
| Rate for Payer: PHCS Commercial |
$11,263.95
|
| Rate for Payer: United Healthcare All Payer |
$10,325.29
|
|
|
LINER ALTRX +4 10DEG 44* 64
|
Facility
|
OP
|
$9,876.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,962.98 |
| Max. Negotiated Rate |
$9,481.54 |
| Rate for Payer: Aetna Commercial |
$7,604.98
|
| Rate for Payer: Anthem Medicaid |
$3,396.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,703.75
|
| Rate for Payer: Cash Price |
$4,938.30
|
| Rate for Payer: Cigna Commercial |
$8,197.58
|
| Rate for Payer: First Health Commercial |
$9,382.77
|
| Rate for Payer: Humana Commercial |
$8,395.11
|
| Rate for Payer: Humana KY Medicaid |
$3,396.56
|
| Rate for Payer: Kentucky WC Medicaid |
$3,431.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,098.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,288.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,962.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,464.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,691.41
|
| Rate for Payer: Ohio Health Group HMO |
$7,407.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,901.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,592.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,814.85
|
| Rate for Payer: PHCS Commercial |
$9,481.54
|
| Rate for Payer: United Healthcare All Payer |
$8,691.41
|
|
|
LINER ALTRX +4 10DEG 44* 64
|
Facility
|
IP
|
$9,876.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,962.98 |
| Max. Negotiated Rate |
$9,481.54 |
| Rate for Payer: Aetna Commercial |
$7,604.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,703.75
|
| Rate for Payer: Cash Price |
$4,938.30
|
| Rate for Payer: Cigna Commercial |
$8,197.58
|
| Rate for Payer: First Health Commercial |
$9,382.77
|
| Rate for Payer: Humana Commercial |
$8,395.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,098.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,288.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,962.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,691.41
|
| Rate for Payer: Ohio Health Group HMO |
$7,407.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,901.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,592.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,814.85
|
| Rate for Payer: PHCS Commercial |
$9,481.54
|
| Rate for Payer: United Healthcare All Payer |
$8,691.41
|
|
|
LINER ALTRX +4 10DEG 44*66
|
Facility
|
OP
|
$18,559.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,567.97 |
| Max. Negotiated Rate |
$17,817.50 |
| Rate for Payer: Aetna Commercial |
$14,291.12
|
| Rate for Payer: Anthem Medicaid |
$6,382.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,476.72
|
| Rate for Payer: Cash Price |
$9,279.95
|
| Rate for Payer: Cigna Commercial |
$15,404.72
|
| Rate for Payer: First Health Commercial |
$17,631.90
|
| Rate for Payer: Humana Commercial |
$15,775.92
|
| Rate for Payer: Humana KY Medicaid |
$6,382.75
|
| Rate for Payer: Kentucky WC Medicaid |
$6,447.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,219.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,697.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,567.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,510.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,332.71
|
| Rate for Payer: Ohio Health Group HMO |
$13,919.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,847.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,147.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,806.33
|
| Rate for Payer: PHCS Commercial |
$17,817.50
|
| Rate for Payer: United Healthcare All Payer |
$16,332.71
|
|
|
LINER ALTRX +4 10DEG 44*66
|
Facility
|
IP
|
$18,559.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,567.97 |
| Max. Negotiated Rate |
$17,817.50 |
| Rate for Payer: Aetna Commercial |
$14,291.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,476.72
|
| Rate for Payer: Cash Price |
$9,279.95
|
| Rate for Payer: Cigna Commercial |
$15,404.72
|
| Rate for Payer: First Health Commercial |
$17,631.90
|
| Rate for Payer: Humana Commercial |
$15,775.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,219.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,697.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,567.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,332.71
|
| Rate for Payer: Ohio Health Group HMO |
$13,919.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,847.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,147.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,806.33
|
| Rate for Payer: PHCS Commercial |
$17,817.50
|
| Rate for Payer: United Healthcare All Payer |
$16,332.71
|
|
|
LINER ALTRX +4 10DEG 44*68
|
Facility
|
OP
|
$18,559.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,567.97 |
| Max. Negotiated Rate |
$17,817.50 |
| Rate for Payer: Aetna Commercial |
$14,291.12
|
| Rate for Payer: Anthem Medicaid |
$6,382.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,476.72
|
| Rate for Payer: Cash Price |
$9,279.95
|
| Rate for Payer: Cigna Commercial |
$15,404.72
|
| Rate for Payer: First Health Commercial |
$17,631.90
|
| Rate for Payer: Humana Commercial |
$15,775.92
|
| Rate for Payer: Humana KY Medicaid |
$6,382.75
|
| Rate for Payer: Kentucky WC Medicaid |
$6,447.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,219.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,697.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,567.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,510.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,332.71
|
| Rate for Payer: Ohio Health Group HMO |
$13,919.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,847.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,147.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,806.33
|
| Rate for Payer: PHCS Commercial |
$17,817.50
|
| Rate for Payer: United Healthcare All Payer |
$16,332.71
|
|
|
LINER ALTRX +4 10DEG 44*68
|
Facility
|
IP
|
$18,559.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,567.97 |
| Max. Negotiated Rate |
$17,817.50 |
| Rate for Payer: Aetna Commercial |
$14,291.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,476.72
|
| Rate for Payer: Cash Price |
$9,279.95
|
| Rate for Payer: Cigna Commercial |
$15,404.72
|
| Rate for Payer: First Health Commercial |
$17,631.90
|
| Rate for Payer: Humana Commercial |
$15,775.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,219.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,697.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,567.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,332.71
|
| Rate for Payer: Ohio Health Group HMO |
$13,919.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,847.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,147.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,806.33
|
| Rate for Payer: PHCS Commercial |
$17,817.50
|
| Rate for Payer: United Healthcare All Payer |
$16,332.71
|
|
|
LINER ALTRX +4 10DEG 48*70
|
Facility
|
OP
|
$18,559.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,567.97 |
| Max. Negotiated Rate |
$17,817.50 |
| Rate for Payer: Aetna Commercial |
$14,291.12
|
| Rate for Payer: Anthem Medicaid |
$6,382.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,476.72
|
| Rate for Payer: Cash Price |
$9,279.95
|
| Rate for Payer: Cigna Commercial |
$15,404.72
|
| Rate for Payer: First Health Commercial |
$17,631.90
|
| Rate for Payer: Humana Commercial |
$15,775.92
|
| Rate for Payer: Humana KY Medicaid |
$6,382.75
|
| Rate for Payer: Kentucky WC Medicaid |
$6,447.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,219.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,697.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,567.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,510.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,332.71
|
| Rate for Payer: Ohio Health Group HMO |
$13,919.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,847.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,147.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,806.33
|
| Rate for Payer: PHCS Commercial |
$17,817.50
|
| Rate for Payer: United Healthcare All Payer |
$16,332.71
|
|
|
LINER ALTRX +4 10DEG 48*70
|
Facility
|
IP
|
$18,559.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,567.97 |
| Max. Negotiated Rate |
$17,817.50 |
| Rate for Payer: Aetna Commercial |
$14,291.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,476.72
|
| Rate for Payer: Cash Price |
$9,279.95
|
| Rate for Payer: Cigna Commercial |
$15,404.72
|
| Rate for Payer: First Health Commercial |
$17,631.90
|
| Rate for Payer: Humana Commercial |
$15,775.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,219.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,697.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,567.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,332.71
|
| Rate for Payer: Ohio Health Group HMO |
$13,919.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,847.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,147.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,806.33
|
| Rate for Payer: PHCS Commercial |
$17,817.50
|
| Rate for Payer: United Healthcare All Payer |
$16,332.71
|
|
|
LINER ALTRX +4 10DEG 48*72
|
Facility
|
IP
|
$18,559.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,567.97 |
| Max. Negotiated Rate |
$17,817.50 |
| Rate for Payer: Aetna Commercial |
$14,291.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,476.72
|
| Rate for Payer: Cash Price |
$9,279.95
|
| Rate for Payer: Cigna Commercial |
$15,404.72
|
| Rate for Payer: First Health Commercial |
$17,631.90
|
| Rate for Payer: Humana Commercial |
$15,775.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,219.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,697.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,567.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,332.71
|
| Rate for Payer: Ohio Health Group HMO |
$13,919.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,847.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,147.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,806.33
|
| Rate for Payer: PHCS Commercial |
$17,817.50
|
| Rate for Payer: United Healthcare All Payer |
$16,332.71
|
|
|
LINER ALTRX +4 10DEG 48*72
|
Facility
|
OP
|
$18,559.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,567.97 |
| Max. Negotiated Rate |
$17,817.50 |
| Rate for Payer: Aetna Commercial |
$14,291.12
|
| Rate for Payer: Anthem Medicaid |
$6,382.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,476.72
|
| Rate for Payer: Cash Price |
$9,279.95
|
| Rate for Payer: Cigna Commercial |
$15,404.72
|
| Rate for Payer: First Health Commercial |
$17,631.90
|
| Rate for Payer: Humana Commercial |
$15,775.92
|
| Rate for Payer: Humana KY Medicaid |
$6,382.75
|
| Rate for Payer: Kentucky WC Medicaid |
$6,447.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,219.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,697.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,567.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,510.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,332.71
|
| Rate for Payer: Ohio Health Group HMO |
$13,919.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,847.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,147.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,806.33
|
| Rate for Payer: PHCS Commercial |
$17,817.50
|
| Rate for Payer: United Healthcare All Payer |
$16,332.71
|
|
