|
LINER ALTRX +4 NEUT 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 NEUT 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
|
|
|
LINER ALTRX +4 NEUT 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 NEUT 48*74
|
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 NEUT 48*74
|
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 NEUT 48*76
|
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 NEUT 48*76
|
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 ACETAB 10 40*60 +4
|
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 ACETAB 10 40*60 +4
|
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 ACETAB 10 40*62 +4
|
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 ACETAB 10 40*62 +4
|
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 ACETAB 10 40*64 +4
|
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 ACETAB 10 40*64 +4
|
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 ACETAB 10 40*66 +4
|
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 ACETAB 10 40*66 +4
|
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 NEUTRAL 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 NEUTRAL 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 NEUTRAL 40*58
|
Facility
|
OP
|
$4,625.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.50 |
| Max. Negotiated Rate |
$4,440.00 |
| Rate for Payer: Aetna Commercial |
$3,561.25
|
| Rate for Payer: Anthem Medicaid |
$1,590.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,607.50
|
| Rate for Payer: Cash Price |
$2,312.50
|
| Rate for Payer: Cigna Commercial |
$3,838.75
|
| Rate for Payer: First Health Commercial |
$4,393.75
|
| Rate for Payer: Humana Commercial |
$3,931.25
|
| Rate for Payer: Humana KY Medicaid |
$1,590.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,606.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,792.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,413.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,387.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,622.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,070.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,468.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,023.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,191.25
|
| Rate for Payer: PHCS Commercial |
$4,440.00
|
| Rate for Payer: United Healthcare All Payer |
$4,070.00
|
|
|
LINER ALTRX NEUTRAL 40*58
|
Facility
|
IP
|
$4,625.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.50 |
| Max. Negotiated Rate |
$4,440.00 |
| Rate for Payer: Aetna Commercial |
$3,561.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,607.50
|
| Rate for Payer: Cash Price |
$2,312.50
|
| Rate for Payer: Cigna Commercial |
$3,838.75
|
| Rate for Payer: First Health Commercial |
$4,393.75
|
| Rate for Payer: Humana Commercial |
$3,931.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,792.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,413.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,387.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,070.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,468.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,023.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,191.25
|
| Rate for Payer: PHCS Commercial |
$4,440.00
|
| Rate for Payer: United Healthcare All Payer |
$4,070.00
|
|
|
LINER ALTRX NEUTRAL 40*60
|
Facility
|
OP
|
$20,003.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,001.12 |
| Max. Negotiated Rate |
$19,203.60 |
| Rate for Payer: Aetna Commercial |
$15,402.89
|
| Rate for Payer: Anthem Medicaid |
$6,879.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,602.92
|
| Rate for Payer: Cash Price |
$10,001.88
|
| Rate for Payer: Cigna Commercial |
$16,603.11
|
| Rate for Payer: First Health Commercial |
$19,003.56
|
| Rate for Payer: Humana Commercial |
$17,003.19
|
| Rate for Payer: Humana KY Medicaid |
$6,879.29
|
| Rate for Payer: Kentucky WC Medicaid |
$6,949.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,403.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,762.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,001.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,017.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,603.30
|
| Rate for Payer: Ohio Health Group HMO |
$15,002.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,003.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,403.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,802.59
|
| Rate for Payer: PHCS Commercial |
$19,203.60
|
| Rate for Payer: United Healthcare All Payer |
$17,603.30
|
|
|
LINER ALTRX NEUTRAL 40*60
|
Facility
|
IP
|
$20,003.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,001.12 |
| Max. Negotiated Rate |
$19,203.60 |
| Rate for Payer: Aetna Commercial |
$15,402.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,602.92
|
| Rate for Payer: Cash Price |
$10,001.88
|
| Rate for Payer: Cigna Commercial |
$16,603.11
|
| Rate for Payer: First Health Commercial |
$19,003.56
|
| Rate for Payer: Humana Commercial |
$17,003.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,403.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,762.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,001.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,603.30
|
| Rate for Payer: Ohio Health Group HMO |
$15,002.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,003.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,403.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,802.59
|
| Rate for Payer: PHCS Commercial |
$19,203.60
|
| Rate for Payer: United Healthcare All Payer |
$17,603.30
|
|
|
LINER ALTRX NEUTRAL 40*62
|
Facility
|
IP
|
$4,625.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.50 |
| Max. Negotiated Rate |
$4,440.00 |
| Rate for Payer: Aetna Commercial |
$3,561.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,607.50
|
| Rate for Payer: Cash Price |
$2,312.50
|
| Rate for Payer: Cigna Commercial |
$3,838.75
|
| Rate for Payer: First Health Commercial |
$4,393.75
|
| Rate for Payer: Humana Commercial |
$3,931.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,792.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,413.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,387.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,070.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,468.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,023.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,191.25
|
| Rate for Payer: PHCS Commercial |
$4,440.00
|
| Rate for Payer: United Healthcare All Payer |
$4,070.00
|
|
|
LINER ALTRX NEUTRAL 40*62
|
Facility
|
OP
|
$4,625.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.50 |
| Max. Negotiated Rate |
$4,440.00 |
| Rate for Payer: Aetna Commercial |
$3,561.25
|
| Rate for Payer: Anthem Medicaid |
$1,590.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,607.50
|
| Rate for Payer: Cash Price |
$2,312.50
|
| Rate for Payer: Cigna Commercial |
$3,838.75
|
| Rate for Payer: First Health Commercial |
$4,393.75
|
| Rate for Payer: Humana Commercial |
$3,931.25
|
| Rate for Payer: Humana KY Medicaid |
$1,590.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,606.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,792.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,413.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,387.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,622.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,070.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,468.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,023.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,191.25
|
| Rate for Payer: PHCS Commercial |
$4,440.00
|
| Rate for Payer: United Healthcare All Payer |
$4,070.00
|
|
|
LINER ALTRX NEUTRAL 40*64
|
Facility
|
OP
|
$20,003.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,001.12 |
| Max. Negotiated Rate |
$19,203.60 |
| Rate for Payer: Aetna Commercial |
$15,402.89
|
| Rate for Payer: Anthem Medicaid |
$6,879.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,602.92
|
| Rate for Payer: Cash Price |
$10,001.88
|
| Rate for Payer: Cigna Commercial |
$16,603.11
|
| Rate for Payer: First Health Commercial |
$19,003.56
|
| Rate for Payer: Humana Commercial |
$17,003.19
|
| Rate for Payer: Humana KY Medicaid |
$6,879.29
|
| Rate for Payer: Kentucky WC Medicaid |
$6,949.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,403.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,762.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,001.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,017.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,603.30
|
| Rate for Payer: Ohio Health Group HMO |
$15,002.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,003.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,403.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,802.59
|
| Rate for Payer: PHCS Commercial |
$19,203.60
|
| Rate for Payer: United Healthcare All Payer |
$17,603.30
|
|
|
LINER ALTRX NEUTRAL 40*64
|
Facility
|
IP
|
$20,003.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,001.12 |
| Max. Negotiated Rate |
$19,203.60 |
| Rate for Payer: Aetna Commercial |
$15,402.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,602.92
|
| Rate for Payer: Cash Price |
$10,001.88
|
| Rate for Payer: Cigna Commercial |
$16,603.11
|
| Rate for Payer: First Health Commercial |
$19,003.56
|
| Rate for Payer: Humana Commercial |
$17,003.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,403.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,762.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,001.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,603.30
|
| Rate for Payer: Ohio Health Group HMO |
$15,002.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,003.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,403.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,802.59
|
| Rate for Payer: PHCS Commercial |
$19,203.60
|
| Rate for Payer: United Healthcare All Payer |
$17,603.30
|
|
