|
LINER XLPE 0^ +4 28MMX42MM
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
LINER XLPE 0^ +4 28MMX44MM
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
LINER XLPE 0^ +4 28MMX44MM
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
LINER XLPE 0^ ID 28MMX44MM
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
LINER XLPE 0^ ID 28MMX44MM
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
LINER XLPE 20^ 40ID 58-60 G
|
Facility
|
OP
|
$13,845.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,799.95 |
| Max. Negotiated Rate |
$13,291.93 |
| Rate for Payer: Aetna Commercial |
$10,661.24
|
| Rate for Payer: Anthem Medicaid |
$4,761.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,799.69
|
| Rate for Payer: Cash Price |
$6,922.88
|
| Rate for Payer: Cigna Commercial |
$11,491.98
|
| Rate for Payer: First Health Commercial |
$13,153.47
|
| Rate for Payer: Humana Commercial |
$11,768.90
|
| Rate for Payer: Humana KY Medicaid |
$4,761.56
|
| Rate for Payer: Kentucky WC Medicaid |
$4,810.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,353.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,218.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,153.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,857.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,184.27
|
| Rate for Payer: Ohio Health Group HMO |
$10,384.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,769.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,799.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,292.19
|
| Rate for Payer: PHCS Commercial |
$13,291.93
|
| Rate for Payer: United Healthcare All Payer |
$12,184.27
|
|
|
LINER XLPE 20^ 40ID 58-60 G
|
Facility
|
IP
|
$13,845.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,799.95 |
| Max. Negotiated Rate |
$13,291.93 |
| Rate for Payer: Aetna Commercial |
$10,661.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,799.69
|
| Rate for Payer: Cash Price |
$6,922.88
|
| Rate for Payer: Cigna Commercial |
$11,491.98
|
| Rate for Payer: First Health Commercial |
$13,153.47
|
| Rate for Payer: Humana Commercial |
$11,768.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,353.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,218.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,153.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,184.27
|
| Rate for Payer: Ohio Health Group HMO |
$10,384.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,769.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,799.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,292.19
|
| Rate for Payer: PHCS Commercial |
$13,291.93
|
| Rate for Payer: United Healthcare All Payer |
$12,184.27
|
|
|
LINER XLPE 20^ 40ID 62-64 H
|
Facility
|
IP
|
$13,845.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,799.95 |
| Max. Negotiated Rate |
$13,291.93 |
| Rate for Payer: Aetna Commercial |
$10,661.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,799.69
|
| Rate for Payer: Cash Price |
$6,922.88
|
| Rate for Payer: Cigna Commercial |
$11,491.98
|
| Rate for Payer: First Health Commercial |
$13,153.47
|
| Rate for Payer: Humana Commercial |
$11,768.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,353.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,218.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,153.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,184.27
|
| Rate for Payer: Ohio Health Group HMO |
$10,384.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,769.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,799.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,292.19
|
| Rate for Payer: PHCS Commercial |
$13,291.93
|
| Rate for Payer: United Healthcare All Payer |
$12,184.27
|
|
|
LINER XLPE 20^ 40ID 62-64 H
|
Facility
|
OP
|
$13,845.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,799.95 |
| Max. Negotiated Rate |
$13,291.93 |
| Rate for Payer: Aetna Commercial |
$10,661.24
|
| Rate for Payer: Anthem Medicaid |
$4,761.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,799.69
|
| Rate for Payer: Cash Price |
$6,922.88
|
| Rate for Payer: Cigna Commercial |
$11,491.98
|
| Rate for Payer: First Health Commercial |
$13,153.47
|
| Rate for Payer: Humana Commercial |
$11,768.90
|
| Rate for Payer: Humana KY Medicaid |
$4,761.56
|
| Rate for Payer: Kentucky WC Medicaid |
$4,810.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,353.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,218.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,153.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,857.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,184.27
|
| Rate for Payer: Ohio Health Group HMO |
$10,384.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,769.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,799.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,292.19
|
| Rate for Payer: PHCS Commercial |
$13,291.93
|
| Rate for Payer: United Healthcare All Payer |
$12,184.27
|
|
|
LINER XLPE 20^ 40ID 66-68 J
|
Facility
|
IP
|
$13,845.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,799.95 |
| Max. Negotiated Rate |
$13,291.93 |
| Rate for Payer: Aetna Commercial |
$10,661.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,799.69
|
| Rate for Payer: Cash Price |
$6,922.88
|
| Rate for Payer: Cigna Commercial |
$11,491.98
|
| Rate for Payer: First Health Commercial |
$13,153.47
|
| Rate for Payer: Humana Commercial |
$11,768.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,353.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,218.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,153.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,184.27
|
| Rate for Payer: Ohio Health Group HMO |
$10,384.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,769.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,799.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,292.19
|
| Rate for Payer: PHCS Commercial |
$13,291.93
|
| Rate for Payer: United Healthcare All Payer |
$12,184.27
|
|
|
LINER XLPE 20^ 40ID 66-68 J
|
Facility
|
OP
|
$13,845.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,799.95 |
| Max. Negotiated Rate |
$13,291.93 |
| Rate for Payer: Aetna Commercial |
$10,661.24
|
| Rate for Payer: Anthem Medicaid |
$4,761.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,799.69
|
| Rate for Payer: Cash Price |
$6,922.88
|
| Rate for Payer: Cigna Commercial |
$11,491.98
|
| Rate for Payer: First Health Commercial |
$13,153.47
|
| Rate for Payer: Humana Commercial |
$11,768.90
|
| Rate for Payer: Humana KY Medicaid |
$4,761.56
|
| Rate for Payer: Kentucky WC Medicaid |
$4,810.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,353.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,218.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,153.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,857.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,184.27
|
| Rate for Payer: Ohio Health Group HMO |
$10,384.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,769.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,799.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,292.19
|
| Rate for Payer: PHCS Commercial |
$13,291.93
|
| Rate for Payer: United Healthcare All Payer |
$12,184.27
|
|
|
LINER XLPE 20^ ID 28MMX44MM
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
LINER XLPE 20^ ID 28MMX44MM
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
LINER XLPE ACET 20^ +4 28X58MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LINER XLPE ACET 20^ +4 28X58MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LINER XLPE ANT 20^+4 40 58-60G
|
Facility
|
IP
|
$12,647.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,644.19 |
| Max. Negotiated Rate |
$12,141.74 |
| Rate for Payer: Aetna Commercial |
$9,738.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,865.17
|
| Rate for Payer: Cash Price |
$6,323.82
|
| Rate for Payer: Cigna Commercial |
$10,497.55
|
| Rate for Payer: First Health Commercial |
$12,015.27
|
| Rate for Payer: Humana Commercial |
$10,750.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,371.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,333.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,794.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,129.93
|
| Rate for Payer: Ohio Health Group HMO |
$9,485.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,529.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,644.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,920.77
|
| Rate for Payer: PHCS Commercial |
$12,141.74
|
| Rate for Payer: United Healthcare All Payer |
$11,129.93
|
|
|
LINER XLPE ANT 20^+4 40 58-60G
|
Facility
|
OP
|
$12,647.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,644.19 |
| Max. Negotiated Rate |
$12,141.74 |
| Rate for Payer: Aetna Commercial |
$9,738.69
|
| Rate for Payer: Anthem Medicaid |
$4,349.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,865.17
|
| Rate for Payer: Cash Price |
$6,323.82
|
| Rate for Payer: Cigna Commercial |
$10,497.55
|
| Rate for Payer: First Health Commercial |
$12,015.27
|
| Rate for Payer: Humana Commercial |
$10,750.50
|
| Rate for Payer: Humana KY Medicaid |
$4,349.53
|
| Rate for Payer: Kentucky WC Medicaid |
$4,393.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,371.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,333.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,794.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,436.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,129.93
|
| Rate for Payer: Ohio Health Group HMO |
$9,485.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,529.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,644.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,920.77
|
| Rate for Payer: PHCS Commercial |
$12,141.74
|
| Rate for Payer: United Healthcare All Payer |
$11,129.93
|
|
|
LINER XLPE ANT 20^+4 40 62-64H
|
Facility
|
OP
|
$12,647.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,644.19 |
| Max. Negotiated Rate |
$12,141.74 |
| Rate for Payer: Aetna Commercial |
$9,738.69
|
| Rate for Payer: Anthem Medicaid |
$4,349.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,865.17
|
| Rate for Payer: Cash Price |
$6,323.82
|
| Rate for Payer: Cigna Commercial |
$10,497.55
|
| Rate for Payer: First Health Commercial |
$12,015.27
|
| Rate for Payer: Humana Commercial |
$10,750.50
|
| Rate for Payer: Humana KY Medicaid |
$4,349.53
|
| Rate for Payer: Kentucky WC Medicaid |
$4,393.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,371.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,333.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,794.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,436.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,129.93
|
| Rate for Payer: Ohio Health Group HMO |
$9,485.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,529.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,644.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,920.77
|
| Rate for Payer: PHCS Commercial |
$12,141.74
|
| Rate for Payer: United Healthcare All Payer |
$11,129.93
|
|
|
LINER XLPE ANT 20^+4 40 62-64H
|
Facility
|
IP
|
$12,647.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,644.19 |
| Max. Negotiated Rate |
$12,141.74 |
| Rate for Payer: Aetna Commercial |
$9,738.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,865.17
|
| Rate for Payer: Cash Price |
$6,323.82
|
| Rate for Payer: Cigna Commercial |
$10,497.55
|
| Rate for Payer: First Health Commercial |
$12,015.27
|
| Rate for Payer: Humana Commercial |
$10,750.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,371.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,333.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,794.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,129.93
|
| Rate for Payer: Ohio Health Group HMO |
$9,485.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,529.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,644.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,920.77
|
| Rate for Payer: PHCS Commercial |
$12,141.74
|
| Rate for Payer: United Healthcare All Payer |
$11,129.93
|
|
|
LINER XLPE ANT20^+6 36ID50-52E
|
Facility
|
OP
|
$12,647.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,644.19 |
| Max. Negotiated Rate |
$12,141.74 |
| Rate for Payer: Aetna Commercial |
$9,738.69
|
| Rate for Payer: Anthem Medicaid |
$4,349.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,865.17
|
| Rate for Payer: Cash Price |
$6,323.82
|
| Rate for Payer: Cigna Commercial |
$10,497.55
|
| Rate for Payer: First Health Commercial |
$12,015.27
|
| Rate for Payer: Humana Commercial |
$10,750.50
|
| Rate for Payer: Humana KY Medicaid |
$4,349.53
|
| Rate for Payer: Kentucky WC Medicaid |
$4,393.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,371.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,333.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,794.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,436.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,129.93
|
| Rate for Payer: Ohio Health Group HMO |
$9,485.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,529.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,644.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,920.77
|
| Rate for Payer: PHCS Commercial |
$12,141.74
|
| Rate for Payer: United Healthcare All Payer |
$11,129.93
|
|
|
LINER XLPE ANT20^+6 36ID50-52E
|
Facility
|
IP
|
$12,647.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,644.19 |
| Max. Negotiated Rate |
$12,141.74 |
| Rate for Payer: Aetna Commercial |
$9,738.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,865.17
|
| Rate for Payer: Cash Price |
$6,323.82
|
| Rate for Payer: Cigna Commercial |
$10,497.55
|
| Rate for Payer: First Health Commercial |
$12,015.27
|
| Rate for Payer: Humana Commercial |
$10,750.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,371.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,333.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,794.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,129.93
|
| Rate for Payer: Ohio Health Group HMO |
$9,485.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,529.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,644.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,920.77
|
| Rate for Payer: PHCS Commercial |
$12,141.74
|
| Rate for Payer: United Healthcare All Payer |
$11,129.93
|
|
|
LINER XLPE CMT 0^ 36X58MM
|
Facility
|
IP
|
$7,775.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,010.77 |
| Max. Negotiated Rate |
$7,464.12 |
| Rate for Payer: Aetna Commercial |
$5,986.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,064.60
|
| Rate for Payer: Cash Price |
$3,887.57
|
| Rate for Payer: Cigna Commercial |
$6,453.36
|
| Rate for Payer: First Health Commercial |
$7,386.37
|
| Rate for Payer: Humana Commercial |
$6,608.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,375.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,738.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,332.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,842.11
|
| Rate for Payer: Ohio Health Group HMO |
$5,831.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,555.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,010.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,410.29
|
| Rate for Payer: PHCS Commercial |
$7,464.12
|
| Rate for Payer: United Healthcare All Payer |
$6,842.11
|
|
|
LINER XLPE CMT 0^ 36X58MM
|
Facility
|
OP
|
$7,775.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,010.77 |
| Max. Negotiated Rate |
$7,464.12 |
| Rate for Payer: Aetna Commercial |
$5,986.85
|
| Rate for Payer: Anthem Medicaid |
$2,673.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,064.60
|
| Rate for Payer: Cash Price |
$3,887.57
|
| Rate for Payer: Cigna Commercial |
$6,453.36
|
| Rate for Payer: First Health Commercial |
$7,386.37
|
| Rate for Payer: Humana Commercial |
$6,608.86
|
| Rate for Payer: Humana KY Medicaid |
$2,673.87
|
| Rate for Payer: Kentucky WC Medicaid |
$2,701.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,375.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,738.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,332.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,727.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,842.11
|
| Rate for Payer: Ohio Health Group HMO |
$5,831.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,555.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,010.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,410.29
|
| Rate for Payer: PHCS Commercial |
$7,464.12
|
| Rate for Payer: United Healthcare All Payer |
$6,842.11
|
|
|
LINER XLPE CMT 0^ 36X60MM
|
Facility
|
IP
|
$7,775.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,010.77 |
| Max. Negotiated Rate |
$7,464.12 |
| Rate for Payer: Aetna Commercial |
$5,986.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,064.60
|
| Rate for Payer: Cash Price |
$3,887.57
|
| Rate for Payer: Cigna Commercial |
$6,453.36
|
| Rate for Payer: First Health Commercial |
$7,386.37
|
| Rate for Payer: Humana Commercial |
$6,608.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,375.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,738.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,332.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,842.11
|
| Rate for Payer: Ohio Health Group HMO |
$5,831.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,555.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,010.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,410.29
|
| Rate for Payer: PHCS Commercial |
$7,464.12
|
| Rate for Payer: United Healthcare All Payer |
$6,842.11
|
|
|
LINER XLPE CMT 0^ 36X60MM
|
Facility
|
OP
|
$7,775.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,010.77 |
| Max. Negotiated Rate |
$7,464.12 |
| Rate for Payer: Aetna Commercial |
$5,986.85
|
| Rate for Payer: Anthem Medicaid |
$2,673.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,064.60
|
| Rate for Payer: Cash Price |
$3,887.57
|
| Rate for Payer: Cigna Commercial |
$6,453.36
|
| Rate for Payer: First Health Commercial |
$7,386.37
|
| Rate for Payer: Humana Commercial |
$6,608.86
|
| Rate for Payer: Humana KY Medicaid |
$2,673.87
|
| Rate for Payer: Kentucky WC Medicaid |
$2,701.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,375.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,738.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,332.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,727.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,842.11
|
| Rate for Payer: Ohio Health Group HMO |
$5,831.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,555.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,010.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,410.29
|
| Rate for Payer: PHCS Commercial |
$7,464.12
|
| Rate for Payer: United Healthcare All Payer |
$6,842.11
|
|
