|
LINER XLPE CMT 0^ 36X62MM
|
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^ 36X62MM
|
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^ 36X64MM
|
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^ 36X64MM
|
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^ 36X66-68MM
|
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^ 36X66-68MM
|
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^ 36X70-74MM
|
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^ 36X70-74MM
|
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^ 36X76-80MM
|
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^ 36X76-80MM
|
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^ 40X60MM
|
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^ 40X60MM
|
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^ 40X62MM
|
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^ 40X62MM
|
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^ 40X64MM
|
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^ 40X64MM
|
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^ 40X66-68MM
|
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^ 40X66-68MM
|
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^ 40X70-74MM
|
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^ 40X70-74MM
|
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^ 40X76-80MM
|
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^ 40X76-80MM
|
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 DEG 28X48MM
|
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 DEG 28X48MM
|
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 DEG 28X50MM
|
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
|
|
