|
LINER XLPE CMT 0 DEG 28X50MM
|
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 28X54MM
|
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 28X54MM
|
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 32X52MM
|
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 32X52MM
|
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 32X54MM
|
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 32X54MM
|
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 32X56MM
|
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: Aetna Commercial |
$6,315.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,064.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,397.56
|
| Rate for Payer: Cash Price |
$3,887.57
|
| Rate for Payer: Cash Price |
$4,101.00
|
| Rate for Payer: Cigna Commercial |
$6,453.36
|
| Rate for Payer: Cigna Commercial |
$6,807.66
|
| Rate for Payer: First Health Commercial |
$7,791.90
|
| Rate for Payer: First Health Commercial |
$7,386.37
|
| Rate for Payer: Humana Commercial |
$6,971.70
|
| 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 HMO |
$6,725.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,738.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,053.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,460.60
|
| 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 Choice Commercial |
$7,217.76
|
| Rate for Payer: Ohio Health Group HMO |
$5,831.35
|
| Rate for Payer: Ohio Health Group HMO |
$6,151.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,555.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,010.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,066.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,542.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,410.29
|
| Rate for Payer: PHCS Commercial |
$7,464.12
|
| Rate for Payer: PHCS Commercial |
$7,873.92
|
| Rate for Payer: United Healthcare All Payer |
$6,842.11
|
| Rate for Payer: United Healthcare All Payer |
$7,217.76
|
|
|
LINER XLPE CMT 0 DEG 32X56MM
|
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: Aetna Commercial |
$6,315.54
|
| Rate for Payer: Anthem Medicaid |
$2,673.87
|
| Rate for Payer: Anthem Medicaid |
$2,820.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,064.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,397.56
|
| Rate for Payer: Cash Price |
$3,887.57
|
| Rate for Payer: Cash Price |
$4,101.00
|
| Rate for Payer: Cigna Commercial |
$6,807.66
|
| Rate for Payer: Cigna Commercial |
$6,453.36
|
| Rate for Payer: First Health Commercial |
$7,791.90
|
| Rate for Payer: First Health Commercial |
$7,386.37
|
| Rate for Payer: Humana Commercial |
$6,608.86
|
| Rate for Payer: Humana Commercial |
$6,971.70
|
| Rate for Payer: Humana KY Medicaid |
$2,673.87
|
| Rate for Payer: Humana KY Medicaid |
$2,820.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,849.37
|
| 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 HMO |
$6,725.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,053.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,738.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,460.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,332.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,727.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,877.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,842.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,217.76
|
| Rate for Payer: Ohio Health Group HMO |
$5,831.35
|
| Rate for Payer: Ohio Health Group HMO |
$6,151.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,555.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,010.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,066.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,410.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,542.62
|
| Rate for Payer: PHCS Commercial |
$7,873.92
|
| Rate for Payer: PHCS Commercial |
$7,464.12
|
| Rate for Payer: United Healthcare All Payer |
$7,217.76
|
| Rate for Payer: United Healthcare All Payer |
$6,842.11
|
|
|
LINER XLPE CMT 0 DEG 36X54MM
|
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 36X54MM
|
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 36X56MM
|
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 36X56MM
|
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 40X58MM
|
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 40X58MM
|
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 ID OD +4 36MMX50MM
|
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 ID OD +4 36MMX50MM
|
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
|
|
|
LINR ARCOMXL G7 HI-WALL 28MM C
|
Facility
|
IP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
|
LINR ARCOMXL G7 HI-WALL 28MM C
|
Facility
|
OP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem Medicaid |
$2,469.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Humana KY Medicaid |
$2,469.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,494.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,518.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
|
LINR ARCOMXL G7 HI-WALL 28MM E
|
Facility
|
IP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
|
LINR ARCOMXL G7 HI-WALL 28MM E
|
Facility
|
OP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem Medicaid |
$2,469.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Humana KY Medicaid |
$2,469.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,494.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,518.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
|
LINR ARCOMXL G7 HI-WALL 28MM F
|
Facility
|
IP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
|
LINR ARCOMXL G7 HI-WALL 28MM F
|
Facility
|
OP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem Medicaid |
$2,469.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Humana KY Medicaid |
$2,469.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,494.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,518.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
|
LINR ARCOMXL G7 HI-WALL 28MM G
|
Facility
|
IP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
|
LINR ARCOMXL G7 HI-WALL 28MM G
|
Facility
|
OP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem Medicaid |
$2,469.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Humana KY Medicaid |
$2,469.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,494.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,518.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
