|
LINR ARCOMXL G7 HI-WALL 32MM B
|
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 32MM B
|
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 32MM 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 32MM 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 32MM D
|
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 32MM D
|
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 32MM 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 32MM 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 32MM 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 32MM 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 32MM 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 32MM 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
|
|
|
LINR BIOLOX CER ACE R3 36M 56M
|
Facility
|
OP
|
$11,366.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.64 |
| Max. Negotiated Rate |
$10,911.84 |
| Rate for Payer: Aetna Commercial |
$8,752.20
|
| Rate for Payer: Anthem Medicaid |
$3,908.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,865.87
|
| Rate for Payer: Cash Price |
$5,683.25
|
| Rate for Payer: Cigna Commercial |
$9,434.20
|
| Rate for Payer: First Health Commercial |
$10,798.18
|
| Rate for Payer: Humana Commercial |
$9,661.52
|
| Rate for Payer: Humana KY Medicaid |
$3,908.94
|
| Rate for Payer: Kentucky WC Medicaid |
$3,948.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,320.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,388.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,409.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,987.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,002.52
|
| Rate for Payer: Ohio Health Group HMO |
$8,524.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,273.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,477.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,523.62
|
| Rate for Payer: PHCS Commercial |
$10,911.84
|
| Rate for Payer: United Healthcare All Payer |
$10,002.52
|
|
|
LINR BIOLOX CER ACE R3 36M 56M
|
Facility
|
IP
|
$11,366.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.64 |
| Max. Negotiated Rate |
$10,911.84 |
| Rate for Payer: Aetna Commercial |
$8,752.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,865.87
|
| Rate for Payer: Cash Price |
$5,683.25
|
| Rate for Payer: Cigna Commercial |
$9,434.20
|
| Rate for Payer: First Health Commercial |
$10,798.18
|
| Rate for Payer: Humana Commercial |
$9,661.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,320.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,388.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,409.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,002.52
|
| Rate for Payer: Ohio Health Group HMO |
$8,524.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,273.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,477.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,523.62
|
| Rate for Payer: PHCS Commercial |
$10,911.84
|
| Rate for Payer: United Healthcare All Payer |
$10,002.52
|
|
|
LINR BIOLOX CER ACE R3 36M 58M
|
Facility
|
IP
|
$11,366.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.64 |
| Max. Negotiated Rate |
$10,911.84 |
| Rate for Payer: Aetna Commercial |
$8,752.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,865.87
|
| Rate for Payer: Cash Price |
$5,683.25
|
| Rate for Payer: Cigna Commercial |
$9,434.20
|
| Rate for Payer: First Health Commercial |
$10,798.18
|
| Rate for Payer: Humana Commercial |
$9,661.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,320.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,388.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,409.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,002.52
|
| Rate for Payer: Ohio Health Group HMO |
$8,524.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,273.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,477.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,523.62
|
| Rate for Payer: PHCS Commercial |
$10,911.84
|
| Rate for Payer: United Healthcare All Payer |
$10,002.52
|
|
|
LINR BIOLOX CER ACE R3 36M 58M
|
Facility
|
OP
|
$11,366.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.64 |
| Max. Negotiated Rate |
$10,911.84 |
| Rate for Payer: Aetna Commercial |
$8,752.20
|
| Rate for Payer: Anthem Medicaid |
$3,908.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,865.87
|
| Rate for Payer: Cash Price |
$5,683.25
|
| Rate for Payer: Cigna Commercial |
$9,434.20
|
| Rate for Payer: First Health Commercial |
$10,798.18
|
| Rate for Payer: Humana Commercial |
$9,661.52
|
| Rate for Payer: Humana KY Medicaid |
$3,908.94
|
| Rate for Payer: Kentucky WC Medicaid |
$3,948.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,320.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,388.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,409.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,987.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,002.52
|
| Rate for Payer: Ohio Health Group HMO |
$8,524.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,273.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,477.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,523.62
|
| Rate for Payer: PHCS Commercial |
$10,911.84
|
| Rate for Payer: United Healthcare All Payer |
$10,002.52
|
|
|
LINR LGVITY CONSTRAINED JJI 28
|
Facility
|
OP
|
$17,534.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.50 |
| Max. Negotiated Rate |
$16,833.20 |
| Rate for Payer: Aetna Commercial |
$13,501.63
|
| Rate for Payer: Anthem Medicaid |
$6,030.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,676.97
|
| Rate for Payer: Cash Price |
$8,767.29
|
| Rate for Payer: Cigna Commercial |
$14,553.70
|
| Rate for Payer: First Health Commercial |
$16,657.85
|
| Rate for Payer: Humana Commercial |
$14,904.39
|
| Rate for Payer: Humana KY Medicaid |
$6,030.14
|
| Rate for Payer: Kentucky WC Medicaid |
$6,091.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,378.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,940.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,260.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,151.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,430.43
|
| Rate for Payer: Ohio Health Group HMO |
$13,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,506.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,435.72
|
| Rate for Payer: PHCS Commercial |
$16,833.20
|
| Rate for Payer: United Healthcare All Payer |
$15,430.43
|
|
|
LINR LGVITY CONSTRAINED JJI 28
|
Facility
|
IP
|
$17,534.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.50 |
| Max. Negotiated Rate |
$16,833.20 |
| Rate for Payer: Aetna Commercial |
$13,501.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,676.97
|
| Rate for Payer: Cash Price |
$8,767.29
|
| Rate for Payer: Cigna Commercial |
$14,553.70
|
| Rate for Payer: First Health Commercial |
$16,657.85
|
| Rate for Payer: Humana Commercial |
$14,904.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,378.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,940.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,260.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,430.43
|
| Rate for Payer: Ohio Health Group HMO |
$13,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,506.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,435.72
|
| Rate for Payer: PHCS Commercial |
$16,833.20
|
| Rate for Payer: United Healthcare All Payer |
$15,430.43
|
|
|
LINR NEU ANG+4 50MM OD 32MM ID
|
Facility
|
IP
|
$10,892.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,415.96 |
| Max. Negotiated Rate |
$10,456.32 |
| Rate for Payer: Aetna Commercial |
$8,386.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,495.76
|
| Rate for Payer: Cash Price |
$5,446.00
|
| Rate for Payer: Cigna Commercial |
$9,040.36
|
| Rate for Payer: First Health Commercial |
$10,347.40
|
| Rate for Payer: Humana Commercial |
$9,258.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,931.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,038.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,267.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,584.96
|
| Rate for Payer: Ohio Health Group HMO |
$8,169.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,178.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,415.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,376.52
|
| Rate for Payer: PHCS Commercial |
$10,456.32
|
| Rate for Payer: United Healthcare All Payer |
$9,584.96
|
|
|
LINR NEU ANG+4 50MM OD 32MM ID
|
Facility
|
OP
|
$10,892.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,415.96 |
| Max. Negotiated Rate |
$10,456.32 |
| Rate for Payer: Aetna Commercial |
$8,386.84
|
| Rate for Payer: Anthem Medicaid |
$3,745.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,495.76
|
| Rate for Payer: Cash Price |
$5,446.00
|
| Rate for Payer: Cigna Commercial |
$9,040.36
|
| Rate for Payer: First Health Commercial |
$10,347.40
|
| Rate for Payer: Humana Commercial |
$9,258.20
|
| Rate for Payer: Humana KY Medicaid |
$3,745.76
|
| Rate for Payer: Kentucky WC Medicaid |
$3,783.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,931.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,038.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,267.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,820.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,584.96
|
| Rate for Payer: Ohio Health Group HMO |
$8,169.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,178.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,415.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,376.52
|
| Rate for Payer: PHCS Commercial |
$10,456.32
|
| Rate for Payer: United Healthcare All Payer |
$9,584.96
|
|
|
LINR NEU ANG+4 54MM OD 36MM ID
|
Facility
|
OP
|
$8,404.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,092.55 |
| Max. Negotiated Rate |
$8,068.04 |
| Rate for Payer: Aetna Commercial |
$6,471.24
|
| Rate for Payer: Anthem Medicaid |
$2,890.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,555.28
|
| Rate for Payer: Cash Price |
$4,202.10
|
| Rate for Payer: Cigna Commercial |
$6,975.49
|
| Rate for Payer: First Health Commercial |
$7,984.00
|
| Rate for Payer: Humana Commercial |
$7,143.58
|
| Rate for Payer: Humana KY Medicaid |
$2,890.21
|
| Rate for Payer: Kentucky WC Medicaid |
$2,919.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,891.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,202.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,521.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,948.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,395.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,303.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,680.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,092.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,605.31
|
| Rate for Payer: PHCS Commercial |
$8,068.04
|
| Rate for Payer: United Healthcare All Payer |
$7,395.70
|
|
|
LINR NEU ANG+4 54MM OD 36MM ID
|
Facility
|
IP
|
$8,404.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,092.55 |
| Max. Negotiated Rate |
$8,068.04 |
| Rate for Payer: Aetna Commercial |
$6,471.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,555.28
|
| Rate for Payer: Cash Price |
$4,202.10
|
| Rate for Payer: Cigna Commercial |
$6,975.49
|
| Rate for Payer: First Health Commercial |
$7,984.00
|
| Rate for Payer: Humana Commercial |
$7,143.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,891.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,202.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,521.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,395.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,303.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,680.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,092.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,605.31
|
| Rate for Payer: PHCS Commercial |
$8,068.04
|
| Rate for Payer: United Healthcare All Payer |
$7,395.70
|
|
|
LINR R3 0^+4 XLPE ACE 40*66/70
|
Facility
|
IP
|
$13,294.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,728.29 |
| Max. Negotiated Rate |
$12,762.76 |
| Rate for Payer: Aetna Commercial |
$10,236.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,369.74
|
| Rate for Payer: Cash Price |
$6,647.27
|
| Rate for Payer: Cigna Commercial |
$11,034.47
|
| Rate for Payer: First Health Commercial |
$12,629.81
|
| Rate for Payer: Humana Commercial |
$11,300.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,901.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,811.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,988.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,699.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,970.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,658.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,728.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,121.31
|
| Rate for Payer: PHCS Commercial |
$12,762.76
|
| Rate for Payer: United Healthcare All Payer |
$11,699.20
|
|
|
LINR R3 0^+4 XLPE ACE 40*66/70
|
Facility
|
OP
|
$13,294.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,728.29 |
| Max. Negotiated Rate |
$12,762.76 |
| Rate for Payer: Aetna Commercial |
$10,236.80
|
| Rate for Payer: Anthem Medicaid |
$4,571.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,369.74
|
| Rate for Payer: Cash Price |
$6,647.27
|
| Rate for Payer: Cigna Commercial |
$11,034.47
|
| Rate for Payer: First Health Commercial |
$12,629.81
|
| Rate for Payer: Humana Commercial |
$11,300.36
|
| Rate for Payer: Humana KY Medicaid |
$4,571.99
|
| Rate for Payer: Kentucky WC Medicaid |
$4,618.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,901.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,811.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,988.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,663.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,699.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,970.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,658.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,728.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,121.31
|
| Rate for Payer: PHCS Commercial |
$12,762.76
|
| Rate for Payer: United Healthcare All Payer |
$11,699.20
|
|
|
LINR R3 0^+4 XLPE ACE 40*72-74
|
Facility
|
OP
|
$13,294.54
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,728.29 |
| Max. Negotiated Rate |
$12,762.76 |
| Rate for Payer: Aetna Commercial |
$10,236.80
|
| Rate for Payer: Anthem Medicaid |
$4,571.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,369.74
|
| Rate for Payer: Cash Price |
$6,647.27
|
| Rate for Payer: Cigna Commercial |
$11,034.47
|
| Rate for Payer: First Health Commercial |
$12,629.81
|
| Rate for Payer: Humana Commercial |
$11,300.36
|
| Rate for Payer: Humana KY Medicaid |
$4,571.99
|
| Rate for Payer: Kentucky WC Medicaid |
$4,618.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,901.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,811.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,988.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,663.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,699.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,970.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,658.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,728.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,121.31
|
| Rate for Payer: PHCS Commercial |
$12,762.76
|
| Rate for Payer: United Healthcare All Payer |
$11,699.20
|
|
