|
LINER R3 20^ XLPE ACE 44*72-74
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| 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 |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
LINER R3 20^ XLPE ACE 44*76-80
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| 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 |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
LINER R3 20^ XLPE ACE 44*76-80
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| 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 |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
LINER R3 20^ XLPE ACET36*72-74
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LINER R3 20^ XLPE ACET36*72-74
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
LINER R3 20 XLPE ACET 40*56
|
Facility
|
OP
|
$8,812.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,643.76 |
| Max. Negotiated Rate |
$8,460.02 |
| Rate for Payer: Aetna Commercial |
$6,785.64
|
| Rate for Payer: Anthem Medicaid |
$3,030.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,873.77
|
| Rate for Payer: Cash Price |
$4,406.26
|
| Rate for Payer: Cigna Commercial |
$7,314.39
|
| Rate for Payer: First Health Commercial |
$8,371.89
|
| Rate for Payer: Humana Commercial |
$7,490.64
|
| Rate for Payer: Humana KY Medicaid |
$3,030.63
|
| Rate for Payer: Kentucky WC Medicaid |
$3,061.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,226.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,503.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,643.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,091.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,755.02
|
| Rate for Payer: Ohio Health Group HMO |
$6,609.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,050.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,666.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,080.64
|
| Rate for Payer: PHCS Commercial |
$8,460.02
|
| Rate for Payer: United Healthcare All Payer |
$7,755.02
|
|
|
LINER R3 20 XLPE ACET 40*56
|
Facility
|
IP
|
$8,812.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,643.76 |
| Max. Negotiated Rate |
$8,460.02 |
| Rate for Payer: Aetna Commercial |
$6,785.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,873.77
|
| Rate for Payer: Cash Price |
$4,406.26
|
| Rate for Payer: Cigna Commercial |
$7,314.39
|
| Rate for Payer: First Health Commercial |
$8,371.89
|
| Rate for Payer: Humana Commercial |
$7,490.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,226.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,503.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,643.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,755.02
|
| Rate for Payer: Ohio Health Group HMO |
$6,609.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,050.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,666.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,080.64
|
| Rate for Payer: PHCS Commercial |
$8,460.02
|
| Rate for Payer: United Healthcare All Payer |
$7,755.02
|
|
|
LINER R3 20 XLPE ACET 40*58
|
Facility
|
IP
|
$12,041.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,612.58 |
| Max. Negotiated Rate |
$11,560.24 |
| Rate for Payer: Aetna Commercial |
$9,272.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,392.70
|
| Rate for Payer: Cash Price |
$6,020.96
|
| Rate for Payer: Cigna Commercial |
$9,994.79
|
| Rate for Payer: First Health Commercial |
$11,439.82
|
| Rate for Payer: Humana Commercial |
$10,235.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,874.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,886.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,612.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,596.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,031.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,633.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,476.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,308.92
|
| Rate for Payer: PHCS Commercial |
$11,560.24
|
| Rate for Payer: United Healthcare All Payer |
$10,596.89
|
|
|
LINER R3 20 XLPE ACET 40*58
|
Facility
|
OP
|
$12,041.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,612.58 |
| Max. Negotiated Rate |
$11,560.24 |
| Rate for Payer: Aetna Commercial |
$9,272.28
|
| Rate for Payer: Anthem Medicaid |
$4,141.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,392.70
|
| Rate for Payer: Cash Price |
$6,020.96
|
| Rate for Payer: Cigna Commercial |
$9,994.79
|
| Rate for Payer: First Health Commercial |
$11,439.82
|
| Rate for Payer: Humana Commercial |
$10,235.63
|
| Rate for Payer: Humana KY Medicaid |
$4,141.22
|
| Rate for Payer: Kentucky WC Medicaid |
$4,183.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,874.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,886.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,612.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,224.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,596.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,031.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,633.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,476.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,308.92
|
| Rate for Payer: PHCS Commercial |
$11,560.24
|
| Rate for Payer: United Healthcare All Payer |
$10,596.89
|
|
|
LINER R3 20 XLPE ACET 40*60
|
Facility
|
OP
|
$12,041.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,612.58 |
| Max. Negotiated Rate |
$11,560.24 |
| Rate for Payer: Aetna Commercial |
$9,272.28
|
| Rate for Payer: Anthem Medicaid |
$4,141.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,392.70
|
| Rate for Payer: Cash Price |
$6,020.96
|
| Rate for Payer: Cigna Commercial |
$9,994.79
|
| Rate for Payer: First Health Commercial |
$11,439.82
|
| Rate for Payer: Humana Commercial |
$10,235.63
|
| Rate for Payer: Humana KY Medicaid |
$4,141.22
|
| Rate for Payer: Kentucky WC Medicaid |
$4,183.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,874.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,886.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,612.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,224.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,596.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,031.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,633.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,476.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,308.92
|
| Rate for Payer: PHCS Commercial |
$11,560.24
|
| Rate for Payer: United Healthcare All Payer |
$10,596.89
|
|
|
LINER R3 20 XLPE ACET 40*60
|
Facility
|
IP
|
$12,041.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,612.58 |
| Max. Negotiated Rate |
$11,560.24 |
| Rate for Payer: Aetna Commercial |
$9,272.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,392.70
|
| Rate for Payer: Cash Price |
$6,020.96
|
| Rate for Payer: Cigna Commercial |
$9,994.79
|
| Rate for Payer: First Health Commercial |
$11,439.82
|
| Rate for Payer: Humana Commercial |
$10,235.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,874.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,886.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,612.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,596.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,031.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,633.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,476.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,308.92
|
| Rate for Payer: PHCS Commercial |
$11,560.24
|
| Rate for Payer: United Healthcare All Payer |
$10,596.89
|
|
|
LINER R3 20 XLPE ACET 40*62
|
Facility
|
OP
|
$12,041.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,612.58 |
| Max. Negotiated Rate |
$11,560.24 |
| Rate for Payer: Aetna Commercial |
$9,272.28
|
| Rate for Payer: Anthem Medicaid |
$4,141.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,392.70
|
| Rate for Payer: Cash Price |
$6,020.96
|
| Rate for Payer: Cigna Commercial |
$9,994.79
|
| Rate for Payer: First Health Commercial |
$11,439.82
|
| Rate for Payer: Humana Commercial |
$10,235.63
|
| Rate for Payer: Humana KY Medicaid |
$4,141.22
|
| Rate for Payer: Kentucky WC Medicaid |
$4,183.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,874.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,886.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,612.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,224.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,596.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,031.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,633.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,476.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,308.92
|
| Rate for Payer: PHCS Commercial |
$11,560.24
|
| Rate for Payer: United Healthcare All Payer |
$10,596.89
|
|
|
LINER R3 20 XLPE ACET 40*62
|
Facility
|
IP
|
$12,041.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,612.58 |
| Max. Negotiated Rate |
$11,560.24 |
| Rate for Payer: Aetna Commercial |
$9,272.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,392.70
|
| Rate for Payer: Cash Price |
$6,020.96
|
| Rate for Payer: Cigna Commercial |
$9,994.79
|
| Rate for Payer: First Health Commercial |
$11,439.82
|
| Rate for Payer: Humana Commercial |
$10,235.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,874.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,886.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,612.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,596.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,031.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,633.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,476.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,308.92
|
| Rate for Payer: PHCS Commercial |
$11,560.24
|
| Rate for Payer: United Healthcare All Payer |
$10,596.89
|
|
|
LINER R3 20 XLPE ACET 40*64
|
Facility
|
IP
|
$13,549.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,064.79 |
| Max. Negotiated Rate |
$13,007.33 |
| Rate for Payer: Aetna Commercial |
$10,432.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,568.45
|
| Rate for Payer: Cash Price |
$6,774.65
|
| Rate for Payer: Cigna Commercial |
$11,245.92
|
| Rate for Payer: First Health Commercial |
$12,871.83
|
| Rate for Payer: Humana Commercial |
$11,516.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,110.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,999.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,064.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,923.38
|
| Rate for Payer: Ohio Health Group HMO |
$10,161.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,839.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,787.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,349.02
|
| Rate for Payer: PHCS Commercial |
$13,007.33
|
| Rate for Payer: United Healthcare All Payer |
$11,923.38
|
|
|
LINER R3 20 XLPE ACET 40*64
|
Facility
|
OP
|
$13,549.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,064.79 |
| Max. Negotiated Rate |
$13,007.33 |
| Rate for Payer: Aetna Commercial |
$10,432.96
|
| Rate for Payer: Anthem Medicaid |
$4,659.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,568.45
|
| Rate for Payer: Cash Price |
$6,774.65
|
| Rate for Payer: Cigna Commercial |
$11,245.92
|
| Rate for Payer: First Health Commercial |
$12,871.83
|
| Rate for Payer: Humana Commercial |
$11,516.91
|
| Rate for Payer: Humana KY Medicaid |
$4,659.60
|
| Rate for Payer: Kentucky WC Medicaid |
$4,707.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,110.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,999.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,064.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,753.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,923.38
|
| Rate for Payer: Ohio Health Group HMO |
$10,161.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,839.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,787.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,349.02
|
| Rate for Payer: PHCS Commercial |
$13,007.33
|
| Rate for Payer: United Healthcare All Payer |
$11,923.38
|
|
|
LINER R3 20 XLPE ACET 40*66/70
|
Facility
|
IP
|
$13,549.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,064.79 |
| Max. Negotiated Rate |
$13,007.33 |
| Rate for Payer: Aetna Commercial |
$10,432.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,568.45
|
| Rate for Payer: Cash Price |
$6,774.65
|
| Rate for Payer: Cigna Commercial |
$11,245.92
|
| Rate for Payer: First Health Commercial |
$12,871.83
|
| Rate for Payer: Humana Commercial |
$11,516.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,110.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,999.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,064.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,923.38
|
| Rate for Payer: Ohio Health Group HMO |
$10,161.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,839.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,787.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,349.02
|
| Rate for Payer: PHCS Commercial |
$13,007.33
|
| Rate for Payer: United Healthcare All Payer |
$11,923.38
|
|
|
LINER R3 20 XLPE ACET 40*66/70
|
Facility
|
OP
|
$13,549.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,064.79 |
| Max. Negotiated Rate |
$13,007.33 |
| Rate for Payer: Aetna Commercial |
$10,432.96
|
| Rate for Payer: Anthem Medicaid |
$4,659.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,568.45
|
| Rate for Payer: Cash Price |
$6,774.65
|
| Rate for Payer: Cigna Commercial |
$11,245.92
|
| Rate for Payer: First Health Commercial |
$12,871.83
|
| Rate for Payer: Humana Commercial |
$11,516.91
|
| Rate for Payer: Humana KY Medicaid |
$4,659.60
|
| Rate for Payer: Kentucky WC Medicaid |
$4,707.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,110.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,999.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,064.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,753.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,923.38
|
| Rate for Payer: Ohio Health Group HMO |
$10,161.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,839.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,787.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,349.02
|
| Rate for Payer: PHCS Commercial |
$13,007.33
|
| Rate for Payer: United Healthcare All Payer |
$11,923.38
|
|
|
LINER R3 20 XLPE ACET 40*72/74
|
Facility
|
IP
|
$15,544.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,663.37 |
| Max. Negotiated Rate |
$14,922.80 |
| Rate for Payer: Aetna Commercial |
$11,969.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,124.77
|
| Rate for Payer: Cash Price |
$7,772.29
|
| Rate for Payer: Cigna Commercial |
$12,902.00
|
| Rate for Payer: First Health Commercial |
$14,767.35
|
| Rate for Payer: Humana Commercial |
$13,212.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,746.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,471.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,663.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,679.23
|
| Rate for Payer: Ohio Health Group HMO |
$11,658.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,435.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,523.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,725.76
|
| Rate for Payer: PHCS Commercial |
$14,922.80
|
| Rate for Payer: United Healthcare All Payer |
$13,679.23
|
|
|
LINER R3 20 XLPE ACET 40*72/74
|
Facility
|
OP
|
$15,544.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,663.37 |
| Max. Negotiated Rate |
$14,922.80 |
| Rate for Payer: Aetna Commercial |
$11,969.33
|
| Rate for Payer: Anthem Medicaid |
$5,345.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,124.77
|
| Rate for Payer: Cash Price |
$7,772.29
|
| Rate for Payer: Cigna Commercial |
$12,902.00
|
| Rate for Payer: First Health Commercial |
$14,767.35
|
| Rate for Payer: Humana Commercial |
$13,212.89
|
| Rate for Payer: Humana KY Medicaid |
$5,345.78
|
| Rate for Payer: Kentucky WC Medicaid |
$5,400.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,746.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,471.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,663.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,453.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,679.23
|
| Rate for Payer: Ohio Health Group HMO |
$11,658.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,435.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,523.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,725.76
|
| Rate for Payer: PHCS Commercial |
$14,922.80
|
| Rate for Payer: United Healthcare All Payer |
$13,679.23
|
|
|
LINER R3 CONST ACET 52MM
|
Facility
|
IP
|
$18,460.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,538.00 |
| Max. Negotiated Rate |
$17,721.60 |
| Rate for Payer: Aetna Commercial |
$14,214.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,398.80
|
| Rate for Payer: Cash Price |
$9,230.00
|
| Rate for Payer: Cigna Commercial |
$15,321.80
|
| Rate for Payer: First Health Commercial |
$17,537.00
|
| Rate for Payer: Humana Commercial |
$15,691.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,137.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,623.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,538.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,244.80
|
| Rate for Payer: Ohio Health Group HMO |
$13,845.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,768.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,060.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,737.40
|
| Rate for Payer: PHCS Commercial |
$17,721.60
|
| Rate for Payer: United Healthcare All Payer |
$16,244.80
|
|
|
LINER R3 CONST ACET 52MM
|
Facility
|
OP
|
$18,460.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,538.00 |
| Max. Negotiated Rate |
$17,721.60 |
| Rate for Payer: Aetna Commercial |
$14,214.20
|
| Rate for Payer: Anthem Medicaid |
$6,348.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,398.80
|
| Rate for Payer: Cash Price |
$9,230.00
|
| Rate for Payer: Cigna Commercial |
$15,321.80
|
| Rate for Payer: First Health Commercial |
$17,537.00
|
| Rate for Payer: Humana Commercial |
$15,691.00
|
| Rate for Payer: Humana KY Medicaid |
$6,348.39
|
| Rate for Payer: Kentucky WC Medicaid |
$6,413.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,137.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,623.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,538.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,475.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,244.80
|
| Rate for Payer: Ohio Health Group HMO |
$13,845.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,768.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,060.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,737.40
|
| Rate for Payer: PHCS Commercial |
$17,721.60
|
| Rate for Payer: United Healthcare All Payer |
$16,244.80
|
|
|
LINER R3 CONST ACET 54MM
|
Facility
|
OP
|
$18,460.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,538.00 |
| Max. Negotiated Rate |
$17,721.60 |
| Rate for Payer: Aetna Commercial |
$14,214.20
|
| Rate for Payer: Anthem Medicaid |
$6,348.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,398.80
|
| Rate for Payer: Cash Price |
$9,230.00
|
| Rate for Payer: Cigna Commercial |
$15,321.80
|
| Rate for Payer: First Health Commercial |
$17,537.00
|
| Rate for Payer: Humana Commercial |
$15,691.00
|
| Rate for Payer: Humana KY Medicaid |
$6,348.39
|
| Rate for Payer: Kentucky WC Medicaid |
$6,413.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,137.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,623.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,538.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,475.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,244.80
|
| Rate for Payer: Ohio Health Group HMO |
$13,845.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,768.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,060.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,737.40
|
| Rate for Payer: PHCS Commercial |
$17,721.60
|
| Rate for Payer: United Healthcare All Payer |
$16,244.80
|
|
|
LINER R3 CONST ACET 54MM
|
Facility
|
IP
|
$18,460.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,538.00 |
| Max. Negotiated Rate |
$17,721.60 |
| Rate for Payer: Aetna Commercial |
$14,214.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,398.80
|
| Rate for Payer: Cash Price |
$9,230.00
|
| Rate for Payer: Cigna Commercial |
$15,321.80
|
| Rate for Payer: First Health Commercial |
$17,537.00
|
| Rate for Payer: Humana Commercial |
$15,691.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,137.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,623.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,538.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,244.80
|
| Rate for Payer: Ohio Health Group HMO |
$13,845.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,768.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,060.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,737.40
|
| Rate for Payer: PHCS Commercial |
$17,721.60
|
| Rate for Payer: United Healthcare All Payer |
$16,244.80
|
|
|
LINER R3 CONST ACET 56MM
|
Facility
|
OP
|
$18,460.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,538.00 |
| Max. Negotiated Rate |
$17,721.60 |
| Rate for Payer: Aetna Commercial |
$14,214.20
|
| Rate for Payer: Anthem Medicaid |
$6,348.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,398.80
|
| Rate for Payer: Cash Price |
$9,230.00
|
| Rate for Payer: Cigna Commercial |
$15,321.80
|
| Rate for Payer: First Health Commercial |
$17,537.00
|
| Rate for Payer: Humana Commercial |
$15,691.00
|
| Rate for Payer: Humana KY Medicaid |
$6,348.39
|
| Rate for Payer: Kentucky WC Medicaid |
$6,413.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,137.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,623.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,538.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,475.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,244.80
|
| Rate for Payer: Ohio Health Group HMO |
$13,845.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,768.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,060.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,737.40
|
| Rate for Payer: PHCS Commercial |
$17,721.60
|
| Rate for Payer: United Healthcare All Payer |
$16,244.80
|
|
|
LINER R3 CONST ACET 56MM
|
Facility
|
IP
|
$18,460.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,538.00 |
| Max. Negotiated Rate |
$17,721.60 |
| Rate for Payer: Aetna Commercial |
$14,214.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,398.80
|
| Rate for Payer: Cash Price |
$9,230.00
|
| Rate for Payer: Cigna Commercial |
$15,321.80
|
| Rate for Payer: First Health Commercial |
$17,537.00
|
| Rate for Payer: Humana Commercial |
$15,691.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,137.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,623.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,538.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,244.80
|
| Rate for Payer: Ohio Health Group HMO |
$13,845.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,768.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,060.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,737.40
|
| Rate for Payer: PHCS Commercial |
$17,721.60
|
| Rate for Payer: United Healthcare All Payer |
$16,244.80
|
|
