|
LINER XLPE 20^ 40ID 62-64 H
|
Facility
|
OP
|
$14,103.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,231.06 |
| Max. Negotiated Rate |
$13,539.41 |
| Rate for Payer: Aetna Commercial |
$10,859.73
|
| Rate for Payer: Anthem Medicaid |
$4,850.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,000.77
|
| Rate for Payer: Cash Price |
$7,051.77
|
| Rate for Payer: Cigna Commercial |
$11,705.95
|
| Rate for Payer: First Health Commercial |
$13,398.37
|
| Rate for Payer: Humana Commercial |
$11,988.02
|
| Rate for Payer: Humana KY Medicaid |
$4,850.21
|
| Rate for Payer: Kentucky WC Medicaid |
$4,899.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,564.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,408.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,231.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,947.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,411.12
|
| Rate for Payer: Ohio Health Group HMO |
$10,577.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,282.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,270.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,731.45
|
| Rate for Payer: PHCS Commercial |
$13,539.41
|
| Rate for Payer: United Healthcare All Payer |
$12,411.12
|
|
|
LINER XLPE 20^ 40ID 66-68 J
|
Facility
|
IP
|
$14,103.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,231.06 |
| Max. Negotiated Rate |
$13,539.41 |
| Rate for Payer: Aetna Commercial |
$10,859.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,000.77
|
| Rate for Payer: Cash Price |
$7,051.77
|
| Rate for Payer: Cigna Commercial |
$11,705.95
|
| Rate for Payer: First Health Commercial |
$13,398.37
|
| Rate for Payer: Humana Commercial |
$11,988.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,564.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,408.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,231.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,411.12
|
| Rate for Payer: Ohio Health Group HMO |
$10,577.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,282.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,270.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,731.45
|
| Rate for Payer: PHCS Commercial |
$13,539.41
|
| Rate for Payer: United Healthcare All Payer |
$12,411.12
|
|
|
LINER XLPE 20^ 40ID 66-68 J
|
Facility
|
OP
|
$14,103.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,231.06 |
| Max. Negotiated Rate |
$13,539.41 |
| Rate for Payer: Aetna Commercial |
$10,859.73
|
| Rate for Payer: Anthem Medicaid |
$4,850.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,000.77
|
| Rate for Payer: Cash Price |
$7,051.77
|
| Rate for Payer: Cigna Commercial |
$11,705.95
|
| Rate for Payer: First Health Commercial |
$13,398.37
|
| Rate for Payer: Humana Commercial |
$11,988.02
|
| Rate for Payer: Humana KY Medicaid |
$4,850.21
|
| Rate for Payer: Kentucky WC Medicaid |
$4,899.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,564.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,408.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,231.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,947.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,411.12
|
| Rate for Payer: Ohio Health Group HMO |
$10,577.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,282.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,270.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,731.45
|
| Rate for Payer: PHCS Commercial |
$13,539.41
|
| Rate for Payer: United Healthcare All Payer |
$12,411.12
|
|
|
LINER XLPE 20^ ID 28MMX44MM
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$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 XLPE 20^ ID 28MMX44MM
|
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 XLPE ACET 20^ +4 28X58MM
|
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 XLPE ACET 20^ +4 28X58MM
|
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 XLPE ANT 20^+4 40 58-60G
|
Facility
|
IP
|
$12,898.87
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,869.66 |
| Max. Negotiated Rate |
$12,382.92 |
| Rate for Payer: Aetna Commercial |
$9,932.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,061.12
|
| Rate for Payer: Cash Price |
$6,449.44
|
| Rate for Payer: Cigna Commercial |
$10,706.06
|
| Rate for Payer: First Health Commercial |
$12,253.93
|
| Rate for Payer: Humana Commercial |
$10,964.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,577.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,519.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,869.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,351.01
|
| Rate for Payer: Ohio Health Group HMO |
$9,674.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,319.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,222.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,900.22
|
| Rate for Payer: PHCS Commercial |
$12,382.92
|
| Rate for Payer: United Healthcare All Payer |
$11,351.01
|
|
|
LINER XLPE ANT 20^+4 40 58-60G
|
Facility
|
OP
|
$12,898.87
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,869.66 |
| Max. Negotiated Rate |
$12,382.92 |
| Rate for Payer: Aetna Commercial |
$9,932.13
|
| Rate for Payer: Anthem Medicaid |
$4,435.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,061.12
|
| Rate for Payer: Cash Price |
$6,449.44
|
| Rate for Payer: Cigna Commercial |
$10,706.06
|
| Rate for Payer: First Health Commercial |
$12,253.93
|
| Rate for Payer: Humana Commercial |
$10,964.04
|
| Rate for Payer: Humana KY Medicaid |
$4,435.92
|
| Rate for Payer: Kentucky WC Medicaid |
$4,481.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,577.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,519.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,869.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,524.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,351.01
|
| Rate for Payer: Ohio Health Group HMO |
$9,674.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,319.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,222.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,900.22
|
| Rate for Payer: PHCS Commercial |
$12,382.92
|
| Rate for Payer: United Healthcare All Payer |
$11,351.01
|
|
|
LINER XLPE ANT 20^+4 40 62-64H
|
Facility
|
IP
|
$12,898.87
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,869.66 |
| Max. Negotiated Rate |
$12,382.92 |
| Rate for Payer: Aetna Commercial |
$9,932.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,061.12
|
| Rate for Payer: Cash Price |
$6,449.44
|
| Rate for Payer: Cigna Commercial |
$10,706.06
|
| Rate for Payer: First Health Commercial |
$12,253.93
|
| Rate for Payer: Humana Commercial |
$10,964.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,577.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,519.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,869.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,351.01
|
| Rate for Payer: Ohio Health Group HMO |
$9,674.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,319.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,222.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,900.22
|
| Rate for Payer: PHCS Commercial |
$12,382.92
|
| Rate for Payer: United Healthcare All Payer |
$11,351.01
|
|
|
LINER XLPE ANT 20^+4 40 62-64H
|
Facility
|
OP
|
$12,898.87
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,869.66 |
| Max. Negotiated Rate |
$12,382.92 |
| Rate for Payer: Aetna Commercial |
$9,932.13
|
| Rate for Payer: Anthem Medicaid |
$4,435.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,061.12
|
| Rate for Payer: Cash Price |
$6,449.44
|
| Rate for Payer: Cigna Commercial |
$10,706.06
|
| Rate for Payer: First Health Commercial |
$12,253.93
|
| Rate for Payer: Humana Commercial |
$10,964.04
|
| Rate for Payer: Humana KY Medicaid |
$4,435.92
|
| Rate for Payer: Kentucky WC Medicaid |
$4,481.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,577.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,519.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,869.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,524.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,351.01
|
| Rate for Payer: Ohio Health Group HMO |
$9,674.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,319.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,222.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,900.22
|
| Rate for Payer: PHCS Commercial |
$12,382.92
|
| Rate for Payer: United Healthcare All Payer |
$11,351.01
|
|
|
LINER XLPE ANT20^+6 36ID50-52E
|
Facility
|
IP
|
$12,898.87
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,869.66 |
| Max. Negotiated Rate |
$12,382.92 |
| Rate for Payer: Aetna Commercial |
$9,932.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,061.12
|
| Rate for Payer: Cash Price |
$6,449.44
|
| Rate for Payer: Cigna Commercial |
$10,706.06
|
| Rate for Payer: First Health Commercial |
$12,253.93
|
| Rate for Payer: Humana Commercial |
$10,964.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,577.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,519.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,869.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,351.01
|
| Rate for Payer: Ohio Health Group HMO |
$9,674.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,319.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,222.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,900.22
|
| Rate for Payer: PHCS Commercial |
$12,382.92
|
| Rate for Payer: United Healthcare All Payer |
$11,351.01
|
|
|
LINER XLPE ANT20^+6 36ID50-52E
|
Facility
|
OP
|
$12,898.87
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,869.66 |
| Max. Negotiated Rate |
$12,382.92 |
| Rate for Payer: Aetna Commercial |
$9,932.13
|
| Rate for Payer: Anthem Medicaid |
$4,435.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,061.12
|
| Rate for Payer: Cash Price |
$6,449.44
|
| Rate for Payer: Cigna Commercial |
$10,706.06
|
| Rate for Payer: First Health Commercial |
$12,253.93
|
| Rate for Payer: Humana Commercial |
$10,964.04
|
| Rate for Payer: Humana KY Medicaid |
$4,435.92
|
| Rate for Payer: Kentucky WC Medicaid |
$4,481.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,577.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,519.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,869.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,524.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,351.01
|
| Rate for Payer: Ohio Health Group HMO |
$9,674.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,319.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,222.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,900.22
|
| Rate for Payer: PHCS Commercial |
$12,382.92
|
| Rate for Payer: United Healthcare All Payer |
$11,351.01
|
|
|
LINER XLPE CMT 0^ 36X58MM
|
Facility
|
IP
|
$7,975.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,392.54 |
| Max. Negotiated Rate |
$7,656.12 |
| Rate for Payer: Aetna Commercial |
$6,140.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,220.60
|
| Rate for Payer: Cash Price |
$3,987.57
|
| Rate for Payer: Cigna Commercial |
$6,619.36
|
| Rate for Payer: First Health Commercial |
$7,576.37
|
| Rate for Payer: Humana Commercial |
$6,778.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,539.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,885.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,392.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,018.11
|
| Rate for Payer: Ohio Health Group HMO |
$5,981.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,380.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,938.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,502.84
|
| Rate for Payer: PHCS Commercial |
$7,656.12
|
| Rate for Payer: United Healthcare All Payer |
$7,018.11
|
|
|
LINER XLPE CMT 0^ 36X58MM
|
Facility
|
OP
|
$7,975.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,392.54 |
| Max. Negotiated Rate |
$7,656.12 |
| Rate for Payer: Aetna Commercial |
$6,140.85
|
| Rate for Payer: Anthem Medicaid |
$2,742.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,220.60
|
| Rate for Payer: Cash Price |
$3,987.57
|
| Rate for Payer: Cigna Commercial |
$6,619.36
|
| Rate for Payer: First Health Commercial |
$7,576.37
|
| Rate for Payer: Humana Commercial |
$6,778.86
|
| Rate for Payer: Humana KY Medicaid |
$2,742.65
|
| Rate for Payer: Kentucky WC Medicaid |
$2,770.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,539.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,885.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,392.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,797.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,018.11
|
| Rate for Payer: Ohio Health Group HMO |
$5,981.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,380.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,938.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,502.84
|
| Rate for Payer: PHCS Commercial |
$7,656.12
|
| Rate for Payer: United Healthcare All Payer |
$7,018.11
|
|
|
LINER XLPE CMT 0^ 36X60MM
|
Facility
|
IP
|
$7,975.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,392.54 |
| Max. Negotiated Rate |
$7,656.12 |
| Rate for Payer: Aetna Commercial |
$6,140.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,220.60
|
| Rate for Payer: Cash Price |
$3,987.57
|
| Rate for Payer: Cigna Commercial |
$6,619.36
|
| Rate for Payer: First Health Commercial |
$7,576.37
|
| Rate for Payer: Humana Commercial |
$6,778.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,539.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,885.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,392.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,018.11
|
| Rate for Payer: Ohio Health Group HMO |
$5,981.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,380.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,938.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,502.84
|
| Rate for Payer: PHCS Commercial |
$7,656.12
|
| Rate for Payer: United Healthcare All Payer |
$7,018.11
|
|
|
LINER XLPE CMT 0^ 36X60MM
|
Facility
|
OP
|
$7,975.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,392.54 |
| Max. Negotiated Rate |
$7,656.12 |
| Rate for Payer: Aetna Commercial |
$6,140.85
|
| Rate for Payer: Anthem Medicaid |
$2,742.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,220.60
|
| Rate for Payer: Cash Price |
$3,987.57
|
| Rate for Payer: Cigna Commercial |
$6,619.36
|
| Rate for Payer: First Health Commercial |
$7,576.37
|
| Rate for Payer: Humana Commercial |
$6,778.86
|
| Rate for Payer: Humana KY Medicaid |
$2,742.65
|
| Rate for Payer: Kentucky WC Medicaid |
$2,770.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,539.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,885.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,392.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,797.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,018.11
|
| Rate for Payer: Ohio Health Group HMO |
$5,981.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,380.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,938.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,502.84
|
| Rate for Payer: PHCS Commercial |
$7,656.12
|
| Rate for Payer: United Healthcare All Payer |
$7,018.11
|
|
|
LINER XLPE CMT 0^ 36X62MM
|
Facility
|
IP
|
$7,975.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,392.54 |
| Max. Negotiated Rate |
$7,656.12 |
| Rate for Payer: Aetna Commercial |
$6,140.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,220.60
|
| Rate for Payer: Cash Price |
$3,987.57
|
| Rate for Payer: Cigna Commercial |
$6,619.36
|
| Rate for Payer: First Health Commercial |
$7,576.37
|
| Rate for Payer: Humana Commercial |
$6,778.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,539.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,885.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,392.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,018.11
|
| Rate for Payer: Ohio Health Group HMO |
$5,981.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,380.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,938.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,502.84
|
| Rate for Payer: PHCS Commercial |
$7,656.12
|
| Rate for Payer: United Healthcare All Payer |
$7,018.11
|
|
|
LINER XLPE CMT 0^ 36X62MM
|
Facility
|
OP
|
$7,975.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,392.54 |
| Max. Negotiated Rate |
$7,656.12 |
| Rate for Payer: Aetna Commercial |
$6,140.85
|
| Rate for Payer: Anthem Medicaid |
$2,742.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,220.60
|
| Rate for Payer: Cash Price |
$3,987.57
|
| Rate for Payer: Cigna Commercial |
$6,619.36
|
| Rate for Payer: First Health Commercial |
$7,576.37
|
| Rate for Payer: Humana Commercial |
$6,778.86
|
| Rate for Payer: Humana KY Medicaid |
$2,742.65
|
| Rate for Payer: Kentucky WC Medicaid |
$2,770.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,539.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,885.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,392.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,797.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,018.11
|
| Rate for Payer: Ohio Health Group HMO |
$5,981.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,380.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,938.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,502.84
|
| Rate for Payer: PHCS Commercial |
$7,656.12
|
| Rate for Payer: United Healthcare All Payer |
$7,018.11
|
|
|
LINER XLPE CMT 0^ 36X64MM
|
Facility
|
IP
|
$7,975.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,392.54 |
| Max. Negotiated Rate |
$7,656.12 |
| Rate for Payer: Aetna Commercial |
$6,140.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,220.60
|
| Rate for Payer: Cash Price |
$3,987.57
|
| Rate for Payer: Cigna Commercial |
$6,619.36
|
| Rate for Payer: First Health Commercial |
$7,576.37
|
| Rate for Payer: Humana Commercial |
$6,778.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,539.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,885.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,392.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,018.11
|
| Rate for Payer: Ohio Health Group HMO |
$5,981.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,380.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,938.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,502.84
|
| Rate for Payer: PHCS Commercial |
$7,656.12
|
| Rate for Payer: United Healthcare All Payer |
$7,018.11
|
|
|
LINER XLPE CMT 0^ 36X64MM
|
Facility
|
OP
|
$7,975.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,392.54 |
| Max. Negotiated Rate |
$7,656.12 |
| Rate for Payer: Aetna Commercial |
$6,140.85
|
| Rate for Payer: Anthem Medicaid |
$2,742.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,220.60
|
| Rate for Payer: Cash Price |
$3,987.57
|
| Rate for Payer: Cigna Commercial |
$6,619.36
|
| Rate for Payer: First Health Commercial |
$7,576.37
|
| Rate for Payer: Humana Commercial |
$6,778.86
|
| Rate for Payer: Humana KY Medicaid |
$2,742.65
|
| Rate for Payer: Kentucky WC Medicaid |
$2,770.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,539.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,885.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,392.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,797.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,018.11
|
| Rate for Payer: Ohio Health Group HMO |
$5,981.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,380.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,938.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,502.84
|
| Rate for Payer: PHCS Commercial |
$7,656.12
|
| Rate for Payer: United Healthcare All Payer |
$7,018.11
|
|
|
LINER XLPE CMT 0^ 36X66-68MM
|
Facility
|
IP
|
$7,975.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,392.54 |
| Max. Negotiated Rate |
$7,656.12 |
| Rate for Payer: Aetna Commercial |
$6,140.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,220.60
|
| Rate for Payer: Cash Price |
$3,987.57
|
| Rate for Payer: Cigna Commercial |
$6,619.36
|
| Rate for Payer: First Health Commercial |
$7,576.37
|
| Rate for Payer: Humana Commercial |
$6,778.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,539.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,885.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,392.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,018.11
|
| Rate for Payer: Ohio Health Group HMO |
$5,981.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,380.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,938.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,502.84
|
| Rate for Payer: PHCS Commercial |
$7,656.12
|
| Rate for Payer: United Healthcare All Payer |
$7,018.11
|
|
|
LINER XLPE CMT 0^ 36X66-68MM
|
Facility
|
OP
|
$7,975.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,392.54 |
| Max. Negotiated Rate |
$7,656.12 |
| Rate for Payer: Aetna Commercial |
$6,140.85
|
| Rate for Payer: Anthem Medicaid |
$2,742.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,220.60
|
| Rate for Payer: Cash Price |
$3,987.57
|
| Rate for Payer: Cigna Commercial |
$6,619.36
|
| Rate for Payer: First Health Commercial |
$7,576.37
|
| Rate for Payer: Humana Commercial |
$6,778.86
|
| Rate for Payer: Humana KY Medicaid |
$2,742.65
|
| Rate for Payer: Kentucky WC Medicaid |
$2,770.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,539.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,885.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,392.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,797.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,018.11
|
| Rate for Payer: Ohio Health Group HMO |
$5,981.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,380.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,938.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,502.84
|
| Rate for Payer: PHCS Commercial |
$7,656.12
|
| Rate for Payer: United Healthcare All Payer |
$7,018.11
|
|
|
LINER XLPE CMT 0^ 36X70-74MM
|
Facility
|
IP
|
$7,975.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,392.54 |
| Max. Negotiated Rate |
$7,656.12 |
| Rate for Payer: Aetna Commercial |
$6,140.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,220.60
|
| Rate for Payer: Cash Price |
$3,987.57
|
| Rate for Payer: Cigna Commercial |
$6,619.36
|
| Rate for Payer: First Health Commercial |
$7,576.37
|
| Rate for Payer: Humana Commercial |
$6,778.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,539.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,885.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,392.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,018.11
|
| Rate for Payer: Ohio Health Group HMO |
$5,981.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,380.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,938.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,502.84
|
| Rate for Payer: PHCS Commercial |
$7,656.12
|
| Rate for Payer: United Healthcare All Payer |
$7,018.11
|
|
|
LINER XLPE CMT 0^ 36X70-74MM
|
Facility
|
OP
|
$7,975.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,392.54 |
| Max. Negotiated Rate |
$7,656.12 |
| Rate for Payer: Aetna Commercial |
$6,140.85
|
| Rate for Payer: Anthem Medicaid |
$2,742.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,220.60
|
| Rate for Payer: Cash Price |
$3,987.57
|
| Rate for Payer: Cigna Commercial |
$6,619.36
|
| Rate for Payer: First Health Commercial |
$7,576.37
|
| Rate for Payer: Humana Commercial |
$6,778.86
|
| Rate for Payer: Humana KY Medicaid |
$2,742.65
|
| Rate for Payer: Kentucky WC Medicaid |
$2,770.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,539.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,885.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,392.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,797.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,018.11
|
| Rate for Payer: Ohio Health Group HMO |
$5,981.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,380.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,938.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,502.84
|
| Rate for Payer: PHCS Commercial |
$7,656.12
|
| Rate for Payer: United Healthcare All Payer |
$7,018.11
|
|
