|
LINER XLPE CMT 0^ 36X76-80MM
|
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^ 36X76-80MM
|
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^ 40X60MM
|
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^ 40X60MM
|
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^ 40X62MM
|
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^ 40X62MM
|
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^ 40X64MM
|
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^ 40X64MM
|
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^ 40X66-68MM
|
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^ 40X66-68MM
|
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^ 40X70-74MM
|
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
|
|
|
LINER XLPE CMT 0^ 40X70-74MM
|
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^ 40X76-80MM
|
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^ 40X76-80MM
|
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 DEG 28X48MM
|
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 DEG 28X48MM
|
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 DEG 28X50MM
|
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 DEG 28X50MM
|
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 DEG 28X54MM
|
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 DEG 28X54MM
|
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 DEG 32X52MM
|
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 DEG 32X52MM
|
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 DEG 32X54MM
|
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 DEG 32X54MM
|
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 DEG 32X56MM
|
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: Aetna Commercial |
$6,469.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,220.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,553.56
|
| Rate for Payer: Cash Price |
$3,987.57
|
| Rate for Payer: Cash Price |
$4,201.00
|
| Rate for Payer: Cigna Commercial |
$6,619.36
|
| Rate for Payer: Cigna Commercial |
$6,973.66
|
| Rate for Payer: First Health Commercial |
$7,981.90
|
| Rate for Payer: First Health Commercial |
$7,576.37
|
| Rate for Payer: Humana Commercial |
$7,141.70
|
| 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 HMO |
$6,889.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,885.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,200.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,520.60
|
| 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 Choice Commercial |
$7,393.76
|
| Rate for Payer: Ohio Health Group HMO |
$5,981.35
|
| Rate for Payer: Ohio Health Group HMO |
$6,301.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,380.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,721.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,938.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,309.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,797.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,502.84
|
| Rate for Payer: PHCS Commercial |
$7,656.12
|
| Rate for Payer: PHCS Commercial |
$8,065.92
|
| Rate for Payer: United Healthcare All Payer |
$7,018.11
|
| Rate for Payer: United Healthcare All Payer |
$7,393.76
|
|
