|
LINR ARCOMXL G7 HI-WALL 32MM F
|
Facility
|
OP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem Medicaid |
$2,537.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Humana KY Medicaid |
$2,537.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,563.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,588.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
|
LINR ARCOMXL G7 HI-WALL 32MM F
|
Facility
|
IP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
|
LINR ARCOMXL G7 HI-WALL 32MM G
|
Facility
|
OP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem Medicaid |
$2,537.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Humana KY Medicaid |
$2,537.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,563.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,588.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
|
LINR ARCOMXL G7 HI-WALL 32MM G
|
Facility
|
IP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
|
LINR BIOLOX CER ACE R3 36M 56M
|
Facility
|
OP
|
$11,610.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,483.21 |
| Max. Negotiated Rate |
$11,146.27 |
| Rate for Payer: Aetna Commercial |
$8,940.24
|
| Rate for Payer: Anthem Medicaid |
$3,992.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,056.35
|
| Rate for Payer: Cash Price |
$5,805.35
|
| Rate for Payer: Cigna Commercial |
$9,636.88
|
| Rate for Payer: First Health Commercial |
$11,030.17
|
| Rate for Payer: Humana Commercial |
$9,869.09
|
| Rate for Payer: Humana KY Medicaid |
$3,992.92
|
| Rate for Payer: Kentucky WC Medicaid |
$4,033.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,520.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,568.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,483.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,073.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,217.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,708.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,288.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,101.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,011.38
|
| Rate for Payer: PHCS Commercial |
$11,146.27
|
| Rate for Payer: United Healthcare All Payer |
$10,217.42
|
|
|
LINR BIOLOX CER ACE R3 36M 56M
|
Facility
|
IP
|
$11,610.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,483.21 |
| Max. Negotiated Rate |
$11,146.27 |
| Rate for Payer: Aetna Commercial |
$8,940.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,056.35
|
| Rate for Payer: Cash Price |
$5,805.35
|
| Rate for Payer: Cigna Commercial |
$9,636.88
|
| Rate for Payer: First Health Commercial |
$11,030.17
|
| Rate for Payer: Humana Commercial |
$9,869.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,520.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,568.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,483.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,217.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,708.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,288.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,101.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,011.38
|
| Rate for Payer: PHCS Commercial |
$11,146.27
|
| Rate for Payer: United Healthcare All Payer |
$10,217.42
|
|
|
LINR BIOLOX CER ACE R3 36M 58M
|
Facility
|
IP
|
$11,610.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,483.21 |
| Max. Negotiated Rate |
$11,146.27 |
| Rate for Payer: Aetna Commercial |
$8,940.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,056.35
|
| Rate for Payer: Cash Price |
$5,805.35
|
| Rate for Payer: Cigna Commercial |
$9,636.88
|
| Rate for Payer: First Health Commercial |
$11,030.17
|
| Rate for Payer: Humana Commercial |
$9,869.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,520.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,568.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,483.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,217.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,708.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,288.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,101.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,011.38
|
| Rate for Payer: PHCS Commercial |
$11,146.27
|
| Rate for Payer: United Healthcare All Payer |
$10,217.42
|
|
|
LINR BIOLOX CER ACE R3 36M 58M
|
Facility
|
OP
|
$11,610.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,483.21 |
| Max. Negotiated Rate |
$11,146.27 |
| Rate for Payer: Aetna Commercial |
$8,940.24
|
| Rate for Payer: Anthem Medicaid |
$3,992.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,056.35
|
| Rate for Payer: Cash Price |
$5,805.35
|
| Rate for Payer: Cigna Commercial |
$9,636.88
|
| Rate for Payer: First Health Commercial |
$11,030.17
|
| Rate for Payer: Humana Commercial |
$9,869.09
|
| Rate for Payer: Humana KY Medicaid |
$3,992.92
|
| Rate for Payer: Kentucky WC Medicaid |
$4,033.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,520.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,568.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,483.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,073.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,217.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,708.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,288.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,101.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,011.38
|
| Rate for Payer: PHCS Commercial |
$11,146.27
|
| Rate for Payer: United Healthcare All Payer |
$10,217.42
|
|
|
LINR LGVITY CONSTRAINED JJI 28
|
Facility
|
IP
|
$18,104.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,431.49 |
| Max. Negotiated Rate |
$17,380.78 |
| Rate for Payer: Aetna Commercial |
$13,940.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,121.88
|
| Rate for Payer: Cash Price |
$9,052.49
|
| Rate for Payer: Cigna Commercial |
$15,027.13
|
| Rate for Payer: First Health Commercial |
$17,199.73
|
| Rate for Payer: Humana Commercial |
$15,389.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,846.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,361.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,431.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,932.38
|
| Rate for Payer: Ohio Health Group HMO |
$13,578.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,483.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,751.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,492.44
|
| Rate for Payer: PHCS Commercial |
$17,380.78
|
| Rate for Payer: United Healthcare All Payer |
$15,932.38
|
|
|
LINR LGVITY CONSTRAINED JJI 28
|
Facility
|
OP
|
$18,104.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,431.49 |
| Max. Negotiated Rate |
$17,380.78 |
| Rate for Payer: Aetna Commercial |
$13,940.83
|
| Rate for Payer: Anthem Medicaid |
$6,226.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,121.88
|
| Rate for Payer: Cash Price |
$9,052.49
|
| Rate for Payer: Cigna Commercial |
$15,027.13
|
| Rate for Payer: First Health Commercial |
$17,199.73
|
| Rate for Payer: Humana Commercial |
$15,389.23
|
| Rate for Payer: Humana KY Medicaid |
$6,226.30
|
| Rate for Payer: Kentucky WC Medicaid |
$6,289.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,846.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,361.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,431.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,351.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,932.38
|
| Rate for Payer: Ohio Health Group HMO |
$13,578.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,483.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,751.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,492.44
|
| Rate for Payer: PHCS Commercial |
$17,380.78
|
| Rate for Payer: United Healthcare All Payer |
$15,932.38
|
|
|
LINR NEU ANG+4 50MM OD 32MM ID
|
Facility
|
OP
|
$11,133.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,340.08 |
| Max. Negotiated Rate |
$10,688.26 |
| Rate for Payer: Aetna Commercial |
$8,572.87
|
| Rate for Payer: Anthem Medicaid |
$3,828.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,684.21
|
| Rate for Payer: Cash Price |
$5,566.80
|
| Rate for Payer: Cigna Commercial |
$9,240.89
|
| Rate for Payer: First Health Commercial |
$10,576.92
|
| Rate for Payer: Humana Commercial |
$9,463.56
|
| Rate for Payer: Humana KY Medicaid |
$3,828.85
|
| Rate for Payer: Kentucky WC Medicaid |
$3,867.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,129.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,216.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,340.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,905.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,797.57
|
| Rate for Payer: Ohio Health Group HMO |
$8,350.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,906.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,686.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,682.18
|
| Rate for Payer: PHCS Commercial |
$10,688.26
|
| Rate for Payer: United Healthcare All Payer |
$9,797.57
|
|
|
LINR NEU ANG+4 50MM OD 32MM ID
|
Facility
|
IP
|
$11,133.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,340.08 |
| Max. Negotiated Rate |
$10,688.26 |
| Rate for Payer: Aetna Commercial |
$8,572.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,684.21
|
| Rate for Payer: Cash Price |
$5,566.80
|
| Rate for Payer: Cigna Commercial |
$9,240.89
|
| Rate for Payer: First Health Commercial |
$10,576.92
|
| Rate for Payer: Humana Commercial |
$9,463.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,129.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,216.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,340.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,797.57
|
| Rate for Payer: Ohio Health Group HMO |
$8,350.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,906.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,686.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,682.18
|
| Rate for Payer: PHCS Commercial |
$10,688.26
|
| Rate for Payer: United Healthcare All Payer |
$9,797.57
|
|
|
LINR NEU ANG+4 54MM OD 36MM ID
|
Facility
|
IP
|
$8,604.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,581.26 |
| Max. Negotiated Rate |
$8,260.04 |
| Rate for Payer: Aetna Commercial |
$6,625.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,711.28
|
| Rate for Payer: Cash Price |
$4,302.10
|
| Rate for Payer: Cigna Commercial |
$7,141.49
|
| Rate for Payer: First Health Commercial |
$8,174.00
|
| Rate for Payer: Humana Commercial |
$7,313.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,055.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,349.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,581.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,571.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,453.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,883.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,485.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,936.90
|
| Rate for Payer: PHCS Commercial |
$8,260.04
|
| Rate for Payer: United Healthcare All Payer |
$7,571.70
|
|
|
LINR NEU ANG+4 54MM OD 36MM ID
|
Facility
|
OP
|
$8,604.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,581.26 |
| Max. Negotiated Rate |
$8,260.04 |
| Rate for Payer: Aetna Commercial |
$6,625.24
|
| Rate for Payer: Anthem Medicaid |
$2,958.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,711.28
|
| Rate for Payer: Cash Price |
$4,302.10
|
| Rate for Payer: Cigna Commercial |
$7,141.49
|
| Rate for Payer: First Health Commercial |
$8,174.00
|
| Rate for Payer: Humana Commercial |
$7,313.58
|
| Rate for Payer: Humana KY Medicaid |
$2,958.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,989.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,055.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,349.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,581.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,018.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,571.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,453.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,883.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,485.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,936.90
|
| Rate for Payer: PHCS Commercial |
$8,260.04
|
| Rate for Payer: United Healthcare All Payer |
$7,571.70
|
|
|
LINR R3 0^+4 XLPE ACE 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
|
|
|
LINR R3 0^+4 XLPE ACE 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
|
|
|
LINR R3 0^+4 XLPE ACE 40*72-74
|
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
|
|
|
LINR R3 0^+4 XLPE ACE 40*72-74
|
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
|
|
|
LINR R3 0^+4 XLPE ACE 44*66-70
|
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
|
|
|
LINR R3 0^+4 XLPE ACE 44*66-70
|
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
|
|
|
LINR R3 0^+4 XLPE ACE 44*72-74
|
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
|
|
|
LINR R3 0^+4 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
|
|
|
LINR R3 0^+4 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
|
|
|
LINR R3 0^+4 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
|
|
|
LINR TMREV 10^OBL 28*66/68/70
|
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
|
|
