|
TM REVERSE DUAL TPR INSERT
|
Facility
|
IP
|
$5,218.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$678.39 |
| Max. Negotiated Rate |
$5,009.66 |
| Rate for Payer: Aetna Commercial |
$4,018.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,070.35
|
| Rate for Payer: Cash Price |
$2,609.20
|
| Rate for Payer: Cigna Commercial |
$4,331.27
|
| Rate for Payer: First Health Commercial |
$4,957.48
|
| Rate for Payer: Humana Commercial |
$4,435.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,279.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,851.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,565.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,592.19
|
| Rate for Payer: Ohio Health Group HMO |
$3,913.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,043.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$678.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,617.70
|
| Rate for Payer: PHCS Commercial |
$5,009.66
|
| Rate for Payer: United Healthcare All Payer |
$4,592.19
|
|
|
TM REVERSE STEM 10MM*130MM
|
Facility
|
IP
|
$32,744.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,256.77 |
| Max. Negotiated Rate |
$31,434.62 |
| Rate for Payer: Aetna Commercial |
$25,213.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,540.63
|
| Rate for Payer: Cash Price |
$16,372.20
|
| Rate for Payer: Cigna Commercial |
$27,177.85
|
| Rate for Payer: First Health Commercial |
$31,107.18
|
| Rate for Payer: Humana Commercial |
$27,832.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,850.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,165.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,823.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,815.07
|
| Rate for Payer: Ohio Health Group HMO |
$24,558.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,548.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,256.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,150.76
|
| Rate for Payer: PHCS Commercial |
$31,434.62
|
| Rate for Payer: United Healthcare All Payer |
$28,815.07
|
|
|
TM REVERSE STEM 10MM*130MM
|
Facility
|
OP
|
$32,744.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,256.77 |
| Max. Negotiated Rate |
$31,434.62 |
| Rate for Payer: Aetna Commercial |
$25,213.19
|
| Rate for Payer: Anthem Medicaid |
$11,260.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,540.63
|
| Rate for Payer: Cash Price |
$16,372.20
|
| Rate for Payer: Cigna Commercial |
$27,177.85
|
| Rate for Payer: First Health Commercial |
$31,107.18
|
| Rate for Payer: Humana Commercial |
$27,832.74
|
| Rate for Payer: Humana KY Medicaid |
$11,260.80
|
| Rate for Payer: Kentucky WC Medicaid |
$11,375.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,850.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,165.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,823.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,486.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,815.07
|
| Rate for Payer: Ohio Health Group HMO |
$24,558.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,548.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,256.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,150.76
|
| Rate for Payer: PHCS Commercial |
$31,434.62
|
| Rate for Payer: United Healthcare All Payer |
$28,815.07
|
|
|
TM REVERSE STEM 10MM*170MM
|
Facility
|
OP
|
$32,744.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,256.77 |
| Max. Negotiated Rate |
$31,434.62 |
| Rate for Payer: Aetna Commercial |
$25,213.19
|
| Rate for Payer: Anthem Medicaid |
$11,260.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,540.63
|
| Rate for Payer: Cash Price |
$16,372.20
|
| Rate for Payer: Cigna Commercial |
$27,177.85
|
| Rate for Payer: First Health Commercial |
$31,107.18
|
| Rate for Payer: Humana Commercial |
$27,832.74
|
| Rate for Payer: Humana KY Medicaid |
$11,260.80
|
| Rate for Payer: Kentucky WC Medicaid |
$11,375.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,850.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,165.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,823.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,486.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,815.07
|
| Rate for Payer: Ohio Health Group HMO |
$24,558.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,548.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,256.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,150.76
|
| Rate for Payer: PHCS Commercial |
$31,434.62
|
| Rate for Payer: United Healthcare All Payer |
$28,815.07
|
|
|
TM REVERSE STEM 10MM*170MM
|
Facility
|
IP
|
$32,744.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,256.77 |
| Max. Negotiated Rate |
$31,434.62 |
| Rate for Payer: Aetna Commercial |
$25,213.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,540.63
|
| Rate for Payer: Cash Price |
$16,372.20
|
| Rate for Payer: Cigna Commercial |
$27,177.85
|
| Rate for Payer: First Health Commercial |
$31,107.18
|
| Rate for Payer: Humana Commercial |
$27,832.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,850.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,165.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,823.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,815.07
|
| Rate for Payer: Ohio Health Group HMO |
$24,558.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,548.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,256.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,150.76
|
| Rate for Payer: PHCS Commercial |
$31,434.62
|
| Rate for Payer: United Healthcare All Payer |
$28,815.07
|
|
|
TM REVERSE STEM 12MM*170MM
|
Facility
|
OP
|
$32,744.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,256.77 |
| Max. Negotiated Rate |
$31,434.62 |
| Rate for Payer: Aetna Commercial |
$25,213.19
|
| Rate for Payer: Anthem Medicaid |
$11,260.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,540.63
|
| Rate for Payer: Cash Price |
$16,372.20
|
| Rate for Payer: Cigna Commercial |
$27,177.85
|
| Rate for Payer: First Health Commercial |
$31,107.18
|
| Rate for Payer: Humana Commercial |
$27,832.74
|
| Rate for Payer: Humana KY Medicaid |
$11,260.80
|
| Rate for Payer: Kentucky WC Medicaid |
$11,375.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,850.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,165.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,823.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,486.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,815.07
|
| Rate for Payer: Ohio Health Group HMO |
$24,558.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,548.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,256.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,150.76
|
| Rate for Payer: PHCS Commercial |
$31,434.62
|
| Rate for Payer: United Healthcare All Payer |
$28,815.07
|
|
|
TM REVERSE STEM 12MM*170MM
|
Facility
|
IP
|
$32,744.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,256.77 |
| Max. Negotiated Rate |
$31,434.62 |
| Rate for Payer: Aetna Commercial |
$25,213.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,540.63
|
| Rate for Payer: Cash Price |
$16,372.20
|
| Rate for Payer: Cigna Commercial |
$27,177.85
|
| Rate for Payer: First Health Commercial |
$31,107.18
|
| Rate for Payer: Humana Commercial |
$27,832.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,850.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,165.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,823.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,815.07
|
| Rate for Payer: Ohio Health Group HMO |
$24,558.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,548.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,256.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,150.76
|
| Rate for Payer: PHCS Commercial |
$31,434.62
|
| Rate for Payer: United Healthcare All Payer |
$28,815.07
|
|
|
TM REVERSE STEM 14MM*130MM
|
Facility
|
IP
|
$32,744.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,256.77 |
| Max. Negotiated Rate |
$31,434.62 |
| Rate for Payer: Aetna Commercial |
$25,213.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,540.63
|
| Rate for Payer: Cash Price |
$16,372.20
|
| Rate for Payer: Cigna Commercial |
$27,177.85
|
| Rate for Payer: First Health Commercial |
$31,107.18
|
| Rate for Payer: Humana Commercial |
$27,832.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,850.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,165.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,823.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,815.07
|
| Rate for Payer: Ohio Health Group HMO |
$24,558.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,548.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,256.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,150.76
|
| Rate for Payer: PHCS Commercial |
$31,434.62
|
| Rate for Payer: United Healthcare All Payer |
$28,815.07
|
|
|
TM REVERSE STEM 14MM*130MM
|
Facility
|
OP
|
$32,744.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,256.77 |
| Max. Negotiated Rate |
$31,434.62 |
| Rate for Payer: Aetna Commercial |
$25,213.19
|
| Rate for Payer: Anthem Medicaid |
$11,260.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,540.63
|
| Rate for Payer: Cash Price |
$16,372.20
|
| Rate for Payer: Cigna Commercial |
$27,177.85
|
| Rate for Payer: First Health Commercial |
$31,107.18
|
| Rate for Payer: Humana Commercial |
$27,832.74
|
| Rate for Payer: Humana KY Medicaid |
$11,260.80
|
| Rate for Payer: Kentucky WC Medicaid |
$11,375.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,850.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,165.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,823.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,486.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,815.07
|
| Rate for Payer: Ohio Health Group HMO |
$24,558.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,548.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,256.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,150.76
|
| Rate for Payer: PHCS Commercial |
$31,434.62
|
| Rate for Payer: United Healthcare All Payer |
$28,815.07
|
|
|
TM REVERSE STEM 8MM*130MM
|
Facility
|
IP
|
$32,744.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,256.77 |
| Max. Negotiated Rate |
$31,434.62 |
| Rate for Payer: Aetna Commercial |
$25,213.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,540.63
|
| Rate for Payer: Cash Price |
$16,372.20
|
| Rate for Payer: Cigna Commercial |
$27,177.85
|
| Rate for Payer: First Health Commercial |
$31,107.18
|
| Rate for Payer: Humana Commercial |
$27,832.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,850.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,165.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,823.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,815.07
|
| Rate for Payer: Ohio Health Group HMO |
$24,558.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,548.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,256.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,150.76
|
| Rate for Payer: PHCS Commercial |
$31,434.62
|
| Rate for Payer: United Healthcare All Payer |
$28,815.07
|
|
|
TM REVERSE STEM 8MM*130MM
|
Facility
|
OP
|
$32,744.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,256.77 |
| Max. Negotiated Rate |
$31,434.62 |
| Rate for Payer: Aetna Commercial |
$25,213.19
|
| Rate for Payer: Anthem Medicaid |
$11,260.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,540.63
|
| Rate for Payer: Cash Price |
$16,372.20
|
| Rate for Payer: Cigna Commercial |
$27,177.85
|
| Rate for Payer: First Health Commercial |
$31,107.18
|
| Rate for Payer: Humana Commercial |
$27,832.74
|
| Rate for Payer: Humana KY Medicaid |
$11,260.80
|
| Rate for Payer: Kentucky WC Medicaid |
$11,375.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,850.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,165.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,823.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,486.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,815.07
|
| Rate for Payer: Ohio Health Group HMO |
$24,558.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,548.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,256.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,150.76
|
| Rate for Payer: PHCS Commercial |
$31,434.62
|
| Rate for Payer: United Healthcare All Payer |
$28,815.07
|
|
|
TM REVERSE STEM 8MM*170MM
|
Facility
|
IP
|
$32,744.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,256.77 |
| Max. Negotiated Rate |
$31,434.62 |
| Rate for Payer: Aetna Commercial |
$25,213.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,540.63
|
| Rate for Payer: Cash Price |
$16,372.20
|
| Rate for Payer: Cigna Commercial |
$27,177.85
|
| Rate for Payer: First Health Commercial |
$31,107.18
|
| Rate for Payer: Humana Commercial |
$27,832.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,850.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,165.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,823.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,815.07
|
| Rate for Payer: Ohio Health Group HMO |
$24,558.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,548.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,256.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,150.76
|
| Rate for Payer: PHCS Commercial |
$31,434.62
|
| Rate for Payer: United Healthcare All Payer |
$28,815.07
|
|
|
TM REVERSE STEM 8MM*170MM
|
Facility
|
OP
|
$32,744.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,256.77 |
| Max. Negotiated Rate |
$31,434.62 |
| Rate for Payer: Aetna Commercial |
$25,213.19
|
| Rate for Payer: Anthem Medicaid |
$11,260.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,540.63
|
| Rate for Payer: Cash Price |
$16,372.20
|
| Rate for Payer: Cigna Commercial |
$27,177.85
|
| Rate for Payer: First Health Commercial |
$31,107.18
|
| Rate for Payer: Humana Commercial |
$27,832.74
|
| Rate for Payer: Humana KY Medicaid |
$11,260.80
|
| Rate for Payer: Kentucky WC Medicaid |
$11,375.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,850.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,165.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,823.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,486.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,815.07
|
| Rate for Payer: Ohio Health Group HMO |
$24,558.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,548.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,256.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,150.76
|
| Rate for Payer: PHCS Commercial |
$31,434.62
|
| Rate for Payer: United Healthcare All Payer |
$28,815.07
|
|
|
TM REVRSE 36MM POLY LINER +0MM
|
Facility
|
IP
|
$5,637.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$732.82 |
| Max. Negotiated Rate |
$5,411.59 |
| Rate for Payer: Aetna Commercial |
$4,340.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,396.91
|
| Rate for Payer: Cash Price |
$2,818.53
|
| Rate for Payer: Cigna Commercial |
$4,678.77
|
| Rate for Payer: First Health Commercial |
$5,355.22
|
| Rate for Payer: Humana Commercial |
$4,791.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,622.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,160.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,691.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,960.62
|
| Rate for Payer: Ohio Health Group HMO |
$4,227.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,127.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,747.49
|
| Rate for Payer: PHCS Commercial |
$5,411.59
|
| Rate for Payer: United Healthcare All Payer |
$4,960.62
|
|
|
TM REVRSE 36MM POLY LINER +0MM
|
Facility
|
OP
|
$5,637.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$732.82 |
| Max. Negotiated Rate |
$5,411.59 |
| Rate for Payer: Aetna Commercial |
$4,340.54
|
| Rate for Payer: Anthem Medicaid |
$1,938.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,396.91
|
| Rate for Payer: Cash Price |
$2,818.53
|
| Rate for Payer: Cigna Commercial |
$4,678.77
|
| Rate for Payer: First Health Commercial |
$5,355.22
|
| Rate for Payer: Humana Commercial |
$4,791.51
|
| Rate for Payer: Humana KY Medicaid |
$1,938.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,958.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,622.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,160.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,691.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,977.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,960.62
|
| Rate for Payer: Ohio Health Group HMO |
$4,227.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,127.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,747.49
|
| Rate for Payer: PHCS Commercial |
$5,411.59
|
| Rate for Payer: United Healthcare All Payer |
$4,960.62
|
|
|
TM RVRSE 2.5MM PIN REV 2.5 PIN
|
Facility
|
IP
|
$1,962.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.12 |
| Max. Negotiated Rate |
$1,884.00 |
| Rate for Payer: Aetna Commercial |
$1,511.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,530.75
|
| Rate for Payer: Cash Price |
$981.25
|
| Rate for Payer: Cigna Commercial |
$1,628.88
|
| Rate for Payer: First Health Commercial |
$1,864.38
|
| Rate for Payer: Humana Commercial |
$1,668.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,609.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,448.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,727.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,471.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$392.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$608.38
|
| Rate for Payer: PHCS Commercial |
$1,884.00
|
| Rate for Payer: United Healthcare All Payer |
$1,727.00
|
|
|
TM RVRSE 2.5MM PIN REV 2.5 PIN
|
Facility
|
OP
|
$1,962.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.12 |
| Max. Negotiated Rate |
$1,884.00 |
| Rate for Payer: Aetna Commercial |
$1,511.12
|
| Rate for Payer: Anthem Medicaid |
$674.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,530.75
|
| Rate for Payer: Cash Price |
$981.25
|
| Rate for Payer: Cigna Commercial |
$1,628.88
|
| Rate for Payer: First Health Commercial |
$1,864.38
|
| Rate for Payer: Humana Commercial |
$1,668.12
|
| Rate for Payer: Humana KY Medicaid |
$674.90
|
| Rate for Payer: Kentucky WC Medicaid |
$681.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,609.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,448.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$688.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,727.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,471.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$392.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$608.38
|
| Rate for Payer: PHCS Commercial |
$1,884.00
|
| Rate for Payer: United Healthcare All Payer |
$1,727.00
|
|
|
TM RVRSE 36MM POLY LINER +3MM
|
Facility
|
OP
|
$5,637.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$732.82 |
| Max. Negotiated Rate |
$5,411.59 |
| Rate for Payer: Aetna Commercial |
$4,340.54
|
| Rate for Payer: Anthem Medicaid |
$1,938.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,396.91
|
| Rate for Payer: Cash Price |
$2,818.53
|
| Rate for Payer: Cigna Commercial |
$4,678.77
|
| Rate for Payer: First Health Commercial |
$5,355.22
|
| Rate for Payer: Humana Commercial |
$4,791.51
|
| Rate for Payer: Humana KY Medicaid |
$1,938.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,958.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,622.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,160.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,691.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,977.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,960.62
|
| Rate for Payer: Ohio Health Group HMO |
$4,227.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,127.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,747.49
|
| Rate for Payer: PHCS Commercial |
$5,411.59
|
| Rate for Payer: United Healthcare All Payer |
$4,960.62
|
|
|
TM RVRSE 36MM POLY LINER +3MM
|
Facility
|
IP
|
$5,637.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$732.82 |
| Max. Negotiated Rate |
$5,411.59 |
| Rate for Payer: Aetna Commercial |
$4,340.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,396.91
|
| Rate for Payer: Cash Price |
$2,818.53
|
| Rate for Payer: Cigna Commercial |
$4,678.77
|
| Rate for Payer: First Health Commercial |
$5,355.22
|
| Rate for Payer: Humana Commercial |
$4,791.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,622.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,160.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,691.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,960.62
|
| Rate for Payer: Ohio Health Group HMO |
$4,227.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,127.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,747.49
|
| Rate for Payer: PHCS Commercial |
$5,411.59
|
| Rate for Payer: United Healthcare All Payer |
$4,960.62
|
|
|
TM RVRSE 36MM POLY LINER +6MM
|
Facility
|
IP
|
$5,637.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$732.82 |
| Max. Negotiated Rate |
$5,411.59 |
| Rate for Payer: Aetna Commercial |
$4,340.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,396.91
|
| Rate for Payer: Cash Price |
$2,818.53
|
| Rate for Payer: Cigna Commercial |
$4,678.77
|
| Rate for Payer: First Health Commercial |
$5,355.22
|
| Rate for Payer: Humana Commercial |
$4,791.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,622.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,160.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,691.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,960.62
|
| Rate for Payer: Ohio Health Group HMO |
$4,227.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,127.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,747.49
|
| Rate for Payer: PHCS Commercial |
$5,411.59
|
| Rate for Payer: United Healthcare All Payer |
$4,960.62
|
|
|
TM RVRSE 36MM POLY LINER +6MM
|
Facility
|
OP
|
$5,637.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$732.82 |
| Max. Negotiated Rate |
$5,411.59 |
| Rate for Payer: Aetna Commercial |
$4,340.54
|
| Rate for Payer: Anthem Medicaid |
$1,938.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,396.91
|
| Rate for Payer: Cash Price |
$2,818.53
|
| Rate for Payer: Cigna Commercial |
$4,678.77
|
| Rate for Payer: First Health Commercial |
$5,355.22
|
| Rate for Payer: Humana Commercial |
$4,791.51
|
| Rate for Payer: Humana KY Medicaid |
$1,938.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,958.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,622.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,160.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,691.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,977.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,960.62
|
| Rate for Payer: Ohio Health Group HMO |
$4,227.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,127.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,747.49
|
| Rate for Payer: PHCS Commercial |
$5,411.59
|
| Rate for Payer: United Healthcare All Payer |
$4,960.62
|
|
|
TM RVRSE 40MM POLY LINER +0MM
|
Facility
|
IP
|
$5,637.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$732.82 |
| Max. Negotiated Rate |
$5,411.59 |
| Rate for Payer: Aetna Commercial |
$4,340.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,396.91
|
| Rate for Payer: Cash Price |
$2,818.53
|
| Rate for Payer: Cigna Commercial |
$4,678.77
|
| Rate for Payer: First Health Commercial |
$5,355.22
|
| Rate for Payer: Humana Commercial |
$4,791.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,622.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,160.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,691.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,960.62
|
| Rate for Payer: Ohio Health Group HMO |
$4,227.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,127.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,747.49
|
| Rate for Payer: PHCS Commercial |
$5,411.59
|
| Rate for Payer: United Healthcare All Payer |
$4,960.62
|
|
|
TM RVRSE 40MM POLY LINER +0MM
|
Facility
|
OP
|
$5,637.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$732.82 |
| Max. Negotiated Rate |
$5,411.59 |
| Rate for Payer: Aetna Commercial |
$4,340.54
|
| Rate for Payer: Anthem Medicaid |
$1,938.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,396.91
|
| Rate for Payer: Cash Price |
$2,818.53
|
| Rate for Payer: Cigna Commercial |
$4,678.77
|
| Rate for Payer: First Health Commercial |
$5,355.22
|
| Rate for Payer: Humana Commercial |
$4,791.51
|
| Rate for Payer: Humana KY Medicaid |
$1,938.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,958.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,622.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,160.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,691.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,977.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,960.62
|
| Rate for Payer: Ohio Health Group HMO |
$4,227.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,127.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,747.49
|
| Rate for Payer: PHCS Commercial |
$5,411.59
|
| Rate for Payer: United Healthcare All Payer |
$4,960.62
|
|
|
TM RVRSE 40MM POLY LINER +3MM
|
Facility
|
IP
|
$5,637.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$732.82 |
| Max. Negotiated Rate |
$5,411.59 |
| Rate for Payer: Aetna Commercial |
$4,340.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,396.91
|
| Rate for Payer: Cash Price |
$2,818.53
|
| Rate for Payer: Cigna Commercial |
$4,678.77
|
| Rate for Payer: First Health Commercial |
$5,355.22
|
| Rate for Payer: Humana Commercial |
$4,791.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,622.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,160.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,691.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,960.62
|
| Rate for Payer: Ohio Health Group HMO |
$4,227.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,127.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,747.49
|
| Rate for Payer: PHCS Commercial |
$5,411.59
|
| Rate for Payer: United Healthcare All Payer |
$4,960.62
|
|
|
TM RVRSE 40MM POLY LINER +3MM
|
Facility
|
OP
|
$5,637.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$732.82 |
| Max. Negotiated Rate |
$5,411.59 |
| Rate for Payer: Aetna Commercial |
$4,340.54
|
| Rate for Payer: Anthem Medicaid |
$1,938.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,396.91
|
| Rate for Payer: Cash Price |
$2,818.53
|
| Rate for Payer: Cigna Commercial |
$4,678.77
|
| Rate for Payer: First Health Commercial |
$5,355.22
|
| Rate for Payer: Humana Commercial |
$4,791.51
|
| Rate for Payer: Humana KY Medicaid |
$1,938.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,958.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,622.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,160.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,691.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,977.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,960.62
|
| Rate for Payer: Ohio Health Group HMO |
$4,227.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,127.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,747.49
|
| Rate for Payer: PHCS Commercial |
$5,411.59
|
| Rate for Payer: United Healthcare All Payer |
$4,960.62
|
|
