|
CONTR ACE RECN RNG 68OD 64ID L
|
Facility
|
IP
|
$12,529.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,758.74 |
| Max. Negotiated Rate |
$12,027.96 |
| Rate for Payer: Aetna Commercial |
$9,647.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,772.71
|
| Rate for Payer: Cash Price |
$6,264.56
|
| Rate for Payer: Cigna Commercial |
$10,399.17
|
| Rate for Payer: First Health Commercial |
$11,902.66
|
| Rate for Payer: Humana Commercial |
$10,649.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,758.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,025.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,396.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,023.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,900.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,645.09
|
| Rate for Payer: PHCS Commercial |
$12,027.96
|
| Rate for Payer: United Healthcare All Payer |
$11,025.63
|
|
|
CONTR ACE RECN RNG 68OD 64ID R
|
Facility
|
OP
|
$12,529.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,758.74 |
| Max. Negotiated Rate |
$12,027.96 |
| Rate for Payer: Aetna Commercial |
$9,647.42
|
| Rate for Payer: Anthem Medicaid |
$4,308.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,772.71
|
| Rate for Payer: Cash Price |
$6,264.56
|
| Rate for Payer: Cigna Commercial |
$10,399.17
|
| Rate for Payer: First Health Commercial |
$11,902.66
|
| Rate for Payer: Humana Commercial |
$10,649.75
|
| Rate for Payer: Humana KY Medicaid |
$4,308.76
|
| Rate for Payer: Kentucky WC Medicaid |
$4,352.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,758.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,395.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,025.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,396.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,023.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,900.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,645.09
|
| Rate for Payer: PHCS Commercial |
$12,027.96
|
| Rate for Payer: United Healthcare All Payer |
$11,025.63
|
|
|
CONTR ACE RECN RNG 68OD 64ID R
|
Facility
|
IP
|
$12,529.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,758.74 |
| Max. Negotiated Rate |
$12,027.96 |
| Rate for Payer: Aetna Commercial |
$9,647.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,772.71
|
| Rate for Payer: Cash Price |
$6,264.56
|
| Rate for Payer: Cigna Commercial |
$10,399.17
|
| Rate for Payer: First Health Commercial |
$11,902.66
|
| Rate for Payer: Humana Commercial |
$10,649.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,758.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,025.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,396.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,023.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,900.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,645.09
|
| Rate for Payer: PHCS Commercial |
$12,027.96
|
| Rate for Payer: United Healthcare All Payer |
$11,025.63
|
|
|
CONTR ACE RECN RNG 74OD 70ID L
|
Facility
|
IP
|
$12,529.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,758.74 |
| Max. Negotiated Rate |
$12,027.96 |
| Rate for Payer: Aetna Commercial |
$9,647.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,772.71
|
| Rate for Payer: Cash Price |
$6,264.56
|
| Rate for Payer: Cigna Commercial |
$10,399.17
|
| Rate for Payer: First Health Commercial |
$11,902.66
|
| Rate for Payer: Humana Commercial |
$10,649.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,758.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,025.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,396.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,023.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,900.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,645.09
|
| Rate for Payer: PHCS Commercial |
$12,027.96
|
| Rate for Payer: United Healthcare All Payer |
$11,025.63
|
|
|
CONTR ACE RECN RNG 74OD 70ID L
|
Facility
|
OP
|
$12,529.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,758.74 |
| Max. Negotiated Rate |
$12,027.96 |
| Rate for Payer: Aetna Commercial |
$9,647.42
|
| Rate for Payer: Anthem Medicaid |
$4,308.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,772.71
|
| Rate for Payer: Cash Price |
$6,264.56
|
| Rate for Payer: Cigna Commercial |
$10,399.17
|
| Rate for Payer: First Health Commercial |
$11,902.66
|
| Rate for Payer: Humana Commercial |
$10,649.75
|
| Rate for Payer: Humana KY Medicaid |
$4,308.76
|
| Rate for Payer: Kentucky WC Medicaid |
$4,352.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,758.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,395.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,025.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,396.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,023.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,900.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,645.09
|
| Rate for Payer: PHCS Commercial |
$12,027.96
|
| Rate for Payer: United Healthcare All Payer |
$11,025.63
|
|
|
CONTR ACE RECN RNG 74OD 70ID R
|
Facility
|
IP
|
$12,529.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,758.74 |
| Max. Negotiated Rate |
$12,027.96 |
| Rate for Payer: Aetna Commercial |
$9,647.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,772.71
|
| Rate for Payer: Cash Price |
$6,264.56
|
| Rate for Payer: Cigna Commercial |
$10,399.17
|
| Rate for Payer: First Health Commercial |
$11,902.66
|
| Rate for Payer: Humana Commercial |
$10,649.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,758.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,025.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,396.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,023.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,900.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,645.09
|
| Rate for Payer: PHCS Commercial |
$12,027.96
|
| Rate for Payer: United Healthcare All Payer |
$11,025.63
|
|
|
CONTR ACE RECN RNG 74OD 70ID R
|
Facility
|
OP
|
$12,529.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,758.74 |
| Max. Negotiated Rate |
$12,027.96 |
| Rate for Payer: Aetna Commercial |
$9,647.42
|
| Rate for Payer: Anthem Medicaid |
$4,308.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,772.71
|
| Rate for Payer: Cash Price |
$6,264.56
|
| Rate for Payer: Cigna Commercial |
$10,399.17
|
| Rate for Payer: First Health Commercial |
$11,902.66
|
| Rate for Payer: Humana Commercial |
$10,649.75
|
| Rate for Payer: Humana KY Medicaid |
$4,308.76
|
| Rate for Payer: Kentucky WC Medicaid |
$4,352.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,758.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,395.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,025.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,396.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,023.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,900.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,645.09
|
| Rate for Payer: PHCS Commercial |
$12,027.96
|
| Rate for Payer: United Healthcare All Payer |
$11,025.63
|
|
|
CONTR ACE REINF RING 44OD 40ID
|
Facility
|
IP
|
$12,529.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,758.74 |
| Max. Negotiated Rate |
$12,027.96 |
| Rate for Payer: Aetna Commercial |
$9,647.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,772.71
|
| Rate for Payer: Cash Price |
$6,264.56
|
| Rate for Payer: Cigna Commercial |
$10,399.17
|
| Rate for Payer: First Health Commercial |
$11,902.66
|
| Rate for Payer: Humana Commercial |
$10,649.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,758.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,025.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,396.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,023.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,900.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,645.09
|
| Rate for Payer: PHCS Commercial |
$12,027.96
|
| Rate for Payer: United Healthcare All Payer |
$11,025.63
|
|
|
CONTR ACE REINF RING 44OD 40ID
|
Facility
|
OP
|
$12,529.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,758.74 |
| Max. Negotiated Rate |
$12,027.96 |
| Rate for Payer: Aetna Commercial |
$9,647.42
|
| Rate for Payer: Anthem Medicaid |
$4,308.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,772.71
|
| Rate for Payer: Cash Price |
$6,264.56
|
| Rate for Payer: Cigna Commercial |
$10,399.17
|
| Rate for Payer: First Health Commercial |
$11,902.66
|
| Rate for Payer: Humana Commercial |
$10,649.75
|
| Rate for Payer: Humana KY Medicaid |
$4,308.76
|
| Rate for Payer: Kentucky WC Medicaid |
$4,352.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,758.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,395.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,025.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,396.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,023.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,900.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,645.09
|
| Rate for Payer: PHCS Commercial |
$12,027.96
|
| Rate for Payer: United Healthcare All Payer |
$11,025.63
|
|
|
CONTR ACE REINF RING 47OD 43ID
|
Facility
|
IP
|
$12,529.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,758.74 |
| Max. Negotiated Rate |
$12,027.96 |
| Rate for Payer: Aetna Commercial |
$9,647.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,772.71
|
| Rate for Payer: Cash Price |
$6,264.56
|
| Rate for Payer: Cigna Commercial |
$10,399.17
|
| Rate for Payer: First Health Commercial |
$11,902.66
|
| Rate for Payer: Humana Commercial |
$10,649.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,758.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,025.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,396.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,023.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,900.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,645.09
|
| Rate for Payer: PHCS Commercial |
$12,027.96
|
| Rate for Payer: United Healthcare All Payer |
$11,025.63
|
|
|
CONTR ACE REINF RING 47OD 43ID
|
Facility
|
OP
|
$12,529.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,758.74 |
| Max. Negotiated Rate |
$12,027.96 |
| Rate for Payer: Aetna Commercial |
$9,647.42
|
| Rate for Payer: Anthem Medicaid |
$4,308.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,772.71
|
| Rate for Payer: Cash Price |
$6,264.56
|
| Rate for Payer: Cigna Commercial |
$10,399.17
|
| Rate for Payer: First Health Commercial |
$11,902.66
|
| Rate for Payer: Humana Commercial |
$10,649.75
|
| Rate for Payer: Humana KY Medicaid |
$4,308.76
|
| Rate for Payer: Kentucky WC Medicaid |
$4,352.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,758.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,395.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,025.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,396.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,023.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,900.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,645.09
|
| Rate for Payer: PHCS Commercial |
$12,027.96
|
| Rate for Payer: United Healthcare All Payer |
$11,025.63
|
|
|
CONTR ACE REINF RING 50OD 46ID
|
Facility
|
IP
|
$12,529.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,758.74 |
| Max. Negotiated Rate |
$12,027.96 |
| Rate for Payer: Aetna Commercial |
$9,647.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,772.71
|
| Rate for Payer: Cash Price |
$6,264.56
|
| Rate for Payer: Cigna Commercial |
$10,399.17
|
| Rate for Payer: First Health Commercial |
$11,902.66
|
| Rate for Payer: Humana Commercial |
$10,649.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,758.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,025.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,396.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,023.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,900.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,645.09
|
| Rate for Payer: PHCS Commercial |
$12,027.96
|
| Rate for Payer: United Healthcare All Payer |
$11,025.63
|
|
|
CONTR ACE REINF RING 50OD 46ID
|
Facility
|
OP
|
$12,529.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,758.74 |
| Max. Negotiated Rate |
$12,027.96 |
| Rate for Payer: Aetna Commercial |
$9,647.42
|
| Rate for Payer: Anthem Medicaid |
$4,308.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,772.71
|
| Rate for Payer: Cash Price |
$6,264.56
|
| Rate for Payer: Cigna Commercial |
$10,399.17
|
| Rate for Payer: First Health Commercial |
$11,902.66
|
| Rate for Payer: Humana Commercial |
$10,649.75
|
| Rate for Payer: Humana KY Medicaid |
$4,308.76
|
| Rate for Payer: Kentucky WC Medicaid |
$4,352.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,758.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,395.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,025.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,396.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,023.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,900.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,645.09
|
| Rate for Payer: PHCS Commercial |
$12,027.96
|
| Rate for Payer: United Healthcare All Payer |
$11,025.63
|
|
|
CONTR ACE REINF RING 53OD 49ID
|
Facility
|
IP
|
$12,529.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,758.74 |
| Max. Negotiated Rate |
$12,027.96 |
| Rate for Payer: Aetna Commercial |
$9,647.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,772.71
|
| Rate for Payer: Cash Price |
$6,264.56
|
| Rate for Payer: Cigna Commercial |
$10,399.17
|
| Rate for Payer: First Health Commercial |
$11,902.66
|
| Rate for Payer: Humana Commercial |
$10,649.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,758.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,025.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,396.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,023.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,900.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,645.09
|
| Rate for Payer: PHCS Commercial |
$12,027.96
|
| Rate for Payer: United Healthcare All Payer |
$11,025.63
|
|
|
CONTR ACE REINF RING 53OD 49ID
|
Facility
|
OP
|
$12,529.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,758.74 |
| Max. Negotiated Rate |
$12,027.96 |
| Rate for Payer: Aetna Commercial |
$9,647.42
|
| Rate for Payer: Anthem Medicaid |
$4,308.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,772.71
|
| Rate for Payer: Cash Price |
$6,264.56
|
| Rate for Payer: Cigna Commercial |
$10,399.17
|
| Rate for Payer: First Health Commercial |
$11,902.66
|
| Rate for Payer: Humana Commercial |
$10,649.75
|
| Rate for Payer: Humana KY Medicaid |
$4,308.76
|
| Rate for Payer: Kentucky WC Medicaid |
$4,352.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,758.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,395.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,025.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,396.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,023.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,900.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,645.09
|
| Rate for Payer: PHCS Commercial |
$12,027.96
|
| Rate for Payer: United Healthcare All Payer |
$11,025.63
|
|
|
CONTR ACE REINF RING 56OD 52ID
|
Facility
|
IP
|
$12,529.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,758.74 |
| Max. Negotiated Rate |
$12,027.96 |
| Rate for Payer: Aetna Commercial |
$9,647.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,772.71
|
| Rate for Payer: Cash Price |
$6,264.56
|
| Rate for Payer: Cigna Commercial |
$10,399.17
|
| Rate for Payer: First Health Commercial |
$11,902.66
|
| Rate for Payer: Humana Commercial |
$10,649.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,758.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,025.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,396.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,023.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,900.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,645.09
|
| Rate for Payer: PHCS Commercial |
$12,027.96
|
| Rate for Payer: United Healthcare All Payer |
$11,025.63
|
|
|
CONTR ACE REINF RING 56OD 52ID
|
Facility
|
OP
|
$12,529.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,758.74 |
| Max. Negotiated Rate |
$12,027.96 |
| Rate for Payer: Aetna Commercial |
$9,647.42
|
| Rate for Payer: Anthem Medicaid |
$4,308.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,772.71
|
| Rate for Payer: Cash Price |
$6,264.56
|
| Rate for Payer: Cigna Commercial |
$10,399.17
|
| Rate for Payer: First Health Commercial |
$11,902.66
|
| Rate for Payer: Humana Commercial |
$10,649.75
|
| Rate for Payer: Humana KY Medicaid |
$4,308.76
|
| Rate for Payer: Kentucky WC Medicaid |
$4,352.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,758.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,395.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,025.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,396.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,023.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,900.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,645.09
|
| Rate for Payer: PHCS Commercial |
$12,027.96
|
| Rate for Payer: United Healthcare All Payer |
$11,025.63
|
|
|
CONTR ACE REINF RING 59OD 55ID
|
Facility
|
OP
|
$12,529.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,758.74 |
| Max. Negotiated Rate |
$12,027.96 |
| Rate for Payer: Aetna Commercial |
$9,647.42
|
| Rate for Payer: Anthem Medicaid |
$4,308.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,772.71
|
| Rate for Payer: Cash Price |
$6,264.56
|
| Rate for Payer: Cigna Commercial |
$10,399.17
|
| Rate for Payer: First Health Commercial |
$11,902.66
|
| Rate for Payer: Humana Commercial |
$10,649.75
|
| Rate for Payer: Humana KY Medicaid |
$4,308.76
|
| Rate for Payer: Kentucky WC Medicaid |
$4,352.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,758.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,395.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,025.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,396.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,023.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,900.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,645.09
|
| Rate for Payer: PHCS Commercial |
$12,027.96
|
| Rate for Payer: United Healthcare All Payer |
$11,025.63
|
|
|
CONTR ACE REINF RING 59OD 55ID
|
Facility
|
IP
|
$12,529.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,758.74 |
| Max. Negotiated Rate |
$12,027.96 |
| Rate for Payer: Aetna Commercial |
$9,647.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,772.71
|
| Rate for Payer: Cash Price |
$6,264.56
|
| Rate for Payer: Cigna Commercial |
$10,399.17
|
| Rate for Payer: First Health Commercial |
$11,902.66
|
| Rate for Payer: Humana Commercial |
$10,649.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,758.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,025.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,396.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,023.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,900.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,645.09
|
| Rate for Payer: PHCS Commercial |
$12,027.96
|
| Rate for Payer: United Healthcare All Payer |
$11,025.63
|
|
|
CONTR ACE REINF RING 62OD 58ID
|
Facility
|
IP
|
$12,529.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,758.74 |
| Max. Negotiated Rate |
$12,027.96 |
| Rate for Payer: Aetna Commercial |
$9,647.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,772.71
|
| Rate for Payer: Cash Price |
$6,264.56
|
| Rate for Payer: Cigna Commercial |
$10,399.17
|
| Rate for Payer: First Health Commercial |
$11,902.66
|
| Rate for Payer: Humana Commercial |
$10,649.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,758.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,025.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,396.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,023.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,900.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,645.09
|
| Rate for Payer: PHCS Commercial |
$12,027.96
|
| Rate for Payer: United Healthcare All Payer |
$11,025.63
|
|
|
CONTR ACE REINF RING 62OD 58ID
|
Facility
|
OP
|
$12,529.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,758.74 |
| Max. Negotiated Rate |
$12,027.96 |
| Rate for Payer: Aetna Commercial |
$9,647.42
|
| Rate for Payer: Anthem Medicaid |
$4,308.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,772.71
|
| Rate for Payer: Cash Price |
$6,264.56
|
| Rate for Payer: Cigna Commercial |
$10,399.17
|
| Rate for Payer: First Health Commercial |
$11,902.66
|
| Rate for Payer: Humana Commercial |
$10,649.75
|
| Rate for Payer: Humana KY Medicaid |
$4,308.76
|
| Rate for Payer: Kentucky WC Medicaid |
$4,352.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,758.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,395.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,025.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,396.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,023.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,900.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,645.09
|
| Rate for Payer: PHCS Commercial |
$12,027.96
|
| Rate for Payer: United Healthcare All Payer |
$11,025.63
|
|
|
CONTR ACE REINF RING 65OD 61ID
|
Facility
|
OP
|
$12,529.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,758.74 |
| Max. Negotiated Rate |
$12,027.96 |
| Rate for Payer: Aetna Commercial |
$9,647.42
|
| Rate for Payer: Anthem Medicaid |
$4,308.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,772.71
|
| Rate for Payer: Cash Price |
$6,264.56
|
| Rate for Payer: Cigna Commercial |
$10,399.17
|
| Rate for Payer: First Health Commercial |
$11,902.66
|
| Rate for Payer: Humana Commercial |
$10,649.75
|
| Rate for Payer: Humana KY Medicaid |
$4,308.76
|
| Rate for Payer: Kentucky WC Medicaid |
$4,352.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,758.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,395.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,025.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,396.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,023.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,900.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,645.09
|
| Rate for Payer: PHCS Commercial |
$12,027.96
|
| Rate for Payer: United Healthcare All Payer |
$11,025.63
|
|
|
CONTR ACE REINF RING 65OD 61ID
|
Facility
|
IP
|
$12,529.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,758.74 |
| Max. Negotiated Rate |
$12,027.96 |
| Rate for Payer: Aetna Commercial |
$9,647.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,772.71
|
| Rate for Payer: Cash Price |
$6,264.56
|
| Rate for Payer: Cigna Commercial |
$10,399.17
|
| Rate for Payer: First Health Commercial |
$11,902.66
|
| Rate for Payer: Humana Commercial |
$10,649.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,758.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,025.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,396.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,023.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,900.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,645.09
|
| Rate for Payer: PHCS Commercial |
$12,027.96
|
| Rate for Payer: United Healthcare All Payer |
$11,025.63
|
|
|
CONTR ACE REINF RING 68OD 64ID
|
Facility
|
IP
|
$12,529.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,758.74 |
| Max. Negotiated Rate |
$12,027.96 |
| Rate for Payer: Aetna Commercial |
$9,647.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,772.71
|
| Rate for Payer: Cash Price |
$6,264.56
|
| Rate for Payer: Cigna Commercial |
$10,399.17
|
| Rate for Payer: First Health Commercial |
$11,902.66
|
| Rate for Payer: Humana Commercial |
$10,649.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,758.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,025.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,396.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,023.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,900.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,645.09
|
| Rate for Payer: PHCS Commercial |
$12,027.96
|
| Rate for Payer: United Healthcare All Payer |
$11,025.63
|
|
|
CONTR ACE REINF RING 68OD 64ID
|
Facility
|
OP
|
$12,529.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,758.74 |
| Max. Negotiated Rate |
$12,027.96 |
| Rate for Payer: Aetna Commercial |
$9,647.42
|
| Rate for Payer: Anthem Medicaid |
$4,308.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,772.71
|
| Rate for Payer: Cash Price |
$6,264.56
|
| Rate for Payer: Cigna Commercial |
$10,399.17
|
| Rate for Payer: First Health Commercial |
$11,902.66
|
| Rate for Payer: Humana Commercial |
$10,649.75
|
| Rate for Payer: Humana KY Medicaid |
$4,308.76
|
| Rate for Payer: Kentucky WC Medicaid |
$4,352.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,758.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,395.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,025.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,396.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,023.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,900.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,645.09
|
| Rate for Payer: PHCS Commercial |
$12,027.96
|
| Rate for Payer: United Healthcare All Payer |
$11,025.63
|
|
