|
FAN LIME 11.5X30 LF
|
Facility
|
OP
|
$9,730.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.98 |
| Max. Negotiated Rate |
$9,341.40 |
| Rate for Payer: Aetna Commercial |
$7,492.58
|
| Rate for Payer: Anthem Medicaid |
$3,346.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,589.88
|
| Rate for Payer: Cash Price |
$4,865.31
|
| Rate for Payer: Cigna Commercial |
$8,076.41
|
| Rate for Payer: First Health Commercial |
$9,244.09
|
| Rate for Payer: Humana Commercial |
$8,271.03
|
| Rate for Payer: Humana KY Medicaid |
$3,346.36
|
| Rate for Payer: Kentucky WC Medicaid |
$3,380.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,979.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,181.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,919.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,413.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,562.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,297.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,946.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,016.49
|
| Rate for Payer: PHCS Commercial |
$9,341.40
|
| Rate for Payer: United Healthcare All Payer |
$8,562.95
|
|
|
FAN LIME 11.5X30 LF
|
Facility
|
IP
|
$9,730.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.98 |
| Max. Negotiated Rate |
$9,341.40 |
| Rate for Payer: Aetna Commercial |
$7,492.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,589.88
|
| Rate for Payer: Cash Price |
$4,865.31
|
| Rate for Payer: Cigna Commercial |
$8,076.41
|
| Rate for Payer: First Health Commercial |
$9,244.09
|
| Rate for Payer: Humana Commercial |
$8,271.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,979.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,181.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,919.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,562.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,297.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,946.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,016.49
|
| Rate for Payer: PHCS Commercial |
$9,341.40
|
| Rate for Payer: United Healthcare All Payer |
$8,562.95
|
|
|
FAN LIME 11.5X32 LF
|
Facility
|
IP
|
$9,730.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.98 |
| Max. Negotiated Rate |
$9,341.40 |
| Rate for Payer: Aetna Commercial |
$7,492.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,589.88
|
| Rate for Payer: Cash Price |
$4,865.31
|
| Rate for Payer: Cigna Commercial |
$8,076.41
|
| Rate for Payer: First Health Commercial |
$9,244.09
|
| Rate for Payer: Humana Commercial |
$8,271.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,979.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,181.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,919.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,562.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,297.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,946.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,016.49
|
| Rate for Payer: PHCS Commercial |
$9,341.40
|
| Rate for Payer: United Healthcare All Payer |
$8,562.95
|
|
|
FAN LIME 11.5X32 LF
|
Facility
|
OP
|
$9,730.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.98 |
| Max. Negotiated Rate |
$9,341.40 |
| Rate for Payer: Aetna Commercial |
$7,492.58
|
| Rate for Payer: Anthem Medicaid |
$3,346.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,589.88
|
| Rate for Payer: Cash Price |
$4,865.31
|
| Rate for Payer: Cigna Commercial |
$8,076.41
|
| Rate for Payer: First Health Commercial |
$9,244.09
|
| Rate for Payer: Humana Commercial |
$8,271.03
|
| Rate for Payer: Humana KY Medicaid |
$3,346.36
|
| Rate for Payer: Kentucky WC Medicaid |
$3,380.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,979.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,181.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,919.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,413.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,562.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,297.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,946.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,016.49
|
| Rate for Payer: PHCS Commercial |
$9,341.40
|
| Rate for Payer: United Healthcare All Payer |
$8,562.95
|
|
|
FAN LIME 11.5X34 LF
|
Facility
|
IP
|
$9,730.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.98 |
| Max. Negotiated Rate |
$9,341.40 |
| Rate for Payer: Aetna Commercial |
$7,492.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,589.88
|
| Rate for Payer: Cash Price |
$4,865.31
|
| Rate for Payer: Cigna Commercial |
$8,076.41
|
| Rate for Payer: First Health Commercial |
$9,244.09
|
| Rate for Payer: Humana Commercial |
$8,271.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,979.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,181.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,919.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,562.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,297.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,946.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,016.49
|
| Rate for Payer: PHCS Commercial |
$9,341.40
|
| Rate for Payer: United Healthcare All Payer |
$8,562.95
|
|
|
FAN LIME 11.5X34 LF
|
Facility
|
OP
|
$9,730.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.98 |
| Max. Negotiated Rate |
$9,341.40 |
| Rate for Payer: Aetna Commercial |
$7,492.58
|
| Rate for Payer: Anthem Medicaid |
$3,346.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,589.88
|
| Rate for Payer: Cash Price |
$4,865.31
|
| Rate for Payer: Cigna Commercial |
$8,076.41
|
| Rate for Payer: First Health Commercial |
$9,244.09
|
| Rate for Payer: Humana Commercial |
$8,271.03
|
| Rate for Payer: Humana KY Medicaid |
$3,346.36
|
| Rate for Payer: Kentucky WC Medicaid |
$3,380.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,979.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,181.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,919.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,413.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,562.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,297.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,946.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,016.49
|
| Rate for Payer: PHCS Commercial |
$9,341.40
|
| Rate for Payer: United Healthcare All Payer |
$8,562.95
|
|
|
FAN LIME 11.5X36 LF
|
Facility
|
OP
|
$9,730.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.98 |
| Max. Negotiated Rate |
$9,341.40 |
| Rate for Payer: Aetna Commercial |
$7,492.58
|
| Rate for Payer: Anthem Medicaid |
$3,346.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,589.88
|
| Rate for Payer: Cash Price |
$4,865.31
|
| Rate for Payer: Cigna Commercial |
$8,076.41
|
| Rate for Payer: First Health Commercial |
$9,244.09
|
| Rate for Payer: Humana Commercial |
$8,271.03
|
| Rate for Payer: Humana KY Medicaid |
$3,346.36
|
| Rate for Payer: Kentucky WC Medicaid |
$3,380.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,979.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,181.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,919.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,413.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,562.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,297.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,946.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,016.49
|
| Rate for Payer: PHCS Commercial |
$9,341.40
|
| Rate for Payer: United Healthcare All Payer |
$8,562.95
|
|
|
FAN LIME 11.5X36 LF
|
Facility
|
IP
|
$9,730.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.98 |
| Max. Negotiated Rate |
$9,341.40 |
| Rate for Payer: Aetna Commercial |
$7,492.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,589.88
|
| Rate for Payer: Cash Price |
$4,865.31
|
| Rate for Payer: Cigna Commercial |
$8,076.41
|
| Rate for Payer: First Health Commercial |
$9,244.09
|
| Rate for Payer: Humana Commercial |
$8,271.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,979.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,181.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,919.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,562.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,297.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,946.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,016.49
|
| Rate for Payer: PHCS Commercial |
$9,341.40
|
| Rate for Payer: United Healthcare All Payer |
$8,562.95
|
|
|
FAN LIME 11.5X38 LF
|
Facility
|
IP
|
$9,730.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.98 |
| Max. Negotiated Rate |
$9,341.40 |
| Rate for Payer: Aetna Commercial |
$7,492.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,589.88
|
| Rate for Payer: Cash Price |
$4,865.31
|
| Rate for Payer: Cigna Commercial |
$8,076.41
|
| Rate for Payer: First Health Commercial |
$9,244.09
|
| Rate for Payer: Humana Commercial |
$8,271.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,979.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,181.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,919.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,562.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,297.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,946.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,016.49
|
| Rate for Payer: PHCS Commercial |
$9,341.40
|
| Rate for Payer: United Healthcare All Payer |
$8,562.95
|
|
|
FAN LIME 11.5X38 LF
|
Facility
|
OP
|
$9,730.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.98 |
| Max. Negotiated Rate |
$9,341.40 |
| Rate for Payer: Aetna Commercial |
$7,492.58
|
| Rate for Payer: Anthem Medicaid |
$3,346.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,589.88
|
| Rate for Payer: Cash Price |
$4,865.31
|
| Rate for Payer: Cigna Commercial |
$8,076.41
|
| Rate for Payer: First Health Commercial |
$9,244.09
|
| Rate for Payer: Humana Commercial |
$8,271.03
|
| Rate for Payer: Humana KY Medicaid |
$3,346.36
|
| Rate for Payer: Kentucky WC Medicaid |
$3,380.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,979.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,181.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,919.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,413.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,562.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,297.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,946.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,016.49
|
| Rate for Payer: PHCS Commercial |
$9,341.40
|
| Rate for Payer: United Healthcare All Payer |
$8,562.95
|
|
|
FAN LIME 11.5X40 LF
|
Facility
|
OP
|
$9,730.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.98 |
| Max. Negotiated Rate |
$9,341.40 |
| Rate for Payer: Aetna Commercial |
$7,492.58
|
| Rate for Payer: Anthem Medicaid |
$3,346.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,589.88
|
| Rate for Payer: Cash Price |
$4,865.31
|
| Rate for Payer: Cigna Commercial |
$8,076.41
|
| Rate for Payer: First Health Commercial |
$9,244.09
|
| Rate for Payer: Humana Commercial |
$8,271.03
|
| Rate for Payer: Humana KY Medicaid |
$3,346.36
|
| Rate for Payer: Kentucky WC Medicaid |
$3,380.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,979.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,181.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,919.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,413.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,562.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,297.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,946.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,016.49
|
| Rate for Payer: PHCS Commercial |
$9,341.40
|
| Rate for Payer: United Healthcare All Payer |
$8,562.95
|
|
|
FAN LIME 11.5X40 LF
|
Facility
|
IP
|
$9,730.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.98 |
| Max. Negotiated Rate |
$9,341.40 |
| Rate for Payer: Aetna Commercial |
$7,492.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,589.88
|
| Rate for Payer: Cash Price |
$4,865.31
|
| Rate for Payer: Cigna Commercial |
$8,076.41
|
| Rate for Payer: First Health Commercial |
$9,244.09
|
| Rate for Payer: Humana Commercial |
$8,271.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,979.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,181.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,919.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,562.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,297.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,946.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,016.49
|
| Rate for Payer: PHCS Commercial |
$9,341.40
|
| Rate for Payer: United Healthcare All Payer |
$8,562.95
|
|
|
FAN LIME 11.5X42 LF
|
Facility
|
IP
|
$9,730.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.98 |
| Max. Negotiated Rate |
$9,341.40 |
| Rate for Payer: Aetna Commercial |
$7,492.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,589.88
|
| Rate for Payer: Cash Price |
$4,865.31
|
| Rate for Payer: Cigna Commercial |
$8,076.41
|
| Rate for Payer: First Health Commercial |
$9,244.09
|
| Rate for Payer: Humana Commercial |
$8,271.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,979.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,181.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,919.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,562.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,297.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,946.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,016.49
|
| Rate for Payer: PHCS Commercial |
$9,341.40
|
| Rate for Payer: United Healthcare All Payer |
$8,562.95
|
|
|
FAN LIME 11.5X42 LF
|
Facility
|
OP
|
$9,730.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.98 |
| Max. Negotiated Rate |
$9,341.40 |
| Rate for Payer: Aetna Commercial |
$7,492.58
|
| Rate for Payer: Anthem Medicaid |
$3,346.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,589.88
|
| Rate for Payer: Cash Price |
$4,865.31
|
| Rate for Payer: Cigna Commercial |
$8,076.41
|
| Rate for Payer: First Health Commercial |
$9,244.09
|
| Rate for Payer: Humana Commercial |
$8,271.03
|
| Rate for Payer: Humana KY Medicaid |
$3,346.36
|
| Rate for Payer: Kentucky WC Medicaid |
$3,380.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,979.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,181.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,919.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,413.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,562.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,297.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,946.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,016.49
|
| Rate for Payer: PHCS Commercial |
$9,341.40
|
| Rate for Payer: United Healthcare All Payer |
$8,562.95
|
|
|
FAN LIME 11.5X44 LF
|
Facility
|
OP
|
$9,730.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.98 |
| Max. Negotiated Rate |
$9,341.40 |
| Rate for Payer: Aetna Commercial |
$7,492.58
|
| Rate for Payer: Anthem Medicaid |
$3,346.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,589.88
|
| Rate for Payer: Cash Price |
$4,865.31
|
| Rate for Payer: Cigna Commercial |
$8,076.41
|
| Rate for Payer: First Health Commercial |
$9,244.09
|
| Rate for Payer: Humana Commercial |
$8,271.03
|
| Rate for Payer: Humana KY Medicaid |
$3,346.36
|
| Rate for Payer: Kentucky WC Medicaid |
$3,380.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,979.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,181.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,919.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,413.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,562.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,297.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,946.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,016.49
|
| Rate for Payer: PHCS Commercial |
$9,341.40
|
| Rate for Payer: United Healthcare All Payer |
$8,562.95
|
|
|
FAN LIME 11.5X44 LF
|
Facility
|
IP
|
$9,730.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.98 |
| Max. Negotiated Rate |
$9,341.40 |
| Rate for Payer: Aetna Commercial |
$7,492.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,589.88
|
| Rate for Payer: Cash Price |
$4,865.31
|
| Rate for Payer: Cigna Commercial |
$8,076.41
|
| Rate for Payer: First Health Commercial |
$9,244.09
|
| Rate for Payer: Humana Commercial |
$8,271.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,979.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,181.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,919.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,562.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,297.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,946.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,016.49
|
| Rate for Payer: PHCS Commercial |
$9,341.40
|
| Rate for Payer: United Healthcare All Payer |
$8,562.95
|
|
|
FAN LIME 11.5X46 LF
|
Facility
|
OP
|
$9,730.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.98 |
| Max. Negotiated Rate |
$9,341.40 |
| Rate for Payer: Aetna Commercial |
$7,492.58
|
| Rate for Payer: Anthem Medicaid |
$3,346.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,589.88
|
| Rate for Payer: Cash Price |
$4,865.31
|
| Rate for Payer: Cigna Commercial |
$8,076.41
|
| Rate for Payer: First Health Commercial |
$9,244.09
|
| Rate for Payer: Humana Commercial |
$8,271.03
|
| Rate for Payer: Humana KY Medicaid |
$3,346.36
|
| Rate for Payer: Kentucky WC Medicaid |
$3,380.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,979.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,181.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,919.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,413.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,562.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,297.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,946.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,016.49
|
| Rate for Payer: PHCS Commercial |
$9,341.40
|
| Rate for Payer: United Healthcare All Payer |
$8,562.95
|
|
|
FAN LIME 11.5X46 LF
|
Facility
|
IP
|
$9,730.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.98 |
| Max. Negotiated Rate |
$9,341.40 |
| Rate for Payer: Aetna Commercial |
$7,492.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,589.88
|
| Rate for Payer: Cash Price |
$4,865.31
|
| Rate for Payer: Cigna Commercial |
$8,076.41
|
| Rate for Payer: First Health Commercial |
$9,244.09
|
| Rate for Payer: Humana Commercial |
$8,271.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,979.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,181.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,919.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,562.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,297.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,946.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,016.49
|
| Rate for Payer: PHCS Commercial |
$9,341.40
|
| Rate for Payer: United Healthcare All Payer |
$8,562.95
|
|
|
FAN LIME 11.5X48 LF
|
Facility
|
IP
|
$9,730.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.98 |
| Max. Negotiated Rate |
$9,341.40 |
| Rate for Payer: Aetna Commercial |
$7,492.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,589.88
|
| Rate for Payer: Cash Price |
$4,865.31
|
| Rate for Payer: Cigna Commercial |
$8,076.41
|
| Rate for Payer: First Health Commercial |
$9,244.09
|
| Rate for Payer: Humana Commercial |
$8,271.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,979.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,181.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,919.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,562.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,297.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,946.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,016.49
|
| Rate for Payer: PHCS Commercial |
$9,341.40
|
| Rate for Payer: United Healthcare All Payer |
$8,562.95
|
|
|
FAN LIME 11.5X48 LF
|
Facility
|
OP
|
$9,730.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.98 |
| Max. Negotiated Rate |
$9,341.40 |
| Rate for Payer: Aetna Commercial |
$7,492.58
|
| Rate for Payer: Anthem Medicaid |
$3,346.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,589.88
|
| Rate for Payer: Cash Price |
$4,865.31
|
| Rate for Payer: Cigna Commercial |
$8,076.41
|
| Rate for Payer: First Health Commercial |
$9,244.09
|
| Rate for Payer: Humana Commercial |
$8,271.03
|
| Rate for Payer: Humana KY Medicaid |
$3,346.36
|
| Rate for Payer: Kentucky WC Medicaid |
$3,380.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,979.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,181.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,919.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,413.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,562.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,297.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,946.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,016.49
|
| Rate for Payer: PHCS Commercial |
$9,341.40
|
| Rate for Payer: United Healthcare All Payer |
$8,562.95
|
|
|
FAN LIME 11.5X50 LF
|
Facility
|
IP
|
$9,730.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.98 |
| Max. Negotiated Rate |
$9,341.40 |
| Rate for Payer: Aetna Commercial |
$7,492.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,589.88
|
| Rate for Payer: Cash Price |
$4,865.31
|
| Rate for Payer: Cigna Commercial |
$8,076.41
|
| Rate for Payer: First Health Commercial |
$9,244.09
|
| Rate for Payer: Humana Commercial |
$8,271.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,979.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,181.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,919.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,562.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,297.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,946.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,016.49
|
| Rate for Payer: PHCS Commercial |
$9,341.40
|
| Rate for Payer: United Healthcare All Payer |
$8,562.95
|
|
|
FAN LIME 11.5X50 LF
|
Facility
|
OP
|
$9,730.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.98 |
| Max. Negotiated Rate |
$9,341.40 |
| Rate for Payer: Aetna Commercial |
$7,492.58
|
| Rate for Payer: Anthem Medicaid |
$3,346.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,589.88
|
| Rate for Payer: Cash Price |
$4,865.31
|
| Rate for Payer: Cigna Commercial |
$8,076.41
|
| Rate for Payer: First Health Commercial |
$9,244.09
|
| Rate for Payer: Humana Commercial |
$8,271.03
|
| Rate for Payer: Humana KY Medicaid |
$3,346.36
|
| Rate for Payer: Kentucky WC Medicaid |
$3,380.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,979.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,181.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,919.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,413.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,562.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,297.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,946.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,016.49
|
| Rate for Payer: PHCS Commercial |
$9,341.40
|
| Rate for Payer: United Healthcare All Payer |
$8,562.95
|
|
|
FAN LIME 13X30 LF
|
Facility
|
OP
|
$9,730.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.98 |
| Max. Negotiated Rate |
$9,341.40 |
| Rate for Payer: Aetna Commercial |
$7,492.58
|
| Rate for Payer: Anthem Medicaid |
$3,346.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,589.88
|
| Rate for Payer: Cash Price |
$4,865.31
|
| Rate for Payer: Cigna Commercial |
$8,076.41
|
| Rate for Payer: First Health Commercial |
$9,244.09
|
| Rate for Payer: Humana Commercial |
$8,271.03
|
| Rate for Payer: Humana KY Medicaid |
$3,346.36
|
| Rate for Payer: Kentucky WC Medicaid |
$3,380.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,979.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,181.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,919.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,413.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,562.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,297.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,946.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,016.49
|
| Rate for Payer: PHCS Commercial |
$9,341.40
|
| Rate for Payer: United Healthcare All Payer |
$8,562.95
|
|
|
FAN LIME 13X30 LF
|
Facility
|
IP
|
$9,730.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.98 |
| Max. Negotiated Rate |
$9,341.40 |
| Rate for Payer: Aetna Commercial |
$7,492.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,589.88
|
| Rate for Payer: Cash Price |
$4,865.31
|
| Rate for Payer: Cigna Commercial |
$8,076.41
|
| Rate for Payer: First Health Commercial |
$9,244.09
|
| Rate for Payer: Humana Commercial |
$8,271.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,979.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,181.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,919.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,562.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,297.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,946.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,016.49
|
| Rate for Payer: PHCS Commercial |
$9,341.40
|
| Rate for Payer: United Healthcare All Payer |
$8,562.95
|
|
|
FAN LIME 13X32 LF
|
Facility
|
IP
|
$9,730.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.98 |
| Max. Negotiated Rate |
$9,341.40 |
| Rate for Payer: Aetna Commercial |
$7,492.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,589.88
|
| Rate for Payer: Cash Price |
$4,865.31
|
| Rate for Payer: Cigna Commercial |
$8,076.41
|
| Rate for Payer: First Health Commercial |
$9,244.09
|
| Rate for Payer: Humana Commercial |
$8,271.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,979.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,181.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,919.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,562.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,297.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,946.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,264.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,016.49
|
| Rate for Payer: PHCS Commercial |
$9,341.40
|
| Rate for Payer: United Healthcare All Payer |
$8,562.95
|
|
