|
FAN LIME 10X44 LF
|
Facility
|
IP
|
$9,930.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,979.19 |
| Max. Negotiated Rate |
$9,533.40 |
| Rate for Payer: Aetna Commercial |
$7,646.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,745.88
|
| Rate for Payer: Cash Price |
$4,965.31
|
| Rate for Payer: Cigna Commercial |
$8,242.41
|
| Rate for Payer: First Health Commercial |
$9,434.09
|
| Rate for Payer: Humana Commercial |
$8,441.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,143.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,328.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,979.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,738.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,447.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,944.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,639.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,852.13
|
| Rate for Payer: PHCS Commercial |
$9,533.40
|
| Rate for Payer: United Healthcare All Payer |
$8,738.95
|
|
|
FAN LIME 10X46 LF
|
Facility
|
IP
|
$9,930.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,979.19 |
| Max. Negotiated Rate |
$9,533.40 |
| Rate for Payer: Aetna Commercial |
$7,646.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,745.88
|
| Rate for Payer: Cash Price |
$4,965.31
|
| Rate for Payer: Cigna Commercial |
$8,242.41
|
| Rate for Payer: First Health Commercial |
$9,434.09
|
| Rate for Payer: Humana Commercial |
$8,441.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,143.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,328.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,979.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,738.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,447.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,944.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,639.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,852.13
|
| Rate for Payer: PHCS Commercial |
$9,533.40
|
| Rate for Payer: United Healthcare All Payer |
$8,738.95
|
|
|
FAN LIME 10X46 LF
|
Facility
|
OP
|
$9,930.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,979.19 |
| Max. Negotiated Rate |
$9,533.40 |
| Rate for Payer: Aetna Commercial |
$7,646.58
|
| Rate for Payer: Anthem Medicaid |
$3,415.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,745.88
|
| Rate for Payer: Cash Price |
$4,965.31
|
| Rate for Payer: Cigna Commercial |
$8,242.41
|
| Rate for Payer: First Health Commercial |
$9,434.09
|
| Rate for Payer: Humana Commercial |
$8,441.03
|
| Rate for Payer: Humana KY Medicaid |
$3,415.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,449.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,143.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,328.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,979.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,483.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,738.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,447.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,944.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,639.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,852.13
|
| Rate for Payer: PHCS Commercial |
$9,533.40
|
| Rate for Payer: United Healthcare All Payer |
$8,738.95
|
|
|
FAN LIME 10X48 LF
|
Facility
|
IP
|
$9,930.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,979.19 |
| Max. Negotiated Rate |
$9,533.40 |
| Rate for Payer: Aetna Commercial |
$7,646.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,745.88
|
| Rate for Payer: Cash Price |
$4,965.31
|
| Rate for Payer: Cigna Commercial |
$8,242.41
|
| Rate for Payer: First Health Commercial |
$9,434.09
|
| Rate for Payer: Humana Commercial |
$8,441.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,143.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,328.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,979.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,738.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,447.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,944.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,639.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,852.13
|
| Rate for Payer: PHCS Commercial |
$9,533.40
|
| Rate for Payer: United Healthcare All Payer |
$8,738.95
|
|
|
FAN LIME 10X48 LF
|
Facility
|
OP
|
$9,930.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,979.19 |
| Max. Negotiated Rate |
$9,533.40 |
| Rate for Payer: Aetna Commercial |
$7,646.58
|
| Rate for Payer: Anthem Medicaid |
$3,415.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,745.88
|
| Rate for Payer: Cash Price |
$4,965.31
|
| Rate for Payer: Cigna Commercial |
$8,242.41
|
| Rate for Payer: First Health Commercial |
$9,434.09
|
| Rate for Payer: Humana Commercial |
$8,441.03
|
| Rate for Payer: Humana KY Medicaid |
$3,415.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,449.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,143.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,328.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,979.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,483.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,738.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,447.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,944.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,639.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,852.13
|
| Rate for Payer: PHCS Commercial |
$9,533.40
|
| Rate for Payer: United Healthcare All Payer |
$8,738.95
|
|
|
FAN LIME 10X50 LF
|
Facility
|
IP
|
$9,930.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,979.19 |
| Max. Negotiated Rate |
$9,533.40 |
| Rate for Payer: Aetna Commercial |
$7,646.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,745.88
|
| Rate for Payer: Cash Price |
$4,965.31
|
| Rate for Payer: Cigna Commercial |
$8,242.41
|
| Rate for Payer: First Health Commercial |
$9,434.09
|
| Rate for Payer: Humana Commercial |
$8,441.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,143.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,328.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,979.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,738.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,447.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,944.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,639.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,852.13
|
| Rate for Payer: PHCS Commercial |
$9,533.40
|
| Rate for Payer: United Healthcare All Payer |
$8,738.95
|
|
|
FAN LIME 10X50 LF
|
Facility
|
OP
|
$9,930.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,979.19 |
| Max. Negotiated Rate |
$9,533.40 |
| Rate for Payer: Aetna Commercial |
$7,646.58
|
| Rate for Payer: Anthem Medicaid |
$3,415.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,745.88
|
| Rate for Payer: Cash Price |
$4,965.31
|
| Rate for Payer: Cigna Commercial |
$8,242.41
|
| Rate for Payer: First Health Commercial |
$9,434.09
|
| Rate for Payer: Humana Commercial |
$8,441.03
|
| Rate for Payer: Humana KY Medicaid |
$3,415.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,449.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,143.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,328.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,979.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,483.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,738.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,447.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,944.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,639.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,852.13
|
| Rate for Payer: PHCS Commercial |
$9,533.40
|
| Rate for Payer: United Healthcare All Payer |
$8,738.95
|
|
|
FAN LIME 11.5X30 LF
|
Facility
|
OP
|
$9,930.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,979.19 |
| Max. Negotiated Rate |
$9,533.40 |
| Rate for Payer: Aetna Commercial |
$7,646.58
|
| Rate for Payer: Anthem Medicaid |
$3,415.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,745.88
|
| Rate for Payer: Cash Price |
$4,965.31
|
| Rate for Payer: Cigna Commercial |
$8,242.41
|
| Rate for Payer: First Health Commercial |
$9,434.09
|
| Rate for Payer: Humana Commercial |
$8,441.03
|
| Rate for Payer: Humana KY Medicaid |
$3,415.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,449.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,143.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,328.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,979.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,483.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,738.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,447.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,944.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,639.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,852.13
|
| Rate for Payer: PHCS Commercial |
$9,533.40
|
| Rate for Payer: United Healthcare All Payer |
$8,738.95
|
|
|
FAN LIME 11.5X30 LF
|
Facility
|
IP
|
$9,930.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,979.19 |
| Max. Negotiated Rate |
$9,533.40 |
| Rate for Payer: Aetna Commercial |
$7,646.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,745.88
|
| Rate for Payer: Cash Price |
$4,965.31
|
| Rate for Payer: Cigna Commercial |
$8,242.41
|
| Rate for Payer: First Health Commercial |
$9,434.09
|
| Rate for Payer: Humana Commercial |
$8,441.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,143.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,328.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,979.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,738.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,447.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,944.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,639.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,852.13
|
| Rate for Payer: PHCS Commercial |
$9,533.40
|
| Rate for Payer: United Healthcare All Payer |
$8,738.95
|
|
|
FAN LIME 11.5X32 LF
|
Facility
|
IP
|
$9,930.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,979.19 |
| Max. Negotiated Rate |
$9,533.40 |
| Rate for Payer: Aetna Commercial |
$7,646.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,745.88
|
| Rate for Payer: Cash Price |
$4,965.31
|
| Rate for Payer: Cigna Commercial |
$8,242.41
|
| Rate for Payer: First Health Commercial |
$9,434.09
|
| Rate for Payer: Humana Commercial |
$8,441.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,143.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,328.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,979.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,738.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,447.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,944.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,639.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,852.13
|
| Rate for Payer: PHCS Commercial |
$9,533.40
|
| Rate for Payer: United Healthcare All Payer |
$8,738.95
|
|
|
FAN LIME 11.5X32 LF
|
Facility
|
OP
|
$9,930.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,979.19 |
| Max. Negotiated Rate |
$9,533.40 |
| Rate for Payer: Aetna Commercial |
$7,646.58
|
| Rate for Payer: Anthem Medicaid |
$3,415.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,745.88
|
| Rate for Payer: Cash Price |
$4,965.31
|
| Rate for Payer: Cigna Commercial |
$8,242.41
|
| Rate for Payer: First Health Commercial |
$9,434.09
|
| Rate for Payer: Humana Commercial |
$8,441.03
|
| Rate for Payer: Humana KY Medicaid |
$3,415.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,449.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,143.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,328.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,979.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,483.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,738.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,447.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,944.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,639.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,852.13
|
| Rate for Payer: PHCS Commercial |
$9,533.40
|
| Rate for Payer: United Healthcare All Payer |
$8,738.95
|
|
|
FAN LIME 11.5X34 LF
|
Facility
|
IP
|
$9,930.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,979.19 |
| Max. Negotiated Rate |
$9,533.40 |
| Rate for Payer: Aetna Commercial |
$7,646.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,745.88
|
| Rate for Payer: Cash Price |
$4,965.31
|
| Rate for Payer: Cigna Commercial |
$8,242.41
|
| Rate for Payer: First Health Commercial |
$9,434.09
|
| Rate for Payer: Humana Commercial |
$8,441.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,143.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,328.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,979.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,738.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,447.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,944.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,639.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,852.13
|
| Rate for Payer: PHCS Commercial |
$9,533.40
|
| Rate for Payer: United Healthcare All Payer |
$8,738.95
|
|
|
FAN LIME 11.5X34 LF
|
Facility
|
OP
|
$9,930.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,979.19 |
| Max. Negotiated Rate |
$9,533.40 |
| Rate for Payer: Aetna Commercial |
$7,646.58
|
| Rate for Payer: Anthem Medicaid |
$3,415.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,745.88
|
| Rate for Payer: Cash Price |
$4,965.31
|
| Rate for Payer: Cigna Commercial |
$8,242.41
|
| Rate for Payer: First Health Commercial |
$9,434.09
|
| Rate for Payer: Humana Commercial |
$8,441.03
|
| Rate for Payer: Humana KY Medicaid |
$3,415.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,449.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,143.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,328.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,979.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,483.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,738.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,447.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,944.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,639.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,852.13
|
| Rate for Payer: PHCS Commercial |
$9,533.40
|
| Rate for Payer: United Healthcare All Payer |
$8,738.95
|
|
|
FAN LIME 11.5X36 LF
|
Facility
|
OP
|
$9,930.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,979.19 |
| Max. Negotiated Rate |
$9,533.40 |
| Rate for Payer: Aetna Commercial |
$7,646.58
|
| Rate for Payer: Anthem Medicaid |
$3,415.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,745.88
|
| Rate for Payer: Cash Price |
$4,965.31
|
| Rate for Payer: Cigna Commercial |
$8,242.41
|
| Rate for Payer: First Health Commercial |
$9,434.09
|
| Rate for Payer: Humana Commercial |
$8,441.03
|
| Rate for Payer: Humana KY Medicaid |
$3,415.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,449.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,143.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,328.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,979.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,483.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,738.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,447.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,944.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,639.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,852.13
|
| Rate for Payer: PHCS Commercial |
$9,533.40
|
| Rate for Payer: United Healthcare All Payer |
$8,738.95
|
|
|
FAN LIME 11.5X36 LF
|
Facility
|
IP
|
$9,930.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,979.19 |
| Max. Negotiated Rate |
$9,533.40 |
| Rate for Payer: Aetna Commercial |
$7,646.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,745.88
|
| Rate for Payer: Cash Price |
$4,965.31
|
| Rate for Payer: Cigna Commercial |
$8,242.41
|
| Rate for Payer: First Health Commercial |
$9,434.09
|
| Rate for Payer: Humana Commercial |
$8,441.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,143.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,328.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,979.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,738.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,447.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,944.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,639.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,852.13
|
| Rate for Payer: PHCS Commercial |
$9,533.40
|
| Rate for Payer: United Healthcare All Payer |
$8,738.95
|
|
|
FAN LIME 11.5X38 LF
|
Facility
|
IP
|
$9,930.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,979.19 |
| Max. Negotiated Rate |
$9,533.40 |
| Rate for Payer: Aetna Commercial |
$7,646.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,745.88
|
| Rate for Payer: Cash Price |
$4,965.31
|
| Rate for Payer: Cigna Commercial |
$8,242.41
|
| Rate for Payer: First Health Commercial |
$9,434.09
|
| Rate for Payer: Humana Commercial |
$8,441.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,143.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,328.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,979.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,738.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,447.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,944.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,639.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,852.13
|
| Rate for Payer: PHCS Commercial |
$9,533.40
|
| Rate for Payer: United Healthcare All Payer |
$8,738.95
|
|
|
FAN LIME 11.5X38 LF
|
Facility
|
OP
|
$9,930.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,979.19 |
| Max. Negotiated Rate |
$9,533.40 |
| Rate for Payer: Aetna Commercial |
$7,646.58
|
| Rate for Payer: Anthem Medicaid |
$3,415.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,745.88
|
| Rate for Payer: Cash Price |
$4,965.31
|
| Rate for Payer: Cigna Commercial |
$8,242.41
|
| Rate for Payer: First Health Commercial |
$9,434.09
|
| Rate for Payer: Humana Commercial |
$8,441.03
|
| Rate for Payer: Humana KY Medicaid |
$3,415.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,449.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,143.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,328.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,979.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,483.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,738.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,447.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,944.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,639.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,852.13
|
| Rate for Payer: PHCS Commercial |
$9,533.40
|
| Rate for Payer: United Healthcare All Payer |
$8,738.95
|
|
|
FAN LIME 11.5X40 LF
|
Facility
|
IP
|
$9,930.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,979.19 |
| Max. Negotiated Rate |
$9,533.40 |
| Rate for Payer: Aetna Commercial |
$7,646.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,745.88
|
| Rate for Payer: Cash Price |
$4,965.31
|
| Rate for Payer: Cigna Commercial |
$8,242.41
|
| Rate for Payer: First Health Commercial |
$9,434.09
|
| Rate for Payer: Humana Commercial |
$8,441.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,143.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,328.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,979.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,738.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,447.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,944.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,639.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,852.13
|
| Rate for Payer: PHCS Commercial |
$9,533.40
|
| Rate for Payer: United Healthcare All Payer |
$8,738.95
|
|
|
FAN LIME 11.5X40 LF
|
Facility
|
OP
|
$9,930.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,979.19 |
| Max. Negotiated Rate |
$9,533.40 |
| Rate for Payer: Aetna Commercial |
$7,646.58
|
| Rate for Payer: Anthem Medicaid |
$3,415.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,745.88
|
| Rate for Payer: Cash Price |
$4,965.31
|
| Rate for Payer: Cigna Commercial |
$8,242.41
|
| Rate for Payer: First Health Commercial |
$9,434.09
|
| Rate for Payer: Humana Commercial |
$8,441.03
|
| Rate for Payer: Humana KY Medicaid |
$3,415.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,449.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,143.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,328.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,979.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,483.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,738.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,447.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,944.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,639.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,852.13
|
| Rate for Payer: PHCS Commercial |
$9,533.40
|
| Rate for Payer: United Healthcare All Payer |
$8,738.95
|
|
|
FAN LIME 11.5X42 LF
|
Facility
|
OP
|
$9,930.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,979.19 |
| Max. Negotiated Rate |
$9,533.40 |
| Rate for Payer: Aetna Commercial |
$7,646.58
|
| Rate for Payer: Anthem Medicaid |
$3,415.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,745.88
|
| Rate for Payer: Cash Price |
$4,965.31
|
| Rate for Payer: Cigna Commercial |
$8,242.41
|
| Rate for Payer: First Health Commercial |
$9,434.09
|
| Rate for Payer: Humana Commercial |
$8,441.03
|
| Rate for Payer: Humana KY Medicaid |
$3,415.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,449.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,143.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,328.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,979.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,483.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,738.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,447.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,944.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,639.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,852.13
|
| Rate for Payer: PHCS Commercial |
$9,533.40
|
| Rate for Payer: United Healthcare All Payer |
$8,738.95
|
|
|
FAN LIME 11.5X42 LF
|
Facility
|
IP
|
$9,930.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,979.19 |
| Max. Negotiated Rate |
$9,533.40 |
| Rate for Payer: Aetna Commercial |
$7,646.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,745.88
|
| Rate for Payer: Cash Price |
$4,965.31
|
| Rate for Payer: Cigna Commercial |
$8,242.41
|
| Rate for Payer: First Health Commercial |
$9,434.09
|
| Rate for Payer: Humana Commercial |
$8,441.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,143.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,328.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,979.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,738.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,447.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,944.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,639.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,852.13
|
| Rate for Payer: PHCS Commercial |
$9,533.40
|
| Rate for Payer: United Healthcare All Payer |
$8,738.95
|
|
|
FAN LIME 11.5X44 LF
|
Facility
|
OP
|
$9,930.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,979.19 |
| Max. Negotiated Rate |
$9,533.40 |
| Rate for Payer: Aetna Commercial |
$7,646.58
|
| Rate for Payer: Anthem Medicaid |
$3,415.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,745.88
|
| Rate for Payer: Cash Price |
$4,965.31
|
| Rate for Payer: Cigna Commercial |
$8,242.41
|
| Rate for Payer: First Health Commercial |
$9,434.09
|
| Rate for Payer: Humana Commercial |
$8,441.03
|
| Rate for Payer: Humana KY Medicaid |
$3,415.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,449.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,143.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,328.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,979.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,483.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,738.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,447.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,944.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,639.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,852.13
|
| Rate for Payer: PHCS Commercial |
$9,533.40
|
| Rate for Payer: United Healthcare All Payer |
$8,738.95
|
|
|
FAN LIME 11.5X44 LF
|
Facility
|
IP
|
$9,930.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,979.19 |
| Max. Negotiated Rate |
$9,533.40 |
| Rate for Payer: Aetna Commercial |
$7,646.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,745.88
|
| Rate for Payer: Cash Price |
$4,965.31
|
| Rate for Payer: Cigna Commercial |
$8,242.41
|
| Rate for Payer: First Health Commercial |
$9,434.09
|
| Rate for Payer: Humana Commercial |
$8,441.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,143.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,328.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,979.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,738.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,447.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,944.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,639.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,852.13
|
| Rate for Payer: PHCS Commercial |
$9,533.40
|
| Rate for Payer: United Healthcare All Payer |
$8,738.95
|
|
|
FAN LIME 11.5X46 LF
|
Facility
|
IP
|
$9,930.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,979.19 |
| Max. Negotiated Rate |
$9,533.40 |
| Rate for Payer: Aetna Commercial |
$7,646.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,745.88
|
| Rate for Payer: Cash Price |
$4,965.31
|
| Rate for Payer: Cigna Commercial |
$8,242.41
|
| Rate for Payer: First Health Commercial |
$9,434.09
|
| Rate for Payer: Humana Commercial |
$8,441.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,143.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,328.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,979.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,738.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,447.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,944.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,639.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,852.13
|
| Rate for Payer: PHCS Commercial |
$9,533.40
|
| Rate for Payer: United Healthcare All Payer |
$8,738.95
|
|
|
FAN LIME 11.5X46 LF
|
Facility
|
OP
|
$9,930.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,979.19 |
| Max. Negotiated Rate |
$9,533.40 |
| Rate for Payer: Aetna Commercial |
$7,646.58
|
| Rate for Payer: Anthem Medicaid |
$3,415.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,745.88
|
| Rate for Payer: Cash Price |
$4,965.31
|
| Rate for Payer: Cigna Commercial |
$8,242.41
|
| Rate for Payer: First Health Commercial |
$9,434.09
|
| Rate for Payer: Humana Commercial |
$8,441.03
|
| Rate for Payer: Humana KY Medicaid |
$3,415.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,449.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,143.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,328.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,979.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,483.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,738.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,447.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,944.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,639.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,852.13
|
| Rate for Payer: PHCS Commercial |
$9,533.40
|
| Rate for Payer: United Healthcare All Payer |
$8,738.95
|
|
