|
G2 CONST INSERT SZ 1-2 25MM
|
Facility
|
IP
|
$10,070.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,021.18 |
| Max. Negotiated Rate |
$9,667.78 |
| Rate for Payer: Aetna Commercial |
$7,754.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,855.07
|
| Rate for Payer: Cash Price |
$5,035.30
|
| Rate for Payer: Cigna Commercial |
$8,358.60
|
| Rate for Payer: First Health Commercial |
$9,567.07
|
| Rate for Payer: Humana Commercial |
$8,560.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,257.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,432.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,021.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,862.13
|
| Rate for Payer: Ohio Health Group HMO |
$7,552.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,056.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,761.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,948.71
|
| Rate for Payer: PHCS Commercial |
$9,667.78
|
| Rate for Payer: United Healthcare All Payer |
$8,862.13
|
|
|
G2 CONST INSERT SZ 1-2 30MM
|
Facility
|
OP
|
$10,070.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,021.18 |
| Max. Negotiated Rate |
$9,667.78 |
| Rate for Payer: Aetna Commercial |
$7,754.36
|
| Rate for Payer: Anthem Medicaid |
$3,463.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,855.07
|
| Rate for Payer: Cash Price |
$5,035.30
|
| Rate for Payer: Cigna Commercial |
$8,358.60
|
| Rate for Payer: First Health Commercial |
$9,567.07
|
| Rate for Payer: Humana Commercial |
$8,560.01
|
| Rate for Payer: Humana KY Medicaid |
$3,463.28
|
| Rate for Payer: Kentucky WC Medicaid |
$3,498.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,257.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,432.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,021.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,532.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,862.13
|
| Rate for Payer: Ohio Health Group HMO |
$7,552.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,056.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,761.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,948.71
|
| Rate for Payer: PHCS Commercial |
$9,667.78
|
| Rate for Payer: United Healthcare All Payer |
$8,862.13
|
|
|
G2 CONST INSERT SZ 1-2 30MM
|
Facility
|
IP
|
$10,070.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,021.18 |
| Max. Negotiated Rate |
$9,667.78 |
| Rate for Payer: Aetna Commercial |
$7,754.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,855.07
|
| Rate for Payer: Cash Price |
$5,035.30
|
| Rate for Payer: Cigna Commercial |
$8,358.60
|
| Rate for Payer: First Health Commercial |
$9,567.07
|
| Rate for Payer: Humana Commercial |
$8,560.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,257.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,432.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,021.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,862.13
|
| Rate for Payer: Ohio Health Group HMO |
$7,552.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,056.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,761.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,948.71
|
| Rate for Payer: PHCS Commercial |
$9,667.78
|
| Rate for Payer: United Healthcare All Payer |
$8,862.13
|
|
|
G2 CONST INSERT SZ 3-4 11MM
|
Facility
|
IP
|
$15,888.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,766.55 |
| Max. Negotiated Rate |
$15,252.96 |
| Rate for Payer: Aetna Commercial |
$12,234.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,393.03
|
| Rate for Payer: Cash Price |
$7,944.25
|
| Rate for Payer: Cigna Commercial |
$13,187.45
|
| Rate for Payer: First Health Commercial |
$15,094.08
|
| Rate for Payer: Humana Commercial |
$13,505.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,028.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,725.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,766.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,981.88
|
| Rate for Payer: Ohio Health Group HMO |
$11,916.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,710.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,823.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,963.07
|
| Rate for Payer: PHCS Commercial |
$15,252.96
|
| Rate for Payer: United Healthcare All Payer |
$13,981.88
|
|
|
G2 CONST INSERT SZ 3-4 11MM
|
Facility
|
OP
|
$15,888.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,766.55 |
| Max. Negotiated Rate |
$15,252.96 |
| Rate for Payer: Aetna Commercial |
$12,234.15
|
| Rate for Payer: Anthem Medicaid |
$5,464.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,393.03
|
| Rate for Payer: Cash Price |
$7,944.25
|
| Rate for Payer: Cigna Commercial |
$13,187.45
|
| Rate for Payer: First Health Commercial |
$15,094.08
|
| Rate for Payer: Humana Commercial |
$13,505.23
|
| Rate for Payer: Humana KY Medicaid |
$5,464.06
|
| Rate for Payer: Kentucky WC Medicaid |
$5,519.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,028.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,725.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,766.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,573.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,981.88
|
| Rate for Payer: Ohio Health Group HMO |
$11,916.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,710.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,823.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,963.07
|
| Rate for Payer: PHCS Commercial |
$15,252.96
|
| Rate for Payer: United Healthcare All Payer |
$13,981.88
|
|
|
G2 CONST INSERT SZ 3-4 13MM
|
Facility
|
OP
|
$15,888.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,766.55 |
| Max. Negotiated Rate |
$15,252.96 |
| Rate for Payer: Aetna Commercial |
$12,234.15
|
| Rate for Payer: Anthem Medicaid |
$5,464.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,393.03
|
| Rate for Payer: Cash Price |
$7,944.25
|
| Rate for Payer: Cigna Commercial |
$13,187.45
|
| Rate for Payer: First Health Commercial |
$15,094.08
|
| Rate for Payer: Humana Commercial |
$13,505.23
|
| Rate for Payer: Humana KY Medicaid |
$5,464.06
|
| Rate for Payer: Kentucky WC Medicaid |
$5,519.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,028.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,725.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,766.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,573.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,981.88
|
| Rate for Payer: Ohio Health Group HMO |
$11,916.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,710.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,823.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,963.07
|
| Rate for Payer: PHCS Commercial |
$15,252.96
|
| Rate for Payer: United Healthcare All Payer |
$13,981.88
|
|
|
G2 CONST INSERT SZ 3-4 13MM
|
Facility
|
IP
|
$15,888.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,766.55 |
| Max. Negotiated Rate |
$15,252.96 |
| Rate for Payer: Aetna Commercial |
$12,234.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,393.03
|
| Rate for Payer: Cash Price |
$7,944.25
|
| Rate for Payer: Cigna Commercial |
$13,187.45
|
| Rate for Payer: First Health Commercial |
$15,094.08
|
| Rate for Payer: Humana Commercial |
$13,505.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,028.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,725.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,766.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,981.88
|
| Rate for Payer: Ohio Health Group HMO |
$11,916.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,710.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,823.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,963.07
|
| Rate for Payer: PHCS Commercial |
$15,252.96
|
| Rate for Payer: United Healthcare All Payer |
$13,981.88
|
|
|
G2 CONST INSERT SZ 3-4 15MM
|
Facility
|
OP
|
$15,888.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,766.55 |
| Max. Negotiated Rate |
$15,252.96 |
| Rate for Payer: Aetna Commercial |
$12,234.15
|
| Rate for Payer: Anthem Medicaid |
$5,464.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,393.03
|
| Rate for Payer: Cash Price |
$7,944.25
|
| Rate for Payer: Cigna Commercial |
$13,187.45
|
| Rate for Payer: First Health Commercial |
$15,094.08
|
| Rate for Payer: Humana Commercial |
$13,505.23
|
| Rate for Payer: Humana KY Medicaid |
$5,464.06
|
| Rate for Payer: Kentucky WC Medicaid |
$5,519.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,028.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,725.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,766.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,573.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,981.88
|
| Rate for Payer: Ohio Health Group HMO |
$11,916.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,710.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,823.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,963.07
|
| Rate for Payer: PHCS Commercial |
$15,252.96
|
| Rate for Payer: United Healthcare All Payer |
$13,981.88
|
|
|
G2 CONST INSERT SZ 3-4 15MM
|
Facility
|
IP
|
$15,888.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,766.55 |
| Max. Negotiated Rate |
$15,252.96 |
| Rate for Payer: Aetna Commercial |
$12,234.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,393.03
|
| Rate for Payer: Cash Price |
$7,944.25
|
| Rate for Payer: Cigna Commercial |
$13,187.45
|
| Rate for Payer: First Health Commercial |
$15,094.08
|
| Rate for Payer: Humana Commercial |
$13,505.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,028.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,725.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,766.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,981.88
|
| Rate for Payer: Ohio Health Group HMO |
$11,916.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,710.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,823.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,963.07
|
| Rate for Payer: PHCS Commercial |
$15,252.96
|
| Rate for Payer: United Healthcare All Payer |
$13,981.88
|
|
|
G2 CONST INSERT SZ 3-4 18MM
|
Facility
|
IP
|
$15,888.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,766.55 |
| Max. Negotiated Rate |
$15,252.96 |
| Rate for Payer: Aetna Commercial |
$12,234.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,393.03
|
| Rate for Payer: Cash Price |
$7,944.25
|
| Rate for Payer: Cigna Commercial |
$13,187.45
|
| Rate for Payer: First Health Commercial |
$15,094.08
|
| Rate for Payer: Humana Commercial |
$13,505.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,028.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,725.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,766.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,981.88
|
| Rate for Payer: Ohio Health Group HMO |
$11,916.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,710.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,823.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,963.07
|
| Rate for Payer: PHCS Commercial |
$15,252.96
|
| Rate for Payer: United Healthcare All Payer |
$13,981.88
|
|
|
G2 CONST INSERT SZ 3-4 18MM
|
Facility
|
OP
|
$15,888.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,766.55 |
| Max. Negotiated Rate |
$15,252.96 |
| Rate for Payer: Aetna Commercial |
$12,234.15
|
| Rate for Payer: Anthem Medicaid |
$5,464.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,393.03
|
| Rate for Payer: Cash Price |
$7,944.25
|
| Rate for Payer: Cigna Commercial |
$13,187.45
|
| Rate for Payer: First Health Commercial |
$15,094.08
|
| Rate for Payer: Humana Commercial |
$13,505.23
|
| Rate for Payer: Humana KY Medicaid |
$5,464.06
|
| Rate for Payer: Kentucky WC Medicaid |
$5,519.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,028.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,725.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,766.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,573.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,981.88
|
| Rate for Payer: Ohio Health Group HMO |
$11,916.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,710.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,823.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,963.07
|
| Rate for Payer: PHCS Commercial |
$15,252.96
|
| Rate for Payer: United Healthcare All Payer |
$13,981.88
|
|
|
G2 CONST INSERT SZ 3-4 21MM
|
Facility
|
IP
|
$9,307.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,792.21 |
| Max. Negotiated Rate |
$8,935.08 |
| Rate for Payer: Aetna Commercial |
$7,166.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,259.76
|
| Rate for Payer: Cash Price |
$4,653.69
|
| Rate for Payer: Cigna Commercial |
$7,725.13
|
| Rate for Payer: First Health Commercial |
$8,842.01
|
| Rate for Payer: Humana Commercial |
$7,911.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,632.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,868.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,792.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,190.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,980.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,445.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,097.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,422.09
|
| Rate for Payer: PHCS Commercial |
$8,935.08
|
| Rate for Payer: United Healthcare All Payer |
$8,190.49
|
|
|
G2 CONST INSERT SZ 3-4 21MM
|
Facility
|
OP
|
$9,307.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,792.21 |
| Max. Negotiated Rate |
$8,935.08 |
| Rate for Payer: Aetna Commercial |
$7,166.68
|
| Rate for Payer: Anthem Medicaid |
$3,200.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,259.76
|
| Rate for Payer: Cash Price |
$4,653.69
|
| Rate for Payer: Cigna Commercial |
$7,725.13
|
| Rate for Payer: First Health Commercial |
$8,842.01
|
| Rate for Payer: Humana Commercial |
$7,911.27
|
| Rate for Payer: Humana KY Medicaid |
$3,200.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,233.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,632.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,868.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,792.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,265.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,190.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,980.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,445.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,097.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,422.09
|
| Rate for Payer: PHCS Commercial |
$8,935.08
|
| Rate for Payer: United Healthcare All Payer |
$8,190.49
|
|
|
G2 CONST INSERT SZ 3-4 25MM
|
Facility
|
OP
|
$9,307.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,792.21 |
| Max. Negotiated Rate |
$8,935.08 |
| Rate for Payer: Aetna Commercial |
$7,166.68
|
| Rate for Payer: Anthem Medicaid |
$3,200.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,259.76
|
| Rate for Payer: Cash Price |
$4,653.69
|
| Rate for Payer: Cigna Commercial |
$7,725.13
|
| Rate for Payer: First Health Commercial |
$8,842.01
|
| Rate for Payer: Humana Commercial |
$7,911.27
|
| Rate for Payer: Humana KY Medicaid |
$3,200.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,233.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,632.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,868.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,792.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,265.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,190.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,980.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,445.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,097.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,422.09
|
| Rate for Payer: PHCS Commercial |
$8,935.08
|
| Rate for Payer: United Healthcare All Payer |
$8,190.49
|
|
|
G2 CONST INSERT SZ 3-4 25MM
|
Facility
|
IP
|
$9,307.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,792.21 |
| Max. Negotiated Rate |
$8,935.08 |
| Rate for Payer: Aetna Commercial |
$7,166.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,259.76
|
| Rate for Payer: Cash Price |
$4,653.69
|
| Rate for Payer: Cigna Commercial |
$7,725.13
|
| Rate for Payer: First Health Commercial |
$8,842.01
|
| Rate for Payer: Humana Commercial |
$7,911.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,632.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,868.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,792.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,190.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,980.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,445.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,097.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,422.09
|
| Rate for Payer: PHCS Commercial |
$8,935.08
|
| Rate for Payer: United Healthcare All Payer |
$8,190.49
|
|
|
G2 CONST INSERT SZ 3-4 30MM
|
Facility
|
IP
|
$9,307.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,792.21 |
| Max. Negotiated Rate |
$8,935.08 |
| Rate for Payer: Aetna Commercial |
$7,166.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,259.76
|
| Rate for Payer: Cash Price |
$4,653.69
|
| Rate for Payer: Cigna Commercial |
$7,725.13
|
| Rate for Payer: First Health Commercial |
$8,842.01
|
| Rate for Payer: Humana Commercial |
$7,911.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,632.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,868.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,792.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,190.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,980.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,445.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,097.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,422.09
|
| Rate for Payer: PHCS Commercial |
$8,935.08
|
| Rate for Payer: United Healthcare All Payer |
$8,190.49
|
|
|
G2 CONST INSERT SZ 3-4 30MM
|
Facility
|
OP
|
$9,307.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,792.21 |
| Max. Negotiated Rate |
$8,935.08 |
| Rate for Payer: Aetna Commercial |
$7,166.68
|
| Rate for Payer: Anthem Medicaid |
$3,200.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,259.76
|
| Rate for Payer: Cash Price |
$4,653.69
|
| Rate for Payer: Cigna Commercial |
$7,725.13
|
| Rate for Payer: First Health Commercial |
$8,842.01
|
| Rate for Payer: Humana Commercial |
$7,911.27
|
| Rate for Payer: Humana KY Medicaid |
$3,200.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,233.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,632.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,868.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,792.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,265.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,190.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,980.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,445.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,097.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,422.09
|
| Rate for Payer: PHCS Commercial |
$8,935.08
|
| Rate for Payer: United Healthcare All Payer |
$8,190.49
|
|
|
G2 CONST INSERT SZ 5-6 11MM
|
Facility
|
OP
|
$15,888.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,766.55 |
| Max. Negotiated Rate |
$15,252.96 |
| Rate for Payer: Aetna Commercial |
$12,234.15
|
| Rate for Payer: Anthem Medicaid |
$5,464.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,393.03
|
| Rate for Payer: Cash Price |
$7,944.25
|
| Rate for Payer: Cigna Commercial |
$13,187.45
|
| Rate for Payer: First Health Commercial |
$15,094.08
|
| Rate for Payer: Humana Commercial |
$13,505.23
|
| Rate for Payer: Humana KY Medicaid |
$5,464.06
|
| Rate for Payer: Kentucky WC Medicaid |
$5,519.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,028.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,725.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,766.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,573.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,981.88
|
| Rate for Payer: Ohio Health Group HMO |
$11,916.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,710.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,823.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,963.07
|
| Rate for Payer: PHCS Commercial |
$15,252.96
|
| Rate for Payer: United Healthcare All Payer |
$13,981.88
|
|
|
G2 CONST INSERT SZ 5-6 11MM
|
Facility
|
IP
|
$15,888.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,766.55 |
| Max. Negotiated Rate |
$15,252.96 |
| Rate for Payer: Aetna Commercial |
$12,234.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,393.03
|
| Rate for Payer: Cash Price |
$7,944.25
|
| Rate for Payer: Cigna Commercial |
$13,187.45
|
| Rate for Payer: First Health Commercial |
$15,094.08
|
| Rate for Payer: Humana Commercial |
$13,505.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,028.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,725.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,766.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,981.88
|
| Rate for Payer: Ohio Health Group HMO |
$11,916.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,710.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,823.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,963.07
|
| Rate for Payer: PHCS Commercial |
$15,252.96
|
| Rate for Payer: United Healthcare All Payer |
$13,981.88
|
|
|
G2 CONST INSERT SZ 5-6 13MM
|
Facility
|
OP
|
$15,888.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,766.55 |
| Max. Negotiated Rate |
$15,252.96 |
| Rate for Payer: Aetna Commercial |
$12,234.15
|
| Rate for Payer: Anthem Medicaid |
$5,464.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,393.03
|
| Rate for Payer: Cash Price |
$7,944.25
|
| Rate for Payer: Cigna Commercial |
$13,187.45
|
| Rate for Payer: First Health Commercial |
$15,094.08
|
| Rate for Payer: Humana Commercial |
$13,505.23
|
| Rate for Payer: Humana KY Medicaid |
$5,464.06
|
| Rate for Payer: Kentucky WC Medicaid |
$5,519.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,028.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,725.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,766.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,573.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,981.88
|
| Rate for Payer: Ohio Health Group HMO |
$11,916.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,710.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,823.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,963.07
|
| Rate for Payer: PHCS Commercial |
$15,252.96
|
| Rate for Payer: United Healthcare All Payer |
$13,981.88
|
|
|
G2 CONST INSERT SZ 5-6 13MM
|
Facility
|
IP
|
$15,888.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,766.55 |
| Max. Negotiated Rate |
$15,252.96 |
| Rate for Payer: Aetna Commercial |
$12,234.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,393.03
|
| Rate for Payer: Cash Price |
$7,944.25
|
| Rate for Payer: Cigna Commercial |
$13,187.45
|
| Rate for Payer: First Health Commercial |
$15,094.08
|
| Rate for Payer: Humana Commercial |
$13,505.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,028.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,725.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,766.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,981.88
|
| Rate for Payer: Ohio Health Group HMO |
$11,916.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,710.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,823.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,963.07
|
| Rate for Payer: PHCS Commercial |
$15,252.96
|
| Rate for Payer: United Healthcare All Payer |
$13,981.88
|
|
|
G2 CONST INSERT SZ 5-6 15MM
|
Facility
|
IP
|
$15,888.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,766.55 |
| Max. Negotiated Rate |
$15,252.96 |
| Rate for Payer: Aetna Commercial |
$12,234.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,393.03
|
| Rate for Payer: Cash Price |
$7,944.25
|
| Rate for Payer: Cigna Commercial |
$13,187.45
|
| Rate for Payer: First Health Commercial |
$15,094.08
|
| Rate for Payer: Humana Commercial |
$13,505.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,028.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,725.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,766.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,981.88
|
| Rate for Payer: Ohio Health Group HMO |
$11,916.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,710.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,823.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,963.07
|
| Rate for Payer: PHCS Commercial |
$15,252.96
|
| Rate for Payer: United Healthcare All Payer |
$13,981.88
|
|
|
G2 CONST INSERT SZ 5-6 15MM
|
Facility
|
OP
|
$15,888.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,766.55 |
| Max. Negotiated Rate |
$15,252.96 |
| Rate for Payer: Aetna Commercial |
$12,234.15
|
| Rate for Payer: Anthem Medicaid |
$5,464.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,393.03
|
| Rate for Payer: Cash Price |
$7,944.25
|
| Rate for Payer: Cigna Commercial |
$13,187.45
|
| Rate for Payer: First Health Commercial |
$15,094.08
|
| Rate for Payer: Humana Commercial |
$13,505.23
|
| Rate for Payer: Humana KY Medicaid |
$5,464.06
|
| Rate for Payer: Kentucky WC Medicaid |
$5,519.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,028.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,725.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,766.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,573.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,981.88
|
| Rate for Payer: Ohio Health Group HMO |
$11,916.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,710.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,823.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,963.07
|
| Rate for Payer: PHCS Commercial |
$15,252.96
|
| Rate for Payer: United Healthcare All Payer |
$13,981.88
|
|
|
G2 CONST INSERT SZ 5-6 18MM
|
Facility
|
OP
|
$13,996.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,198.86 |
| Max. Negotiated Rate |
$13,436.35 |
| Rate for Payer: Aetna Commercial |
$10,777.07
|
| Rate for Payer: Anthem Medicaid |
$4,813.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,917.04
|
| Rate for Payer: Cash Price |
$6,998.10
|
| Rate for Payer: Cigna Commercial |
$11,616.85
|
| Rate for Payer: First Health Commercial |
$13,296.39
|
| Rate for Payer: Humana Commercial |
$11,896.77
|
| Rate for Payer: Humana KY Medicaid |
$4,813.29
|
| Rate for Payer: Kentucky WC Medicaid |
$4,862.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,476.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,329.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,198.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,909.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,316.66
|
| Rate for Payer: Ohio Health Group HMO |
$10,497.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,176.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,657.38
|
| Rate for Payer: PHCS Commercial |
$13,436.35
|
| Rate for Payer: United Healthcare All Payer |
$12,316.66
|
|
|
G2 CONST INSERT SZ 5-6 18MM
|
Facility
|
IP
|
$13,996.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,198.86 |
| Max. Negotiated Rate |
$13,436.35 |
| Rate for Payer: Aetna Commercial |
$10,777.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,917.04
|
| Rate for Payer: Cash Price |
$6,998.10
|
| Rate for Payer: Cigna Commercial |
$11,616.85
|
| Rate for Payer: First Health Commercial |
$13,296.39
|
| Rate for Payer: Humana Commercial |
$11,896.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,476.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,329.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,198.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,316.66
|
| Rate for Payer: Ohio Health Group HMO |
$10,497.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,176.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,657.38
|
| Rate for Payer: PHCS Commercial |
$13,436.35
|
| Rate for Payer: United Healthcare All Payer |
$12,316.66
|
|
