|
GII PS HI FLEX INSRT SZ 7-8 25
|
Facility
|
IP
|
$5,084.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$660.92 |
| Max. Negotiated Rate |
$4,880.64 |
| Rate for Payer: Aetna Commercial |
$3,914.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,965.52
|
| Rate for Payer: Cash Price |
$2,542.00
|
| Rate for Payer: Cigna Commercial |
$4,219.72
|
| Rate for Payer: First Health Commercial |
$4,829.80
|
| Rate for Payer: Humana Commercial |
$4,321.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,168.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,751.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,525.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,473.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,813.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,016.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$660.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,576.04
|
| Rate for Payer: PHCS Commercial |
$4,880.64
|
| Rate for Payer: United Healthcare All Payer |
$4,473.92
|
|
|
GII PS HI FLEX INSRT SZ 7-8 9
|
Facility
|
OP
|
$8,815.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,145.98 |
| Max. Negotiated Rate |
$8,462.59 |
| Rate for Payer: Aetna Commercial |
$6,787.70
|
| Rate for Payer: Anthem Medicaid |
$3,031.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,875.86
|
| Rate for Payer: Cash Price |
$4,407.60
|
| Rate for Payer: Cigna Commercial |
$7,316.62
|
| Rate for Payer: First Health Commercial |
$8,374.44
|
| Rate for Payer: Humana Commercial |
$7,492.92
|
| Rate for Payer: Humana KY Medicaid |
$3,031.55
|
| Rate for Payer: Kentucky WC Medicaid |
$3,062.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,228.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,505.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,644.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,092.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,757.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,611.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,763.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,145.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,732.71
|
| Rate for Payer: PHCS Commercial |
$8,462.59
|
| Rate for Payer: United Healthcare All Payer |
$7,757.38
|
|
|
GII PS HI FLEX INSRT SZ 7-8 9
|
Facility
|
IP
|
$8,815.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,145.98 |
| Max. Negotiated Rate |
$8,462.59 |
| Rate for Payer: Aetna Commercial |
$6,787.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,875.86
|
| Rate for Payer: Cash Price |
$4,407.60
|
| Rate for Payer: Cigna Commercial |
$7,316.62
|
| Rate for Payer: First Health Commercial |
$8,374.44
|
| Rate for Payer: Humana Commercial |
$7,492.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,228.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,505.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,644.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,757.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,611.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,763.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,145.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,732.71
|
| Rate for Payer: PHCS Commercial |
$8,462.59
|
| Rate for Payer: United Healthcare All Payer |
$7,757.38
|
|
|
GII PS INSERT SZ 1-2 11MM
|
Facility
|
IP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
GII PS INSERT SZ 1-2 11MM
|
Facility
|
OP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem Medicaid |
$1,767.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Humana KY Medicaid |
$1,767.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,785.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,803.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
GII PS INSERT SZ 1-2 13MM
|
Facility
|
OP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem Medicaid |
$1,767.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Humana KY Medicaid |
$1,767.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,785.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,803.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
GII PS INSERT SZ 1-2 13MM
|
Facility
|
IP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
GII PS INSERT SZ 1-2 15MM
|
Facility
|
IP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
GII PS INSERT SZ 1-2 15MM
|
Facility
|
OP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem Medicaid |
$1,767.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Humana KY Medicaid |
$1,767.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,785.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,803.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
GII PS INSERT SZ 1-2 18MM
|
Facility
|
OP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem Medicaid |
$1,767.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Humana KY Medicaid |
$1,767.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,785.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,803.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
GII PS INSERT SZ 1-2 18MM
|
Facility
|
IP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
GII PS INSERT SZ 1-2 21MM
|
Facility
|
OP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem Medicaid |
$1,767.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Humana KY Medicaid |
$1,767.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,785.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,803.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
GII PS INSERT SZ 1-2 21MM
|
Facility
|
IP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
GII PS INSERT SZ 1-2 25MM
|
Facility
|
IP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
GII PS INSERT SZ 1-2 25MM
|
Facility
|
OP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem Medicaid |
$1,767.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Humana KY Medicaid |
$1,767.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,785.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,803.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
GII PS INSERT SZ 1-2 9MM
|
Facility
|
IP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
GII PS INSERT SZ 1-2 9MM
|
Facility
|
OP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem Medicaid |
$1,767.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Humana KY Medicaid |
$1,767.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,785.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,803.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
GII PS INSERT SZ 3-4 11MM
|
Facility
|
IP
|
$4,685.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.05 |
| Max. Negotiated Rate |
$4,497.60 |
| Rate for Payer: Aetna Commercial |
$3,607.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,654.30
|
| Rate for Payer: Cash Price |
$2,342.50
|
| Rate for Payer: Cigna Commercial |
$3,888.55
|
| Rate for Payer: First Health Commercial |
$4,450.75
|
| Rate for Payer: Humana Commercial |
$3,982.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,841.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,457.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,405.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,122.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,513.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,452.35
|
| Rate for Payer: PHCS Commercial |
$4,497.60
|
| Rate for Payer: United Healthcare All Payer |
$4,122.80
|
|
|
GII PS INSERT SZ 3-4 11MM
|
Facility
|
OP
|
$4,685.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.05 |
| Max. Negotiated Rate |
$4,497.60 |
| Rate for Payer: Aetna Commercial |
$3,607.45
|
| Rate for Payer: Anthem Medicaid |
$1,611.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,654.30
|
| Rate for Payer: Cash Price |
$2,342.50
|
| Rate for Payer: Cigna Commercial |
$3,888.55
|
| Rate for Payer: First Health Commercial |
$4,450.75
|
| Rate for Payer: Humana Commercial |
$3,982.25
|
| Rate for Payer: Humana KY Medicaid |
$1,611.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,627.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,841.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,457.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,405.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,643.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,122.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,513.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,452.35
|
| Rate for Payer: PHCS Commercial |
$4,497.60
|
| Rate for Payer: United Healthcare All Payer |
$4,122.80
|
|
|
GII PS INSERT SZ 3-4 13MM
|
Facility
|
IP
|
$4,776.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$620.88 |
| Max. Negotiated Rate |
$4,584.96 |
| Rate for Payer: Aetna Commercial |
$3,677.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,725.28
|
| Rate for Payer: Cash Price |
$2,388.00
|
| Rate for Payer: Cigna Commercial |
$3,964.08
|
| Rate for Payer: First Health Commercial |
$4,537.20
|
| Rate for Payer: Humana Commercial |
$4,059.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,916.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,524.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,432.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,202.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,582.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$955.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$620.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,480.56
|
| Rate for Payer: PHCS Commercial |
$4,584.96
|
| Rate for Payer: United Healthcare All Payer |
$4,202.88
|
|
|
GII PS INSERT SZ 3-4 13MM
|
Facility
|
OP
|
$4,776.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$620.88 |
| Max. Negotiated Rate |
$4,584.96 |
| Rate for Payer: Aetna Commercial |
$3,677.52
|
| Rate for Payer: Anthem Medicaid |
$1,642.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,725.28
|
| Rate for Payer: Cash Price |
$2,388.00
|
| Rate for Payer: Cigna Commercial |
$3,964.08
|
| Rate for Payer: First Health Commercial |
$4,537.20
|
| Rate for Payer: Humana Commercial |
$4,059.60
|
| Rate for Payer: Humana KY Medicaid |
$1,642.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,659.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,916.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,524.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,432.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,675.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,202.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,582.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$955.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$620.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,480.56
|
| Rate for Payer: PHCS Commercial |
$4,584.96
|
| Rate for Payer: United Healthcare All Payer |
$4,202.88
|
|
|
GII PS INSERT SZ 3-4 18MM
|
Facility
|
OP
|
$4,776.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$620.88 |
| Max. Negotiated Rate |
$4,584.96 |
| Rate for Payer: Aetna Commercial |
$3,677.52
|
| Rate for Payer: Anthem Medicaid |
$1,642.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,725.28
|
| Rate for Payer: Cash Price |
$2,388.00
|
| Rate for Payer: Cigna Commercial |
$3,964.08
|
| Rate for Payer: First Health Commercial |
$4,537.20
|
| Rate for Payer: Humana Commercial |
$4,059.60
|
| Rate for Payer: Humana KY Medicaid |
$1,642.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,659.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,916.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,524.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,432.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,675.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,202.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,582.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$955.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$620.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,480.56
|
| Rate for Payer: PHCS Commercial |
$4,584.96
|
| Rate for Payer: United Healthcare All Payer |
$4,202.88
|
|
|
GII PS INSERT SZ 3-4 18MM
|
Facility
|
IP
|
$4,776.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$620.88 |
| Max. Negotiated Rate |
$4,584.96 |
| Rate for Payer: Aetna Commercial |
$3,677.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,725.28
|
| Rate for Payer: Cash Price |
$2,388.00
|
| Rate for Payer: Cigna Commercial |
$3,964.08
|
| Rate for Payer: First Health Commercial |
$4,537.20
|
| Rate for Payer: Humana Commercial |
$4,059.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,916.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,524.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,432.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,202.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,582.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$955.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$620.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,480.56
|
| Rate for Payer: PHCS Commercial |
$4,584.96
|
| Rate for Payer: United Healthcare All Payer |
$4,202.88
|
|
|
GII PS INSERT SZ 3-4 21MM
|
Facility
|
IP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
GII PS INSERT SZ 3-4 21MM
|
Facility
|
OP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem Medicaid |
$1,767.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Humana KY Medicaid |
$1,767.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,785.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,803.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
