|
GII PS INSERT SZ 3-4 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 3-4 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 3-4 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 3-4 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 5-6 11MM
|
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 5-6 11MM
|
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 5-6 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 5-6 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 5-6 15MM
|
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 5-6 15MM
|
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 5-6 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 5-6 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 5-6 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 5-6 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 5-6 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 5-6 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 5-6 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 5-6 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 7-8 11MM
|
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 7-8 11MM
|
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 7-8 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 7-8 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 7-8 15MM
|
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 7-8 15MM
|
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 7-8 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
|
|
