|
GMRS FLUTD STEM EXT 23MM*155MM
|
Facility
|
IP
|
$4,994.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$649.27 |
| Max. Negotiated Rate |
$4,794.62 |
| Rate for Payer: Aetna Commercial |
$3,845.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,895.63
|
| Rate for Payer: Cash Price |
$2,497.20
|
| Rate for Payer: Cigna Commercial |
$4,145.35
|
| Rate for Payer: First Health Commercial |
$4,744.68
|
| Rate for Payer: Humana Commercial |
$4,245.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,095.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,685.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,498.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,395.07
|
| Rate for Payer: Ohio Health Group HMO |
$3,745.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$649.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,548.26
|
| Rate for Payer: PHCS Commercial |
$4,794.62
|
| Rate for Payer: United Healthcare All Payer |
$4,395.07
|
|
|
GMRS FLUTED STEM EXT 10MM*80MM
|
Facility
|
OP
|
$4,994.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$649.27 |
| Max. Negotiated Rate |
$4,794.62 |
| Rate for Payer: Aetna Commercial |
$3,845.69
|
| Rate for Payer: Anthem Medicaid |
$1,717.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,895.63
|
| Rate for Payer: Cash Price |
$2,497.20
|
| Rate for Payer: Cigna Commercial |
$4,145.35
|
| Rate for Payer: First Health Commercial |
$4,744.68
|
| Rate for Payer: Humana Commercial |
$4,245.24
|
| Rate for Payer: Humana KY Medicaid |
$1,717.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,735.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,095.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,685.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,498.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,752.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,395.07
|
| Rate for Payer: Ohio Health Group HMO |
$3,745.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$649.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,548.26
|
| Rate for Payer: PHCS Commercial |
$4,794.62
|
| Rate for Payer: United Healthcare All Payer |
$4,395.07
|
|
|
GMRS FLUTED STEM EXT 10MM*80MM
|
Facility
|
IP
|
$4,994.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$649.27 |
| Max. Negotiated Rate |
$4,794.62 |
| Rate for Payer: Aetna Commercial |
$3,845.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,895.63
|
| Rate for Payer: Cash Price |
$2,497.20
|
| Rate for Payer: Cigna Commercial |
$4,145.35
|
| Rate for Payer: First Health Commercial |
$4,744.68
|
| Rate for Payer: Humana Commercial |
$4,245.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,095.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,685.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,498.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,395.07
|
| Rate for Payer: Ohio Health Group HMO |
$3,745.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$649.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,548.26
|
| Rate for Payer: PHCS Commercial |
$4,794.62
|
| Rate for Payer: United Healthcare All Payer |
$4,395.07
|
|
|
GMRS FLUTED STEM EXT 11MM*80MM
|
Facility
|
OP
|
$4,994.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$649.27 |
| Max. Negotiated Rate |
$4,794.62 |
| Rate for Payer: Aetna Commercial |
$3,845.69
|
| Rate for Payer: Anthem Medicaid |
$1,717.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,895.63
|
| Rate for Payer: Cash Price |
$2,497.20
|
| Rate for Payer: Cigna Commercial |
$4,145.35
|
| Rate for Payer: First Health Commercial |
$4,744.68
|
| Rate for Payer: Humana Commercial |
$4,245.24
|
| Rate for Payer: Humana KY Medicaid |
$1,717.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,735.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,095.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,685.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,498.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,752.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,395.07
|
| Rate for Payer: Ohio Health Group HMO |
$3,745.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$649.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,548.26
|
| Rate for Payer: PHCS Commercial |
$4,794.62
|
| Rate for Payer: United Healthcare All Payer |
$4,395.07
|
|
|
GMRS FLUTED STEM EXT 11MM*80MM
|
Facility
|
IP
|
$4,994.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$649.27 |
| Max. Negotiated Rate |
$4,794.62 |
| Rate for Payer: Aetna Commercial |
$3,845.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,895.63
|
| Rate for Payer: Cash Price |
$2,497.20
|
| Rate for Payer: Cigna Commercial |
$4,145.35
|
| Rate for Payer: First Health Commercial |
$4,744.68
|
| Rate for Payer: Humana Commercial |
$4,245.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,095.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,685.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,498.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,395.07
|
| Rate for Payer: Ohio Health Group HMO |
$3,745.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$649.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,548.26
|
| Rate for Payer: PHCS Commercial |
$4,794.62
|
| Rate for Payer: United Healthcare All Payer |
$4,395.07
|
|
|
GMRS FLUTED STEM EXT 12MM*80MM
|
Facility
|
OP
|
$5,520.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$717.70 |
| Max. Negotiated Rate |
$5,299.97 |
| Rate for Payer: Aetna Commercial |
$4,251.02
|
| Rate for Payer: Anthem Medicaid |
$1,898.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,306.22
|
| Rate for Payer: Cash Price |
$2,760.40
|
| Rate for Payer: Cigna Commercial |
$4,582.26
|
| Rate for Payer: First Health Commercial |
$5,244.76
|
| Rate for Payer: Humana Commercial |
$4,692.68
|
| Rate for Payer: Humana KY Medicaid |
$1,898.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,917.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,527.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,074.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,656.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,936.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,858.30
|
| Rate for Payer: Ohio Health Group HMO |
$4,140.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,104.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,711.45
|
| Rate for Payer: PHCS Commercial |
$5,299.97
|
| Rate for Payer: United Healthcare All Payer |
$4,858.30
|
|
|
GMRS FLUTED STEM EXT 12MM*80MM
|
Facility
|
IP
|
$5,520.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$717.70 |
| Max. Negotiated Rate |
$5,299.97 |
| Rate for Payer: Aetna Commercial |
$4,251.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,306.22
|
| Rate for Payer: Cash Price |
$2,760.40
|
| Rate for Payer: Cigna Commercial |
$4,582.26
|
| Rate for Payer: First Health Commercial |
$5,244.76
|
| Rate for Payer: Humana Commercial |
$4,692.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,527.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,074.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,656.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,858.30
|
| Rate for Payer: Ohio Health Group HMO |
$4,140.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,104.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,711.45
|
| Rate for Payer: PHCS Commercial |
$5,299.97
|
| Rate for Payer: United Healthcare All Payer |
$4,858.30
|
|
|
GMRS FLUTED STEM EXT 13MM*80MM
|
Facility
|
IP
|
$7,174.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$932.64 |
| Max. Negotiated Rate |
$6,887.19 |
| Rate for Payer: Aetna Commercial |
$5,524.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,595.84
|
| Rate for Payer: Cash Price |
$3,587.08
|
| Rate for Payer: Cigna Commercial |
$5,954.55
|
| Rate for Payer: First Health Commercial |
$6,815.45
|
| Rate for Payer: Humana Commercial |
$6,098.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,882.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,294.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,152.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,313.26
|
| Rate for Payer: Ohio Health Group HMO |
$5,380.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,434.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$932.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,223.99
|
| Rate for Payer: PHCS Commercial |
$6,887.19
|
| Rate for Payer: United Healthcare All Payer |
$6,313.26
|
|
|
GMRS FLUTED STEM EXT 13MM*80MM
|
Facility
|
OP
|
$7,174.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$932.64 |
| Max. Negotiated Rate |
$6,887.19 |
| Rate for Payer: Aetna Commercial |
$5,524.10
|
| Rate for Payer: Anthem Medicaid |
$2,467.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,595.84
|
| Rate for Payer: Cash Price |
$3,587.08
|
| Rate for Payer: Cigna Commercial |
$5,954.55
|
| Rate for Payer: First Health Commercial |
$6,815.45
|
| Rate for Payer: Humana Commercial |
$6,098.04
|
| Rate for Payer: Humana KY Medicaid |
$2,467.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,492.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,882.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,294.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,152.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,516.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,313.26
|
| Rate for Payer: Ohio Health Group HMO |
$5,380.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,434.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$932.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,223.99
|
| Rate for Payer: PHCS Commercial |
$6,887.19
|
| Rate for Payer: United Healthcare All Payer |
$6,313.26
|
|
|
GMRS FLUTED STEM EXT 14MM*80MM
|
Facility
|
IP
|
$7,004.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$910.62 |
| Max. Negotiated Rate |
$6,724.61 |
| Rate for Payer: Aetna Commercial |
$5,393.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,463.74
|
| Rate for Payer: Cash Price |
$3,502.40
|
| Rate for Payer: Cigna Commercial |
$5,813.98
|
| Rate for Payer: First Health Commercial |
$6,654.56
|
| Rate for Payer: Humana Commercial |
$5,954.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,743.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,169.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,101.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,164.22
|
| Rate for Payer: Ohio Health Group HMO |
$5,253.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,400.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$910.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,171.49
|
| Rate for Payer: PHCS Commercial |
$6,724.61
|
| Rate for Payer: United Healthcare All Payer |
$6,164.22
|
|
|
GMRS FLUTED STEM EXT 14MM*80MM
|
Facility
|
OP
|
$7,004.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$910.62 |
| Max. Negotiated Rate |
$6,724.61 |
| Rate for Payer: Aetna Commercial |
$5,393.70
|
| Rate for Payer: Anthem Medicaid |
$2,408.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,463.74
|
| Rate for Payer: Cash Price |
$3,502.40
|
| Rate for Payer: Cigna Commercial |
$5,813.98
|
| Rate for Payer: First Health Commercial |
$6,654.56
|
| Rate for Payer: Humana Commercial |
$5,954.08
|
| Rate for Payer: Humana KY Medicaid |
$2,408.95
|
| Rate for Payer: Kentucky WC Medicaid |
$2,433.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,743.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,169.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,101.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,457.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,164.22
|
| Rate for Payer: Ohio Health Group HMO |
$5,253.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,400.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$910.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,171.49
|
| Rate for Payer: PHCS Commercial |
$6,724.61
|
| Rate for Payer: United Healthcare All Payer |
$6,164.22
|
|
|
GMRS FLUTED STEM EXT 15MM*80MM
|
Facility
|
OP
|
$7,004.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$910.62 |
| Max. Negotiated Rate |
$6,724.61 |
| Rate for Payer: Aetna Commercial |
$5,393.70
|
| Rate for Payer: Anthem Medicaid |
$2,408.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,463.74
|
| Rate for Payer: Cash Price |
$3,502.40
|
| Rate for Payer: Cigna Commercial |
$5,813.98
|
| Rate for Payer: First Health Commercial |
$6,654.56
|
| Rate for Payer: Humana Commercial |
$5,954.08
|
| Rate for Payer: Humana KY Medicaid |
$2,408.95
|
| Rate for Payer: Kentucky WC Medicaid |
$2,433.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,743.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,169.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,101.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,457.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,164.22
|
| Rate for Payer: Ohio Health Group HMO |
$5,253.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,400.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$910.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,171.49
|
| Rate for Payer: PHCS Commercial |
$6,724.61
|
| Rate for Payer: United Healthcare All Payer |
$6,164.22
|
|
|
GMRS FLUTED STEM EXT 15MM*80MM
|
Facility
|
IP
|
$7,004.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$910.62 |
| Max. Negotiated Rate |
$6,724.61 |
| Rate for Payer: Aetna Commercial |
$5,393.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,463.74
|
| Rate for Payer: Cash Price |
$3,502.40
|
| Rate for Payer: Cigna Commercial |
$5,813.98
|
| Rate for Payer: First Health Commercial |
$6,654.56
|
| Rate for Payer: Humana Commercial |
$5,954.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,743.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,169.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,101.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,164.22
|
| Rate for Payer: Ohio Health Group HMO |
$5,253.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,400.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$910.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,171.49
|
| Rate for Payer: PHCS Commercial |
$6,724.61
|
| Rate for Payer: United Healthcare All Payer |
$6,164.22
|
|
|
GMRS FLUTED STEM EXT 16MM*80MM
|
Facility
|
OP
|
$6,470.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$841.16 |
| Max. Negotiated Rate |
$6,211.62 |
| Rate for Payer: Aetna Commercial |
$4,982.24
|
| Rate for Payer: Anthem Medicaid |
$2,225.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,046.94
|
| Rate for Payer: Cash Price |
$3,235.22
|
| Rate for Payer: Cigna Commercial |
$5,370.47
|
| Rate for Payer: First Health Commercial |
$6,146.92
|
| Rate for Payer: Humana Commercial |
$5,499.87
|
| Rate for Payer: Humana KY Medicaid |
$2,225.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,247.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,305.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,775.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,941.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,269.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,693.99
|
| Rate for Payer: Ohio Health Group HMO |
$4,852.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,294.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$841.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,005.84
|
| Rate for Payer: PHCS Commercial |
$6,211.62
|
| Rate for Payer: United Healthcare All Payer |
$5,693.99
|
|
|
GMRS FLUTED STEM EXT 16MM*80MM
|
Facility
|
IP
|
$6,470.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$841.16 |
| Max. Negotiated Rate |
$6,211.62 |
| Rate for Payer: Aetna Commercial |
$4,982.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,046.94
|
| Rate for Payer: Cash Price |
$3,235.22
|
| Rate for Payer: Cigna Commercial |
$5,370.47
|
| Rate for Payer: First Health Commercial |
$6,146.92
|
| Rate for Payer: Humana Commercial |
$5,499.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,305.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,775.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,941.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,693.99
|
| Rate for Payer: Ohio Health Group HMO |
$4,852.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,294.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$841.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,005.84
|
| Rate for Payer: PHCS Commercial |
$6,211.62
|
| Rate for Payer: United Healthcare All Payer |
$5,693.99
|
|
|
GMRS FLUTED STEM EXT 17MM*80MM
|
Facility
|
OP
|
$4,994.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$649.27 |
| Max. Negotiated Rate |
$4,794.62 |
| Rate for Payer: Aetna Commercial |
$3,845.69
|
| Rate for Payer: Anthem Medicaid |
$1,717.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,895.63
|
| Rate for Payer: Cash Price |
$2,497.20
|
| Rate for Payer: Cigna Commercial |
$4,145.35
|
| Rate for Payer: First Health Commercial |
$4,744.68
|
| Rate for Payer: Humana Commercial |
$4,245.24
|
| Rate for Payer: Humana KY Medicaid |
$1,717.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,735.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,095.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,685.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,498.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,752.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,395.07
|
| Rate for Payer: Ohio Health Group HMO |
$3,745.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$649.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,548.26
|
| Rate for Payer: PHCS Commercial |
$4,794.62
|
| Rate for Payer: United Healthcare All Payer |
$4,395.07
|
|
|
GMRS FLUTED STEM EXT 17MM*80MM
|
Facility
|
IP
|
$4,994.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$649.27 |
| Max. Negotiated Rate |
$4,794.62 |
| Rate for Payer: Aetna Commercial |
$3,845.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,895.63
|
| Rate for Payer: Cash Price |
$2,497.20
|
| Rate for Payer: Cigna Commercial |
$4,145.35
|
| Rate for Payer: First Health Commercial |
$4,744.68
|
| Rate for Payer: Humana Commercial |
$4,245.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,095.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,685.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,498.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,395.07
|
| Rate for Payer: Ohio Health Group HMO |
$3,745.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$998.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$649.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,548.26
|
| Rate for Payer: PHCS Commercial |
$4,794.62
|
| Rate for Payer: United Healthcare All Payer |
$4,395.07
|
|
|
GMRS FLUTED STEM EXT 18MM*80MM
|
Facility
|
IP
|
$6,470.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$841.16 |
| Max. Negotiated Rate |
$6,211.62 |
| Rate for Payer: Aetna Commercial |
$4,982.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,046.94
|
| Rate for Payer: Cash Price |
$3,235.22
|
| Rate for Payer: Cigna Commercial |
$5,370.47
|
| Rate for Payer: First Health Commercial |
$6,146.92
|
| Rate for Payer: Humana Commercial |
$5,499.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,305.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,775.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,941.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,693.99
|
| Rate for Payer: Ohio Health Group HMO |
$4,852.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,294.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$841.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,005.84
|
| Rate for Payer: PHCS Commercial |
$6,211.62
|
| Rate for Payer: United Healthcare All Payer |
$5,693.99
|
|
|
GMRS FLUTED STEM EXT 18MM*80MM
|
Facility
|
OP
|
$6,470.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$841.16 |
| Max. Negotiated Rate |
$6,211.62 |
| Rate for Payer: Aetna Commercial |
$4,982.24
|
| Rate for Payer: Anthem Medicaid |
$2,225.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,046.94
|
| Rate for Payer: Cash Price |
$3,235.22
|
| Rate for Payer: Cigna Commercial |
$5,370.47
|
| Rate for Payer: First Health Commercial |
$6,146.92
|
| Rate for Payer: Humana Commercial |
$5,499.87
|
| Rate for Payer: Humana KY Medicaid |
$2,225.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,247.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,305.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,775.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,941.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,269.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,693.99
|
| Rate for Payer: Ohio Health Group HMO |
$4,852.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,294.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$841.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,005.84
|
| Rate for Payer: PHCS Commercial |
$6,211.62
|
| Rate for Payer: United Healthcare All Payer |
$5,693.99
|
|
|
GMRS FLUTED STEM EXT 19MM*80MM
|
Facility
|
OP
|
$6,470.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$841.16 |
| Max. Negotiated Rate |
$6,211.62 |
| Rate for Payer: Aetna Commercial |
$4,982.24
|
| Rate for Payer: Anthem Medicaid |
$2,225.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,046.94
|
| Rate for Payer: Cash Price |
$3,235.22
|
| Rate for Payer: Cigna Commercial |
$5,370.47
|
| Rate for Payer: First Health Commercial |
$6,146.92
|
| Rate for Payer: Humana Commercial |
$5,499.87
|
| Rate for Payer: Humana KY Medicaid |
$2,225.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,247.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,305.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,775.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,941.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,269.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,693.99
|
| Rate for Payer: Ohio Health Group HMO |
$4,852.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,294.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$841.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,005.84
|
| Rate for Payer: PHCS Commercial |
$6,211.62
|
| Rate for Payer: United Healthcare All Payer |
$5,693.99
|
|
|
GMRS FLUTED STEM EXT 19MM*80MM
|
Facility
|
IP
|
$6,470.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$841.16 |
| Max. Negotiated Rate |
$6,211.62 |
| Rate for Payer: Aetna Commercial |
$4,982.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,046.94
|
| Rate for Payer: Cash Price |
$3,235.22
|
| Rate for Payer: Cigna Commercial |
$5,370.47
|
| Rate for Payer: First Health Commercial |
$6,146.92
|
| Rate for Payer: Humana Commercial |
$5,499.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,305.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,775.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,941.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,693.99
|
| Rate for Payer: Ohio Health Group HMO |
$4,852.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,294.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$841.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,005.84
|
| Rate for Payer: PHCS Commercial |
$6,211.62
|
| Rate for Payer: United Healthcare All Payer |
$5,693.99
|
|
|
GMRS FLUTED STEM EXT 21MM*80MM
|
Facility
|
OP
|
$6,470.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$841.16 |
| Max. Negotiated Rate |
$6,211.62 |
| Rate for Payer: Aetna Commercial |
$4,982.24
|
| Rate for Payer: Anthem Medicaid |
$2,225.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,046.94
|
| Rate for Payer: Cash Price |
$3,235.22
|
| Rate for Payer: Cigna Commercial |
$5,370.47
|
| Rate for Payer: First Health Commercial |
$6,146.92
|
| Rate for Payer: Humana Commercial |
$5,499.87
|
| Rate for Payer: Humana KY Medicaid |
$2,225.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,247.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,305.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,775.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,941.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,269.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,693.99
|
| Rate for Payer: Ohio Health Group HMO |
$4,852.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,294.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$841.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,005.84
|
| Rate for Payer: PHCS Commercial |
$6,211.62
|
| Rate for Payer: United Healthcare All Payer |
$5,693.99
|
|
|
GMRS FLUTED STEM EXT 21MM*80MM
|
Facility
|
IP
|
$6,470.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$841.16 |
| Max. Negotiated Rate |
$6,211.62 |
| Rate for Payer: Aetna Commercial |
$4,982.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,046.94
|
| Rate for Payer: Cash Price |
$3,235.22
|
| Rate for Payer: Cigna Commercial |
$5,370.47
|
| Rate for Payer: First Health Commercial |
$6,146.92
|
| Rate for Payer: Humana Commercial |
$5,499.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,305.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,775.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,941.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,693.99
|
| Rate for Payer: Ohio Health Group HMO |
$4,852.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,294.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$841.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,005.84
|
| Rate for Payer: PHCS Commercial |
$6,211.62
|
| Rate for Payer: United Healthcare All Payer |
$5,693.99
|
|
|
GMRS FLUTED STEM EXT 23MM*80MM
|
Facility
|
OP
|
$5,520.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$717.70 |
| Max. Negotiated Rate |
$5,299.97 |
| Rate for Payer: Aetna Commercial |
$4,251.02
|
| Rate for Payer: Anthem Medicaid |
$1,898.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,306.22
|
| Rate for Payer: Cash Price |
$2,760.40
|
| Rate for Payer: Cigna Commercial |
$4,582.26
|
| Rate for Payer: First Health Commercial |
$5,244.76
|
| Rate for Payer: Humana Commercial |
$4,692.68
|
| Rate for Payer: Humana KY Medicaid |
$1,898.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,917.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,527.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,074.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,656.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,936.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,858.30
|
| Rate for Payer: Ohio Health Group HMO |
$4,140.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,104.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,711.45
|
| Rate for Payer: PHCS Commercial |
$5,299.97
|
| Rate for Payer: United Healthcare All Payer |
$4,858.30
|
|
|
GMRS FLUTED STEM EXT 23MM*80MM
|
Facility
|
IP
|
$5,520.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$717.70 |
| Max. Negotiated Rate |
$5,299.97 |
| Rate for Payer: Aetna Commercial |
$4,251.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,306.22
|
| Rate for Payer: Cash Price |
$2,760.40
|
| Rate for Payer: Cigna Commercial |
$4,582.26
|
| Rate for Payer: First Health Commercial |
$5,244.76
|
| Rate for Payer: Humana Commercial |
$4,692.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,527.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,074.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,656.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,858.30
|
| Rate for Payer: Ohio Health Group HMO |
$4,140.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,104.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,711.45
|
| Rate for Payer: PHCS Commercial |
$5,299.97
|
| Rate for Payer: United Healthcare All Payer |
$4,858.30
|
|
