|
GMRS MRH TIB INSERT 13MM M2/L2
|
Facility
|
IP
|
$7,086.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$921.25 |
| Max. Negotiated Rate |
$6,803.10 |
| Rate for Payer: Aetna Commercial |
$5,456.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,527.52
|
| Rate for Payer: Cash Price |
$3,543.28
|
| Rate for Payer: Cigna Commercial |
$5,881.84
|
| Rate for Payer: First Health Commercial |
$6,732.23
|
| Rate for Payer: Humana Commercial |
$6,023.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,810.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,229.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,125.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,236.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,314.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,417.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$921.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,196.83
|
| Rate for Payer: PHCS Commercial |
$6,803.10
|
| Rate for Payer: United Healthcare All Payer |
$6,236.17
|
|
|
GMRS MRH TIB INSERT 13MM M2/L2
|
Facility
|
OP
|
$7,086.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$921.25 |
| Max. Negotiated Rate |
$6,803.10 |
| Rate for Payer: Aetna Commercial |
$5,456.65
|
| Rate for Payer: Anthem Medicaid |
$2,437.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,527.52
|
| Rate for Payer: Cash Price |
$3,543.28
|
| Rate for Payer: Cigna Commercial |
$5,881.84
|
| Rate for Payer: First Health Commercial |
$6,732.23
|
| Rate for Payer: Humana Commercial |
$6,023.58
|
| Rate for Payer: Humana KY Medicaid |
$2,437.07
|
| Rate for Payer: Kentucky WC Medicaid |
$2,461.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,810.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,229.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,125.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,485.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,236.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,314.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,417.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$921.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,196.83
|
| Rate for Payer: PHCS Commercial |
$6,803.10
|
| Rate for Payer: United Healthcare All Payer |
$6,236.17
|
|
|
GMRS MRH TIB INSERT 13MM S1/S2
|
Facility
|
IP
|
$7,215.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.96 |
| Max. Negotiated Rate |
$6,926.44 |
| Rate for Payer: Aetna Commercial |
$5,555.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,627.73
|
| Rate for Payer: Cash Price |
$3,607.52
|
| Rate for Payer: Cigna Commercial |
$5,988.48
|
| Rate for Payer: First Health Commercial |
$6,854.29
|
| Rate for Payer: Humana Commercial |
$6,132.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,916.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,324.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,164.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,349.24
|
| Rate for Payer: Ohio Health Group HMO |
$5,411.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,443.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$937.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,236.66
|
| Rate for Payer: PHCS Commercial |
$6,926.44
|
| Rate for Payer: United Healthcare All Payer |
$6,349.24
|
|
|
GMRS MRH TIB INSERT 13MM S1/S2
|
Facility
|
OP
|
$7,215.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.96 |
| Max. Negotiated Rate |
$6,926.44 |
| Rate for Payer: Aetna Commercial |
$5,555.58
|
| Rate for Payer: Anthem Medicaid |
$2,481.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,627.73
|
| Rate for Payer: Cash Price |
$3,607.52
|
| Rate for Payer: Cigna Commercial |
$5,988.48
|
| Rate for Payer: First Health Commercial |
$6,854.29
|
| Rate for Payer: Humana Commercial |
$6,132.78
|
| Rate for Payer: Humana KY Medicaid |
$2,481.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,506.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,916.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,324.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,164.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,531.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,349.24
|
| Rate for Payer: Ohio Health Group HMO |
$5,411.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,443.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$937.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,236.66
|
| Rate for Payer: PHCS Commercial |
$6,926.44
|
| Rate for Payer: United Healthcare All Payer |
$6,349.24
|
|
|
GMRS MRH TIB INSERT 16MM M2/L2
|
Facility
|
IP
|
$6,505.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.71 |
| Max. Negotiated Rate |
$6,245.26 |
| Rate for Payer: Aetna Commercial |
$5,009.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,074.27
|
| Rate for Payer: Cash Price |
$3,252.74
|
| Rate for Payer: Cigna Commercial |
$5,399.55
|
| Rate for Payer: First Health Commercial |
$6,180.21
|
| Rate for Payer: Humana Commercial |
$5,529.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,334.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,801.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.82
|
| Rate for Payer: Ohio Health Group HMO |
$4,879.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,301.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.70
|
| Rate for Payer: PHCS Commercial |
$6,245.26
|
| Rate for Payer: United Healthcare All Payer |
$5,724.82
|
|
|
GMRS MRH TIB INSERT 16MM M2/L2
|
Facility
|
OP
|
$6,505.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.71 |
| Max. Negotiated Rate |
$6,245.26 |
| Rate for Payer: Aetna Commercial |
$5,009.22
|
| Rate for Payer: Anthem Medicaid |
$2,237.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,074.27
|
| Rate for Payer: Cash Price |
$3,252.74
|
| Rate for Payer: Cigna Commercial |
$5,399.55
|
| Rate for Payer: First Health Commercial |
$6,180.21
|
| Rate for Payer: Humana Commercial |
$5,529.66
|
| Rate for Payer: Humana KY Medicaid |
$2,237.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,260.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,334.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,801.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,282.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.82
|
| Rate for Payer: Ohio Health Group HMO |
$4,879.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,301.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.70
|
| Rate for Payer: PHCS Commercial |
$6,245.26
|
| Rate for Payer: United Healthcare All Payer |
$5,724.82
|
|
|
GMRS MRH TIB INSERT 16MM S1/S2
|
Facility
|
OP
|
$7,289.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$947.59 |
| Max. Negotiated Rate |
$6,997.57 |
| Rate for Payer: Aetna Commercial |
$5,612.64
|
| Rate for Payer: Anthem Medicaid |
$2,506.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,685.53
|
| Rate for Payer: Cash Price |
$3,644.57
|
| Rate for Payer: Cigna Commercial |
$6,049.99
|
| Rate for Payer: First Health Commercial |
$6,924.68
|
| Rate for Payer: Humana Commercial |
$6,195.77
|
| Rate for Payer: Humana KY Medicaid |
$2,506.74
|
| Rate for Payer: Kentucky WC Medicaid |
$2,532.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,977.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,379.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,186.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,557.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,414.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,466.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,457.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$947.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,259.63
|
| Rate for Payer: PHCS Commercial |
$6,997.57
|
| Rate for Payer: United Healthcare All Payer |
$6,414.44
|
|
|
GMRS MRH TIB INSERT 16MM S1/S2
|
Facility
|
IP
|
$7,289.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$947.59 |
| Max. Negotiated Rate |
$6,997.57 |
| Rate for Payer: Aetna Commercial |
$5,612.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,685.53
|
| Rate for Payer: Cash Price |
$3,644.57
|
| Rate for Payer: Cigna Commercial |
$6,049.99
|
| Rate for Payer: First Health Commercial |
$6,924.68
|
| Rate for Payer: Humana Commercial |
$6,195.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,977.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,379.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,186.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,414.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,466.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,457.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$947.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,259.63
|
| Rate for Payer: PHCS Commercial |
$6,997.57
|
| Rate for Payer: United Healthcare All Payer |
$6,414.44
|
|
|
GMRS MRH TIB INSERT 20MM M2/L2
|
Facility
|
IP
|
$6,505.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.71 |
| Max. Negotiated Rate |
$6,245.26 |
| Rate for Payer: Aetna Commercial |
$5,009.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,074.27
|
| Rate for Payer: Cash Price |
$3,252.74
|
| Rate for Payer: Cigna Commercial |
$5,399.55
|
| Rate for Payer: First Health Commercial |
$6,180.21
|
| Rate for Payer: Humana Commercial |
$5,529.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,334.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,801.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.82
|
| Rate for Payer: Ohio Health Group HMO |
$4,879.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,301.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.70
|
| Rate for Payer: PHCS Commercial |
$6,245.26
|
| Rate for Payer: United Healthcare All Payer |
$5,724.82
|
|
|
GMRS MRH TIB INSERT 20MM M2/L2
|
Facility
|
OP
|
$6,505.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.71 |
| Max. Negotiated Rate |
$6,245.26 |
| Rate for Payer: Aetna Commercial |
$5,009.22
|
| Rate for Payer: Anthem Medicaid |
$2,237.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,074.27
|
| Rate for Payer: Cash Price |
$3,252.74
|
| Rate for Payer: Cigna Commercial |
$5,399.55
|
| Rate for Payer: First Health Commercial |
$6,180.21
|
| Rate for Payer: Humana Commercial |
$5,529.66
|
| Rate for Payer: Humana KY Medicaid |
$2,237.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,260.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,334.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,801.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,282.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.82
|
| Rate for Payer: Ohio Health Group HMO |
$4,879.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,301.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.70
|
| Rate for Payer: PHCS Commercial |
$6,245.26
|
| Rate for Payer: United Healthcare All Payer |
$5,724.82
|
|
|
GMRS MRH TIB INSERT 20MM S1/S2
|
Facility
|
IP
|
$6,467.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$840.78 |
| Max. Negotiated Rate |
$6,208.82 |
| Rate for Payer: Aetna Commercial |
$4,979.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,044.67
|
| Rate for Payer: Cash Price |
$3,233.76
|
| Rate for Payer: Cigna Commercial |
$5,368.04
|
| Rate for Payer: First Health Commercial |
$6,144.14
|
| Rate for Payer: Humana Commercial |
$5,497.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,303.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,773.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,940.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,691.42
|
| Rate for Payer: Ohio Health Group HMO |
$4,850.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,293.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$840.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,004.93
|
| Rate for Payer: PHCS Commercial |
$6,208.82
|
| Rate for Payer: United Healthcare All Payer |
$5,691.42
|
|
|
GMRS MRH TIB INSERT 20MM S1/S2
|
Facility
|
OP
|
$6,467.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$840.78 |
| Max. Negotiated Rate |
$6,208.82 |
| Rate for Payer: Aetna Commercial |
$4,979.99
|
| Rate for Payer: Anthem Medicaid |
$2,224.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,044.67
|
| Rate for Payer: Cash Price |
$3,233.76
|
| Rate for Payer: Cigna Commercial |
$5,368.04
|
| Rate for Payer: First Health Commercial |
$6,144.14
|
| Rate for Payer: Humana Commercial |
$5,497.39
|
| Rate for Payer: Humana KY Medicaid |
$2,224.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,246.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,303.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,773.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,940.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,268.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,691.42
|
| Rate for Payer: Ohio Health Group HMO |
$4,850.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,293.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$840.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,004.93
|
| Rate for Payer: PHCS Commercial |
$6,208.82
|
| Rate for Payer: United Healthcare All Payer |
$5,691.42
|
|
|
GMRS MRH TIB INSERT 22MM S1/S2
|
Facility
|
OP
|
$6,467.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$840.78 |
| Max. Negotiated Rate |
$6,208.82 |
| Rate for Payer: Aetna Commercial |
$4,979.99
|
| Rate for Payer: Anthem Medicaid |
$2,224.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,044.67
|
| Rate for Payer: Cash Price |
$3,233.76
|
| Rate for Payer: Cigna Commercial |
$5,368.04
|
| Rate for Payer: First Health Commercial |
$6,144.14
|
| Rate for Payer: Humana Commercial |
$5,497.39
|
| Rate for Payer: Humana KY Medicaid |
$2,224.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,246.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,303.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,773.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,940.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,268.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,691.42
|
| Rate for Payer: Ohio Health Group HMO |
$4,850.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,293.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$840.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,004.93
|
| Rate for Payer: PHCS Commercial |
$6,208.82
|
| Rate for Payer: United Healthcare All Payer |
$5,691.42
|
|
|
GMRS MRH TIB INSERT 22MM S1/S2
|
Facility
|
IP
|
$6,467.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$840.78 |
| Max. Negotiated Rate |
$6,208.82 |
| Rate for Payer: Aetna Commercial |
$4,979.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,044.67
|
| Rate for Payer: Cash Price |
$3,233.76
|
| Rate for Payer: Cigna Commercial |
$5,368.04
|
| Rate for Payer: First Health Commercial |
$6,144.14
|
| Rate for Payer: Humana Commercial |
$5,497.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,303.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,773.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,940.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,691.42
|
| Rate for Payer: Ohio Health Group HMO |
$4,850.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,293.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$840.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,004.93
|
| Rate for Payer: PHCS Commercial |
$6,208.82
|
| Rate for Payer: United Healthcare All Payer |
$5,691.42
|
|
|
GMRS MRH TIB INSERT 24MM M2/L2
|
Facility
|
OP
|
$6,505.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.71 |
| Max. Negotiated Rate |
$6,245.26 |
| Rate for Payer: Aetna Commercial |
$5,009.22
|
| Rate for Payer: Anthem Medicaid |
$2,237.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,074.27
|
| Rate for Payer: Cash Price |
$3,252.74
|
| Rate for Payer: Cigna Commercial |
$5,399.55
|
| Rate for Payer: First Health Commercial |
$6,180.21
|
| Rate for Payer: Humana Commercial |
$5,529.66
|
| Rate for Payer: Humana KY Medicaid |
$2,237.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,260.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,334.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,801.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,282.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.82
|
| Rate for Payer: Ohio Health Group HMO |
$4,879.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,301.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.70
|
| Rate for Payer: PHCS Commercial |
$6,245.26
|
| Rate for Payer: United Healthcare All Payer |
$5,724.82
|
|
|
GMRS MRH TIB INSERT 24MM M2/L2
|
Facility
|
IP
|
$6,505.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.71 |
| Max. Negotiated Rate |
$6,245.26 |
| Rate for Payer: Aetna Commercial |
$5,009.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,074.27
|
| Rate for Payer: Cash Price |
$3,252.74
|
| Rate for Payer: Cigna Commercial |
$5,399.55
|
| Rate for Payer: First Health Commercial |
$6,180.21
|
| Rate for Payer: Humana Commercial |
$5,529.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,334.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,801.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.82
|
| Rate for Payer: Ohio Health Group HMO |
$4,879.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,301.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.70
|
| Rate for Payer: PHCS Commercial |
$6,245.26
|
| Rate for Payer: United Healthcare All Payer |
$5,724.82
|
|
|
GMRS MRH TIB INSERT 24MM S1/S2
|
Facility
|
IP
|
$6,467.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$840.78 |
| Max. Negotiated Rate |
$6,208.82 |
| Rate for Payer: Aetna Commercial |
$4,979.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,044.67
|
| Rate for Payer: Cash Price |
$3,233.76
|
| Rate for Payer: Cigna Commercial |
$5,368.04
|
| Rate for Payer: First Health Commercial |
$6,144.14
|
| Rate for Payer: Humana Commercial |
$5,497.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,303.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,773.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,940.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,691.42
|
| Rate for Payer: Ohio Health Group HMO |
$4,850.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,293.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$840.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,004.93
|
| Rate for Payer: PHCS Commercial |
$6,208.82
|
| Rate for Payer: United Healthcare All Payer |
$5,691.42
|
|
|
GMRS MRH TIB INSERT 24MM S1/S2
|
Facility
|
OP
|
$6,467.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$840.78 |
| Max. Negotiated Rate |
$6,208.82 |
| Rate for Payer: Aetna Commercial |
$4,979.99
|
| Rate for Payer: Anthem Medicaid |
$2,224.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,044.67
|
| Rate for Payer: Cash Price |
$3,233.76
|
| Rate for Payer: Cigna Commercial |
$5,368.04
|
| Rate for Payer: First Health Commercial |
$6,144.14
|
| Rate for Payer: Humana Commercial |
$5,497.39
|
| Rate for Payer: Humana KY Medicaid |
$2,224.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,246.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,303.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,773.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,940.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,268.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,691.42
|
| Rate for Payer: Ohio Health Group HMO |
$4,850.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,293.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$840.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,004.93
|
| Rate for Payer: PHCS Commercial |
$6,208.82
|
| Rate for Payer: United Healthcare All Payer |
$5,691.42
|
|
|
GMRS PRESS FIT EXT 10MM*155MM
|
Facility
|
IP
|
$5,683.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$738.91 |
| Max. Negotiated Rate |
$5,456.54 |
| Rate for Payer: Aetna Commercial |
$4,376.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,433.44
|
| Rate for Payer: Cash Price |
$2,841.95
|
| Rate for Payer: Cigna Commercial |
$4,717.64
|
| Rate for Payer: First Health Commercial |
$5,399.70
|
| Rate for Payer: Humana Commercial |
$4,831.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,660.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,194.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,705.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,001.83
|
| Rate for Payer: Ohio Health Group HMO |
$4,262.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,136.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$738.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,762.01
|
| Rate for Payer: PHCS Commercial |
$5,456.54
|
| Rate for Payer: United Healthcare All Payer |
$5,001.83
|
|
|
GMRS PRESS FIT EXT 10MM*155MM
|
Facility
|
OP
|
$5,683.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$738.91 |
| Max. Negotiated Rate |
$5,456.54 |
| Rate for Payer: Aetna Commercial |
$4,376.60
|
| Rate for Payer: Anthem Medicaid |
$1,954.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,433.44
|
| Rate for Payer: Cash Price |
$2,841.95
|
| Rate for Payer: Cigna Commercial |
$4,717.64
|
| Rate for Payer: First Health Commercial |
$5,399.70
|
| Rate for Payer: Humana Commercial |
$4,831.32
|
| Rate for Payer: Humana KY Medicaid |
$1,954.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,974.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,660.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,194.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,705.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,993.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,001.83
|
| Rate for Payer: Ohio Health Group HMO |
$4,262.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,136.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$738.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,762.01
|
| Rate for Payer: PHCS Commercial |
$5,456.54
|
| Rate for Payer: United Healthcare All Payer |
$5,001.83
|
|
|
GMRS PRESS FIT EXT 10MM*80MM
|
Facility
|
IP
|
$5,075.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$659.83 |
| Max. Negotiated Rate |
$4,872.58 |
| Rate for Payer: Aetna Commercial |
$3,908.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,958.97
|
| Rate for Payer: Cash Price |
$2,537.80
|
| Rate for Payer: Cigna Commercial |
$4,212.75
|
| Rate for Payer: First Health Commercial |
$4,821.82
|
| Rate for Payer: Humana Commercial |
$4,314.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,161.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,745.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,522.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,466.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,806.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,015.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$659.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,573.44
|
| Rate for Payer: PHCS Commercial |
$4,872.58
|
| Rate for Payer: United Healthcare All Payer |
$4,466.53
|
|
|
GMRS PRESS FIT EXT 10MM*80MM
|
Facility
|
OP
|
$5,075.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$659.83 |
| Max. Negotiated Rate |
$4,872.58 |
| Rate for Payer: Aetna Commercial |
$3,908.21
|
| Rate for Payer: Anthem Medicaid |
$1,745.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,958.97
|
| Rate for Payer: Cash Price |
$2,537.80
|
| Rate for Payer: Cigna Commercial |
$4,212.75
|
| Rate for Payer: First Health Commercial |
$4,821.82
|
| Rate for Payer: Humana Commercial |
$4,314.26
|
| Rate for Payer: Humana KY Medicaid |
$1,745.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,763.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,161.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,745.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,522.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,780.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,466.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,806.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,015.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$659.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,573.44
|
| Rate for Payer: PHCS Commercial |
$4,872.58
|
| Rate for Payer: United Healthcare All Payer |
$4,466.53
|
|
|
GMRS PRESS FIT EXT 11MM*155MM
|
Facility
|
IP
|
$4,484.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$583.02 |
| Max. Negotiated Rate |
$4,305.41 |
| Rate for Payer: Aetna Commercial |
$3,453.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,498.14
|
| Rate for Payer: Cash Price |
$2,242.40
|
| Rate for Payer: Cigna Commercial |
$3,722.38
|
| Rate for Payer: First Health Commercial |
$4,260.56
|
| Rate for Payer: Humana Commercial |
$3,812.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,677.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,309.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,345.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,946.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,363.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$896.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$583.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,390.29
|
| Rate for Payer: PHCS Commercial |
$4,305.41
|
| Rate for Payer: United Healthcare All Payer |
$3,946.62
|
|
|
GMRS PRESS FIT EXT 11MM*155MM
|
Facility
|
OP
|
$4,484.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$583.02 |
| Max. Negotiated Rate |
$4,305.41 |
| Rate for Payer: Aetna Commercial |
$3,453.30
|
| Rate for Payer: Anthem Medicaid |
$1,542.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,498.14
|
| Rate for Payer: Cash Price |
$2,242.40
|
| Rate for Payer: Cigna Commercial |
$3,722.38
|
| Rate for Payer: First Health Commercial |
$4,260.56
|
| Rate for Payer: Humana Commercial |
$3,812.08
|
| Rate for Payer: Humana KY Medicaid |
$1,542.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,558.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,677.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,309.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,345.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,573.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,946.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,363.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$896.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$583.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,390.29
|
| Rate for Payer: PHCS Commercial |
$4,305.41
|
| Rate for Payer: United Healthcare All Payer |
$3,946.62
|
|
|
GMRS PRESS FIT EXT 11MM*80MM
|
Facility
|
OP
|
$5,075.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$659.83 |
| Max. Negotiated Rate |
$4,872.58 |
| Rate for Payer: Aetna Commercial |
$3,908.21
|
| Rate for Payer: Anthem Medicaid |
$1,745.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,958.97
|
| Rate for Payer: Cash Price |
$2,537.80
|
| Rate for Payer: Cigna Commercial |
$4,212.75
|
| Rate for Payer: First Health Commercial |
$4,821.82
|
| Rate for Payer: Humana Commercial |
$4,314.26
|
| Rate for Payer: Humana KY Medicaid |
$1,745.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,763.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,161.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,745.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,522.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,780.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,466.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,806.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,015.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$659.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,573.44
|
| Rate for Payer: PHCS Commercial |
$4,872.58
|
| Rate for Payer: United Healthcare All Payer |
$4,466.53
|
|
