|
GMRS PRESS FIT EXT 11MM*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 12MM*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 12MM*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 12MM*80MM
|
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 12MM*80MM
|
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 13MM*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 13MM*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 13MM*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 13MM*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 14MM*155MM
|
Facility
|
IP
|
$5,534.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$719.52 |
| Max. Negotiated Rate |
$5,313.41 |
| Rate for Payer: Aetna Commercial |
$4,261.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,317.14
|
| Rate for Payer: Cash Price |
$2,767.40
|
| Rate for Payer: Cigna Commercial |
$4,593.88
|
| Rate for Payer: First Health Commercial |
$5,258.06
|
| Rate for Payer: Humana Commercial |
$4,704.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,538.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,084.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,660.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,870.62
|
| Rate for Payer: Ohio Health Group HMO |
$4,151.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,106.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$719.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,715.79
|
| Rate for Payer: PHCS Commercial |
$5,313.41
|
| Rate for Payer: United Healthcare All Payer |
$4,870.62
|
|
|
GMRS PRESS FIT EXT 14MM*155MM
|
Facility
|
OP
|
$5,534.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$719.52 |
| Max. Negotiated Rate |
$5,313.41 |
| Rate for Payer: Aetna Commercial |
$4,261.80
|
| Rate for Payer: Anthem Medicaid |
$1,903.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,317.14
|
| Rate for Payer: Cash Price |
$2,767.40
|
| Rate for Payer: Cigna Commercial |
$4,593.88
|
| Rate for Payer: First Health Commercial |
$5,258.06
|
| Rate for Payer: Humana Commercial |
$4,704.58
|
| Rate for Payer: Humana KY Medicaid |
$1,903.42
|
| Rate for Payer: Kentucky WC Medicaid |
$1,922.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,538.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,084.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,660.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,941.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,870.62
|
| Rate for Payer: Ohio Health Group HMO |
$4,151.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,106.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$719.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,715.79
|
| Rate for Payer: PHCS Commercial |
$5,313.41
|
| Rate for Payer: United Healthcare All Payer |
$4,870.62
|
|
|
GMRS PRESS FIT EXT 14MM*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 14MM*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 15MM*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 15MM*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 15MM*80MM
|
Facility
|
IP
|
$4,913.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.72 |
| Max. Negotiated Rate |
$4,716.67 |
| Rate for Payer: Aetna Commercial |
$3,783.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,832.30
|
| Rate for Payer: Cash Price |
$2,456.60
|
| Rate for Payer: Cigna Commercial |
$4,077.96
|
| Rate for Payer: First Health Commercial |
$4,667.54
|
| Rate for Payer: Humana Commercial |
$4,176.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.09
|
| Rate for Payer: PHCS Commercial |
$4,716.67
|
| Rate for Payer: United Healthcare All Payer |
$4,323.62
|
|
|
GMRS PRESS FIT EXT 15MM*80MM
|
Facility
|
OP
|
$4,913.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.72 |
| Max. Negotiated Rate |
$4,716.67 |
| Rate for Payer: Aetna Commercial |
$3,783.16
|
| Rate for Payer: Anthem Medicaid |
$1,689.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,832.30
|
| Rate for Payer: Cash Price |
$2,456.60
|
| Rate for Payer: Cigna Commercial |
$4,077.96
|
| Rate for Payer: First Health Commercial |
$4,667.54
|
| Rate for Payer: Humana Commercial |
$4,176.22
|
| Rate for Payer: Humana KY Medicaid |
$1,689.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,523.09
|
| Rate for Payer: PHCS Commercial |
$4,716.67
|
| Rate for Payer: United Healthcare All Payer |
$4,323.62
|
|
|
GMRS PRESS FIT EXT 16MM*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 16MM*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 17MM*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 17MM*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 17MM*80MM
|
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 17MM*80MM
|
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 18MM*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 18MM*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
|
|
