|
GMRS PRESS FIT EXT 18MM*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*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 19MM*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 19MM*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 21MM*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 21MM*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 21MM*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 21MM*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 23MM*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 23MM*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 23MM*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 23MM*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 PROX FEM COMPONENT RT
|
Facility
|
OP
|
$23,093.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,002.19 |
| Max. Negotiated Rate |
$22,170.05 |
| Rate for Payer: Aetna Commercial |
$17,782.23
|
| Rate for Payer: Anthem Medicaid |
$7,941.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,013.16
|
| Rate for Payer: Cash Price |
$11,546.90
|
| Rate for Payer: Cigna Commercial |
$19,167.85
|
| Rate for Payer: First Health Commercial |
$21,939.11
|
| Rate for Payer: Humana Commercial |
$19,629.73
|
| Rate for Payer: Humana KY Medicaid |
$7,941.96
|
| Rate for Payer: Kentucky WC Medicaid |
$8,022.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,936.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,043.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,928.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,101.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,322.54
|
| Rate for Payer: Ohio Health Group HMO |
$17,320.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,618.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,002.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,159.08
|
| Rate for Payer: PHCS Commercial |
$22,170.05
|
| Rate for Payer: United Healthcare All Payer |
$20,322.54
|
|
|
GMRS PROX FEM COMPONENT RT
|
Facility
|
IP
|
$23,093.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,002.19 |
| Max. Negotiated Rate |
$22,170.05 |
| Rate for Payer: Aetna Commercial |
$17,782.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,013.16
|
| Rate for Payer: Cash Price |
$11,546.90
|
| Rate for Payer: Cigna Commercial |
$19,167.85
|
| Rate for Payer: First Health Commercial |
$21,939.11
|
| Rate for Payer: Humana Commercial |
$19,629.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,936.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,043.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,928.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,322.54
|
| Rate for Payer: Ohio Health Group HMO |
$17,320.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,618.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,002.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,159.08
|
| Rate for Payer: PHCS Commercial |
$22,170.05
|
| Rate for Payer: United Healthcare All Payer |
$20,322.54
|
|
|
GMRS PROX FEM COMP TPR V40
|
Facility
|
IP
|
$24,866.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,232.71 |
| Max. Negotiated Rate |
$23,872.29 |
| Rate for Payer: Aetna Commercial |
$19,147.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,396.24
|
| Rate for Payer: Cash Price |
$12,433.49
|
| Rate for Payer: Cigna Commercial |
$20,639.59
|
| Rate for Payer: First Health Commercial |
$23,623.62
|
| Rate for Payer: Humana Commercial |
$21,136.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,390.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,351.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,460.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,882.93
|
| Rate for Payer: Ohio Health Group HMO |
$18,650.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,973.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,232.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,708.76
|
| Rate for Payer: PHCS Commercial |
$23,872.29
|
| Rate for Payer: United Healthcare All Payer |
$21,882.93
|
|
|
GMRS PROX FEM COMP TPR V40
|
Facility
|
OP
|
$24,866.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,232.71 |
| Max. Negotiated Rate |
$23,872.29 |
| Rate for Payer: Aetna Commercial |
$19,147.57
|
| Rate for Payer: Anthem Medicaid |
$8,551.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,396.24
|
| Rate for Payer: Cash Price |
$12,433.49
|
| Rate for Payer: Cigna Commercial |
$20,639.59
|
| Rate for Payer: First Health Commercial |
$23,623.62
|
| Rate for Payer: Humana Commercial |
$21,136.92
|
| Rate for Payer: Humana KY Medicaid |
$8,551.75
|
| Rate for Payer: Kentucky WC Medicaid |
$8,638.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,390.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,351.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,460.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,723.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,882.93
|
| Rate for Payer: Ohio Health Group HMO |
$18,650.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,973.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,232.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,708.76
|
| Rate for Payer: PHCS Commercial |
$23,872.29
|
| Rate for Payer: United Healthcare All Payer |
$21,882.93
|
|
|
GMRS SMALL BUSHING
|
Facility
|
IP
|
$3,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$435.24 |
| Max. Negotiated Rate |
$3,214.08 |
| Rate for Payer: Aetna Commercial |
$2,577.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,611.44
|
| Rate for Payer: Cash Price |
$1,674.00
|
| Rate for Payer: Cigna Commercial |
$2,778.84
|
| Rate for Payer: First Health Commercial |
$3,180.60
|
| Rate for Payer: Humana Commercial |
$2,845.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,745.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,470.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,004.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,946.24
|
| Rate for Payer: Ohio Health Group HMO |
$2,511.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$669.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,037.88
|
| Rate for Payer: PHCS Commercial |
$3,214.08
|
| Rate for Payer: United Healthcare All Payer |
$2,946.24
|
|
|
GMRS SMALL BUSHING
|
Facility
|
OP
|
$3,348.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$435.24 |
| Max. Negotiated Rate |
$3,214.08 |
| Rate for Payer: Humana Commercial |
$2,845.80
|
| Rate for Payer: Aetna Commercial |
$2,577.96
|
| Rate for Payer: Anthem Medicaid |
$1,151.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,611.44
|
| Rate for Payer: Cash Price |
$1,674.00
|
| Rate for Payer: Cigna Commercial |
$2,778.84
|
| Rate for Payer: First Health Commercial |
$3,180.60
|
| Rate for Payer: Humana KY Medicaid |
$1,151.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,163.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,745.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,470.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,004.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,174.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,946.24
|
| Rate for Payer: Ohio Health Group HMO |
$2,511.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$669.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,037.88
|
| Rate for Payer: PHCS Commercial |
$3,214.08
|
| Rate for Payer: United Healthcare All Payer |
$2,946.24
|
|
|
GMRS SM PROX TIBIA 80MM
|
Facility
|
OP
|
$33,144.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,308.78 |
| Max. Negotiated Rate |
$31,818.66 |
| Rate for Payer: Aetna Commercial |
$25,521.22
|
| Rate for Payer: Anthem Medicaid |
$11,398.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,852.66
|
| Rate for Payer: Cash Price |
$16,572.22
|
| Rate for Payer: Cigna Commercial |
$27,509.89
|
| Rate for Payer: First Health Commercial |
$31,487.22
|
| Rate for Payer: Humana Commercial |
$28,172.77
|
| Rate for Payer: Humana KY Medicaid |
$11,398.37
|
| Rate for Payer: Kentucky WC Medicaid |
$11,514.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,178.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,460.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,943.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,627.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,167.11
|
| Rate for Payer: Ohio Health Group HMO |
$24,858.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,628.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,308.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,274.78
|
| Rate for Payer: PHCS Commercial |
$31,818.66
|
| Rate for Payer: United Healthcare All Payer |
$29,167.11
|
|
|
GMRS SM PROX TIBIA 80MM
|
Facility
|
IP
|
$33,144.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,308.78 |
| Max. Negotiated Rate |
$31,818.66 |
| Rate for Payer: Aetna Commercial |
$25,521.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,852.66
|
| Rate for Payer: Cash Price |
$16,572.22
|
| Rate for Payer: Cigna Commercial |
$27,509.89
|
| Rate for Payer: First Health Commercial |
$31,487.22
|
| Rate for Payer: Humana Commercial |
$28,172.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,178.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,460.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,943.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,167.11
|
| Rate for Payer: Ohio Health Group HMO |
$24,858.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,628.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,308.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,274.78
|
| Rate for Payer: PHCS Commercial |
$31,818.66
|
| Rate for Payer: United Healthcare All Payer |
$29,167.11
|
|
|
GMRS TIBIAL SLEEVE ALL SIZES
|
Facility
|
OP
|
$4,341.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$564.37 |
| Max. Negotiated Rate |
$4,167.65 |
| Rate for Payer: Aetna Commercial |
$3,342.80
|
| Rate for Payer: Anthem Medicaid |
$1,492.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,386.21
|
| Rate for Payer: Cash Price |
$2,170.65
|
| Rate for Payer: Cigna Commercial |
$3,603.28
|
| Rate for Payer: First Health Commercial |
$4,124.24
|
| Rate for Payer: Humana Commercial |
$3,690.10
|
| Rate for Payer: Humana KY Medicaid |
$1,492.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,508.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,559.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,203.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,302.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,522.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,820.34
|
| Rate for Payer: Ohio Health Group HMO |
$3,255.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$868.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$564.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,345.80
|
| Rate for Payer: PHCS Commercial |
$4,167.65
|
| Rate for Payer: United Healthcare All Payer |
$3,820.34
|
|
|
GMRS TIBIAL SLEEVE ALL SIZES
|
Facility
|
IP
|
$4,341.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$564.37 |
| Max. Negotiated Rate |
$4,167.65 |
| Rate for Payer: Aetna Commercial |
$3,342.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,386.21
|
| Rate for Payer: Cash Price |
$2,170.65
|
| Rate for Payer: Cigna Commercial |
$3,603.28
|
| Rate for Payer: First Health Commercial |
$4,124.24
|
| Rate for Payer: Humana Commercial |
$3,690.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,559.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,203.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,302.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,820.34
|
| Rate for Payer: Ohio Health Group HMO |
$3,255.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$868.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$564.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,345.80
|
| Rate for Payer: PHCS Commercial |
$4,167.65
|
| Rate for Payer: United Healthcare All Payer |
$3,820.34
|
|
|
GMRS TIB ROTATING COMP ALL SIZ
|
Facility
|
OP
|
$16,870.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,193.17 |
| Max. Negotiated Rate |
$16,195.74 |
| Rate for Payer: Aetna Commercial |
$12,990.33
|
| Rate for Payer: Anthem Medicaid |
$5,801.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,159.04
|
| Rate for Payer: Cash Price |
$8,435.28
|
| Rate for Payer: Cigna Commercial |
$14,002.56
|
| Rate for Payer: First Health Commercial |
$16,027.03
|
| Rate for Payer: Humana Commercial |
$14,339.98
|
| Rate for Payer: Humana KY Medicaid |
$5,801.79
|
| Rate for Payer: Kentucky WC Medicaid |
$5,860.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,833.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,450.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,061.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,918.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,846.09
|
| Rate for Payer: Ohio Health Group HMO |
$12,652.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,374.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,193.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,229.87
|
| Rate for Payer: PHCS Commercial |
$16,195.74
|
| Rate for Payer: United Healthcare All Payer |
$14,846.09
|
|
|
GMRS TIB ROTATING COMP ALL SIZ
|
Facility
|
IP
|
$16,870.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,193.17 |
| Max. Negotiated Rate |
$16,195.74 |
| Rate for Payer: Aetna Commercial |
$12,990.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,159.04
|
| Rate for Payer: Cash Price |
$8,435.28
|
| Rate for Payer: Cigna Commercial |
$14,002.56
|
| Rate for Payer: First Health Commercial |
$16,027.03
|
| Rate for Payer: Humana Commercial |
$14,339.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,833.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,450.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,061.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,846.09
|
| Rate for Payer: Ohio Health Group HMO |
$12,652.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,374.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,193.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,229.87
|
| Rate for Payer: PHCS Commercial |
$16,195.74
|
| Rate for Payer: United Healthcare All Payer |
$14,846.09
|
|
|
GNS II ARTICULAR INSRT SZ3-4
|
Facility
|
OP
|
$5,084.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$660.92 |
| Max. Negotiated Rate |
$4,880.64 |
| Rate for Payer: Aetna Commercial |
$3,914.68
|
| Rate for Payer: Anthem Medicaid |
$1,748.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,965.52
|
| Rate for Payer: Cash Price |
$2,542.00
|
| Rate for Payer: Cigna Commercial |
$4,219.72
|
| Rate for Payer: First Health Commercial |
$4,829.80
|
| Rate for Payer: Humana Commercial |
$4,321.40
|
| Rate for Payer: Humana KY Medicaid |
$1,748.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,766.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,168.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,751.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,525.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,783.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,473.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,813.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,016.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$660.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,576.04
|
| Rate for Payer: PHCS Commercial |
$4,880.64
|
| Rate for Payer: United Healthcare All Payer |
$4,473.92
|
|
