|
GII HA POR TIBIAL SZ 5 RT
|
Facility
|
OP
|
$12,785.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,835.53 |
| Max. Negotiated Rate |
$12,273.70 |
| Rate for Payer: Aetna Commercial |
$9,844.53
|
| Rate for Payer: Anthem Medicaid |
$4,396.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,972.38
|
| Rate for Payer: Cash Price |
$6,392.55
|
| Rate for Payer: Cigna Commercial |
$10,611.63
|
| Rate for Payer: First Health Commercial |
$12,145.84
|
| Rate for Payer: Humana Commercial |
$10,867.33
|
| Rate for Payer: Humana KY Medicaid |
$4,396.80
|
| Rate for Payer: Kentucky WC Medicaid |
$4,441.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,483.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,435.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,835.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,485.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,250.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,588.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,228.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,123.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,821.72
|
| Rate for Payer: PHCS Commercial |
$12,273.70
|
| Rate for Payer: United Healthcare All Payer |
$11,250.89
|
|
|
GII HA POR TIBIAL SZ 5 RT
|
Facility
|
IP
|
$12,785.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,835.53 |
| Max. Negotiated Rate |
$12,273.70 |
| Rate for Payer: Aetna Commercial |
$9,844.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,972.38
|
| Rate for Payer: Cash Price |
$6,392.55
|
| Rate for Payer: Cigna Commercial |
$10,611.63
|
| Rate for Payer: First Health Commercial |
$12,145.84
|
| Rate for Payer: Humana Commercial |
$10,867.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,483.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,435.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,835.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,250.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,588.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,228.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,123.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,821.72
|
| Rate for Payer: PHCS Commercial |
$12,273.70
|
| Rate for Payer: United Healthcare All Payer |
$11,250.89
|
|
|
GII HA POR TIBIAL SZ 6 LT
|
Facility
|
IP
|
$8,745.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,623.53 |
| Max. Negotiated Rate |
$8,395.30 |
| Rate for Payer: Aetna Commercial |
$6,733.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,821.18
|
| Rate for Payer: Cash Price |
$4,372.55
|
| Rate for Payer: Cigna Commercial |
$7,258.43
|
| Rate for Payer: First Health Commercial |
$8,307.84
|
| Rate for Payer: Humana Commercial |
$7,433.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,170.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,453.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,623.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,695.69
|
| Rate for Payer: Ohio Health Group HMO |
$6,558.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,996.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,608.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,034.12
|
| Rate for Payer: PHCS Commercial |
$8,395.30
|
| Rate for Payer: United Healthcare All Payer |
$7,695.69
|
|
|
GII HA POR TIBIAL SZ 6 LT
|
Facility
|
OP
|
$8,745.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,623.53 |
| Max. Negotiated Rate |
$8,395.30 |
| Rate for Payer: Aetna Commercial |
$6,733.73
|
| Rate for Payer: Anthem Medicaid |
$3,007.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,821.18
|
| Rate for Payer: Cash Price |
$4,372.55
|
| Rate for Payer: Cigna Commercial |
$7,258.43
|
| Rate for Payer: First Health Commercial |
$8,307.84
|
| Rate for Payer: Humana Commercial |
$7,433.34
|
| Rate for Payer: Humana KY Medicaid |
$3,007.44
|
| Rate for Payer: Kentucky WC Medicaid |
$3,038.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,170.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,453.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,623.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,067.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,695.69
|
| Rate for Payer: Ohio Health Group HMO |
$6,558.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,996.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,608.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,034.12
|
| Rate for Payer: PHCS Commercial |
$8,395.30
|
| Rate for Payer: United Healthcare All Payer |
$7,695.69
|
|
|
GII HA POR TIBIAL SZ 6 RT
|
Facility
|
IP
|
$12,785.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,835.53 |
| Max. Negotiated Rate |
$12,273.70 |
| Rate for Payer: Aetna Commercial |
$9,844.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,972.38
|
| Rate for Payer: Cash Price |
$6,392.55
|
| Rate for Payer: Cigna Commercial |
$10,611.63
|
| Rate for Payer: First Health Commercial |
$12,145.84
|
| Rate for Payer: Humana Commercial |
$10,867.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,483.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,435.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,835.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,250.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,588.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,228.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,123.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,821.72
|
| Rate for Payer: PHCS Commercial |
$12,273.70
|
| Rate for Payer: United Healthcare All Payer |
$11,250.89
|
|
|
GII HA POR TIBIAL SZ 6 RT
|
Facility
|
OP
|
$12,785.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,835.53 |
| Max. Negotiated Rate |
$12,273.70 |
| Rate for Payer: Aetna Commercial |
$9,844.53
|
| Rate for Payer: Anthem Medicaid |
$4,396.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,972.38
|
| Rate for Payer: Cash Price |
$6,392.55
|
| Rate for Payer: Cigna Commercial |
$10,611.63
|
| Rate for Payer: First Health Commercial |
$12,145.84
|
| Rate for Payer: Humana Commercial |
$10,867.33
|
| Rate for Payer: Humana KY Medicaid |
$4,396.80
|
| Rate for Payer: Kentucky WC Medicaid |
$4,441.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,483.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,435.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,835.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,485.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,250.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,588.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,228.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,123.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,821.72
|
| Rate for Payer: PHCS Commercial |
$12,273.70
|
| Rate for Payer: United Healthcare All Payer |
$11,250.89
|
|
|
GII HA POR TIBIAL SZ 7 LT
|
Facility
|
IP
|
$8,745.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,623.53 |
| Max. Negotiated Rate |
$8,395.30 |
| Rate for Payer: Aetna Commercial |
$6,733.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,821.18
|
| Rate for Payer: Cash Price |
$4,372.55
|
| Rate for Payer: Cigna Commercial |
$7,258.43
|
| Rate for Payer: First Health Commercial |
$8,307.84
|
| Rate for Payer: Humana Commercial |
$7,433.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,170.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,453.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,623.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,695.69
|
| Rate for Payer: Ohio Health Group HMO |
$6,558.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,996.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,608.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,034.12
|
| Rate for Payer: PHCS Commercial |
$8,395.30
|
| Rate for Payer: United Healthcare All Payer |
$7,695.69
|
|
|
GII HA POR TIBIAL SZ 7 LT
|
Facility
|
OP
|
$8,745.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,623.53 |
| Max. Negotiated Rate |
$8,395.30 |
| Rate for Payer: Aetna Commercial |
$6,733.73
|
| Rate for Payer: Anthem Medicaid |
$3,007.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,821.18
|
| Rate for Payer: Cash Price |
$4,372.55
|
| Rate for Payer: Cigna Commercial |
$7,258.43
|
| Rate for Payer: First Health Commercial |
$8,307.84
|
| Rate for Payer: Humana Commercial |
$7,433.34
|
| Rate for Payer: Humana KY Medicaid |
$3,007.44
|
| Rate for Payer: Kentucky WC Medicaid |
$3,038.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,170.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,453.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,623.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,067.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,695.69
|
| Rate for Payer: Ohio Health Group HMO |
$6,558.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,996.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,608.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,034.12
|
| Rate for Payer: PHCS Commercial |
$8,395.30
|
| Rate for Payer: United Healthcare All Payer |
$7,695.69
|
|
|
GII HA POR TIBIAL SZ 7 RT
|
Facility
|
OP
|
$12,785.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,835.53 |
| Max. Negotiated Rate |
$12,273.70 |
| Rate for Payer: Aetna Commercial |
$9,844.53
|
| Rate for Payer: Anthem Medicaid |
$4,396.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,972.38
|
| Rate for Payer: Cash Price |
$6,392.55
|
| Rate for Payer: Cigna Commercial |
$10,611.63
|
| Rate for Payer: First Health Commercial |
$12,145.84
|
| Rate for Payer: Humana Commercial |
$10,867.33
|
| Rate for Payer: Humana KY Medicaid |
$4,396.80
|
| Rate for Payer: Kentucky WC Medicaid |
$4,441.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,483.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,435.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,835.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,485.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,250.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,588.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,228.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,123.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,821.72
|
| Rate for Payer: PHCS Commercial |
$12,273.70
|
| Rate for Payer: United Healthcare All Payer |
$11,250.89
|
|
|
GII HA POR TIBIAL SZ 7 RT
|
Facility
|
IP
|
$12,785.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,835.53 |
| Max. Negotiated Rate |
$12,273.70 |
| Rate for Payer: Aetna Commercial |
$9,844.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,972.38
|
| Rate for Payer: Cash Price |
$6,392.55
|
| Rate for Payer: Cigna Commercial |
$10,611.63
|
| Rate for Payer: First Health Commercial |
$12,145.84
|
| Rate for Payer: Humana Commercial |
$10,867.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,483.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,435.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,835.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,250.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,588.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,228.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,123.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,821.72
|
| Rate for Payer: PHCS Commercial |
$12,273.70
|
| Rate for Payer: United Healthcare All Payer |
$11,250.89
|
|
|
GII HA POR TIBIAL SZ 8 LT
|
Facility
|
IP
|
$8,745.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,623.53 |
| Max. Negotiated Rate |
$8,395.30 |
| Rate for Payer: Aetna Commercial |
$6,733.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,821.18
|
| Rate for Payer: Cash Price |
$4,372.55
|
| Rate for Payer: Cigna Commercial |
$7,258.43
|
| Rate for Payer: First Health Commercial |
$8,307.84
|
| Rate for Payer: Humana Commercial |
$7,433.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,170.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,453.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,623.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,695.69
|
| Rate for Payer: Ohio Health Group HMO |
$6,558.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,996.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,608.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,034.12
|
| Rate for Payer: PHCS Commercial |
$8,395.30
|
| Rate for Payer: United Healthcare All Payer |
$7,695.69
|
|
|
GII HA POR TIBIAL SZ 8 LT
|
Facility
|
OP
|
$8,745.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,623.53 |
| Max. Negotiated Rate |
$8,395.30 |
| Rate for Payer: Aetna Commercial |
$6,733.73
|
| Rate for Payer: Anthem Medicaid |
$3,007.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,821.18
|
| Rate for Payer: Cash Price |
$4,372.55
|
| Rate for Payer: Cigna Commercial |
$7,258.43
|
| Rate for Payer: First Health Commercial |
$8,307.84
|
| Rate for Payer: Humana Commercial |
$7,433.34
|
| Rate for Payer: Humana KY Medicaid |
$3,007.44
|
| Rate for Payer: Kentucky WC Medicaid |
$3,038.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,170.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,453.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,623.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,067.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,695.69
|
| Rate for Payer: Ohio Health Group HMO |
$6,558.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,996.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,608.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,034.12
|
| Rate for Payer: PHCS Commercial |
$8,395.30
|
| Rate for Payer: United Healthcare All Payer |
$7,695.69
|
|
|
GII HA POR TIBIAL SZ 8 RT
|
Facility
|
OP
|
$12,785.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,835.53 |
| Max. Negotiated Rate |
$12,273.70 |
| Rate for Payer: Aetna Commercial |
$9,844.53
|
| Rate for Payer: Anthem Medicaid |
$4,396.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,972.38
|
| Rate for Payer: Cash Price |
$6,392.55
|
| Rate for Payer: Cigna Commercial |
$10,611.63
|
| Rate for Payer: First Health Commercial |
$12,145.84
|
| Rate for Payer: Humana Commercial |
$10,867.33
|
| Rate for Payer: Humana KY Medicaid |
$4,396.80
|
| Rate for Payer: Kentucky WC Medicaid |
$4,441.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,483.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,435.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,835.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,485.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,250.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,588.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,228.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,123.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,821.72
|
| Rate for Payer: PHCS Commercial |
$12,273.70
|
| Rate for Payer: United Healthcare All Payer |
$11,250.89
|
|
|
GII HA POR TIBIAL SZ 8 RT
|
Facility
|
IP
|
$12,785.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,835.53 |
| Max. Negotiated Rate |
$12,273.70 |
| Rate for Payer: Aetna Commercial |
$9,844.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,972.38
|
| Rate for Payer: Cash Price |
$6,392.55
|
| Rate for Payer: Cigna Commercial |
$10,611.63
|
| Rate for Payer: First Health Commercial |
$12,145.84
|
| Rate for Payer: Humana Commercial |
$10,867.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,483.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,435.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,835.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,250.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,588.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,228.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,123.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,821.72
|
| Rate for Payer: PHCS Commercial |
$12,273.70
|
| Rate for Payer: United Healthcare All Payer |
$11,250.89
|
|
|
GII PAT W/FLEX LOK PEG 23MM
|
Facility
|
OP
|
$3,726.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,118.06 |
| Max. Negotiated Rate |
$3,577.80 |
| Rate for Payer: Aetna Commercial |
$2,869.70
|
| Rate for Payer: Anthem Medicaid |
$1,281.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,906.97
|
| Rate for Payer: Cash Price |
$1,863.44
|
| Rate for Payer: Cigna Commercial |
$3,093.31
|
| Rate for Payer: First Health Commercial |
$3,540.54
|
| Rate for Payer: Humana Commercial |
$3,167.85
|
| Rate for Payer: Humana KY Medicaid |
$1,281.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,294.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,056.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,750.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,118.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,307.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,279.65
|
| Rate for Payer: Ohio Health Group HMO |
$2,795.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,981.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,242.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,571.55
|
| Rate for Payer: PHCS Commercial |
$3,577.80
|
| Rate for Payer: United Healthcare All Payer |
$3,279.65
|
|
|
GII PAT W/FLEX LOK PEG 23MM
|
Facility
|
IP
|
$3,726.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,118.06 |
| Max. Negotiated Rate |
$3,577.80 |
| Rate for Payer: Aetna Commercial |
$2,869.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,906.97
|
| Rate for Payer: Cash Price |
$1,863.44
|
| Rate for Payer: Cigna Commercial |
$3,093.31
|
| Rate for Payer: First Health Commercial |
$3,540.54
|
| Rate for Payer: Humana Commercial |
$3,167.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,056.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,750.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,118.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,279.65
|
| Rate for Payer: Ohio Health Group HMO |
$2,795.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,981.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,242.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,571.55
|
| Rate for Payer: PHCS Commercial |
$3,577.80
|
| Rate for Payer: United Healthcare All Payer |
$3,279.65
|
|
|
G II PAT W/ FLEX LOK PEG 26MM
|
Facility
|
OP
|
$3,726.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,118.06 |
| Max. Negotiated Rate |
$3,577.80 |
| Rate for Payer: Aetna Commercial |
$2,869.70
|
| Rate for Payer: Anthem Medicaid |
$1,281.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,906.97
|
| Rate for Payer: Cash Price |
$1,863.44
|
| Rate for Payer: Cigna Commercial |
$3,093.31
|
| Rate for Payer: First Health Commercial |
$3,540.54
|
| Rate for Payer: Humana Commercial |
$3,167.85
|
| Rate for Payer: Humana KY Medicaid |
$1,281.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,294.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,056.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,750.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,118.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,307.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,279.65
|
| Rate for Payer: Ohio Health Group HMO |
$2,795.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,981.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,242.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,571.55
|
| Rate for Payer: PHCS Commercial |
$3,577.80
|
| Rate for Payer: United Healthcare All Payer |
$3,279.65
|
|
|
G II PAT W/ FLEX LOK PEG 26MM
|
Facility
|
IP
|
$3,726.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,118.06 |
| Max. Negotiated Rate |
$3,577.80 |
| Rate for Payer: Aetna Commercial |
$2,869.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,906.97
|
| Rate for Payer: Cash Price |
$1,863.44
|
| Rate for Payer: Cigna Commercial |
$3,093.31
|
| Rate for Payer: First Health Commercial |
$3,540.54
|
| Rate for Payer: Humana Commercial |
$3,167.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,056.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,750.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,118.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,279.65
|
| Rate for Payer: Ohio Health Group HMO |
$2,795.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,981.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,242.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,571.55
|
| Rate for Payer: PHCS Commercial |
$3,577.80
|
| Rate for Payer: United Healthcare All Payer |
$3,279.65
|
|
|
GII PAT W/FLEX LOK PEG 29MM
|
Facility
|
IP
|
$3,725.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,117.50 |
| Max. Negotiated Rate |
$3,576.00 |
| Rate for Payer: Aetna Commercial |
$2,868.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,905.50
|
| Rate for Payer: Cash Price |
$1,862.50
|
| Rate for Payer: Cigna Commercial |
$3,091.75
|
| Rate for Payer: First Health Commercial |
$3,538.75
|
| Rate for Payer: Humana Commercial |
$3,166.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,054.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,749.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,117.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,278.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,793.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,980.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,240.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,570.25
|
| Rate for Payer: PHCS Commercial |
$3,576.00
|
| Rate for Payer: United Healthcare All Payer |
$3,278.00
|
|
|
GII PAT W/FLEX LOK PEG 29MM
|
Facility
|
OP
|
$3,725.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,117.50 |
| Max. Negotiated Rate |
$3,576.00 |
| Rate for Payer: Aetna Commercial |
$2,868.25
|
| Rate for Payer: Anthem Medicaid |
$1,281.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,905.50
|
| Rate for Payer: Cash Price |
$1,862.50
|
| Rate for Payer: Cigna Commercial |
$3,091.75
|
| Rate for Payer: First Health Commercial |
$3,538.75
|
| Rate for Payer: Humana Commercial |
$3,166.25
|
| Rate for Payer: Humana KY Medicaid |
$1,281.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,294.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,054.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,749.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,117.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,306.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,278.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,793.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,980.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,240.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,570.25
|
| Rate for Payer: PHCS Commercial |
$3,576.00
|
| Rate for Payer: United Healthcare All Payer |
$3,278.00
|
|
|
GII PAT W/FLEX LOK PEG 32MM
|
Facility
|
IP
|
$3,726.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,118.06 |
| Max. Negotiated Rate |
$3,577.80 |
| Rate for Payer: Aetna Commercial |
$2,869.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,906.97
|
| Rate for Payer: Cash Price |
$1,863.44
|
| Rate for Payer: Cigna Commercial |
$3,093.31
|
| Rate for Payer: First Health Commercial |
$3,540.54
|
| Rate for Payer: Humana Commercial |
$3,167.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,056.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,750.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,118.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,279.65
|
| Rate for Payer: Ohio Health Group HMO |
$2,795.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,981.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,242.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,571.55
|
| Rate for Payer: PHCS Commercial |
$3,577.80
|
| Rate for Payer: United Healthcare All Payer |
$3,279.65
|
|
|
GII PAT W/FLEX LOK PEG 32MM
|
Facility
|
OP
|
$3,726.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,118.06 |
| Max. Negotiated Rate |
$3,577.80 |
| Rate for Payer: Aetna Commercial |
$2,869.70
|
| Rate for Payer: Anthem Medicaid |
$1,281.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,906.97
|
| Rate for Payer: Cash Price |
$1,863.44
|
| Rate for Payer: Cigna Commercial |
$3,093.31
|
| Rate for Payer: First Health Commercial |
$3,540.54
|
| Rate for Payer: Humana Commercial |
$3,167.85
|
| Rate for Payer: Humana KY Medicaid |
$1,281.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,294.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,056.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,750.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,118.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,307.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,279.65
|
| Rate for Payer: Ohio Health Group HMO |
$2,795.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,981.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,242.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,571.55
|
| Rate for Payer: PHCS Commercial |
$3,577.80
|
| Rate for Payer: United Healthcare All Payer |
$3,279.65
|
|
|
GII PS HI FLEX INSRT SZ 1-2 11
|
Facility
|
IP
|
$5,090.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,527.00 |
| Max. Negotiated Rate |
$4,886.40 |
| Rate for Payer: Aetna Commercial |
$3,919.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,970.20
|
| Rate for Payer: Cash Price |
$2,545.00
|
| Rate for Payer: Cigna Commercial |
$4,224.70
|
| Rate for Payer: First Health Commercial |
$4,835.50
|
| Rate for Payer: Humana Commercial |
$4,326.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,173.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,756.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,527.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,479.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,817.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,428.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.10
|
| Rate for Payer: PHCS Commercial |
$4,886.40
|
| Rate for Payer: United Healthcare All Payer |
$4,479.20
|
|
|
GII PS HI FLEX INSRT SZ 1-2 11
|
Facility
|
OP
|
$5,090.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,527.00 |
| Max. Negotiated Rate |
$4,886.40 |
| Rate for Payer: Aetna Commercial |
$3,919.30
|
| Rate for Payer: Anthem Medicaid |
$1,750.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,970.20
|
| Rate for Payer: Cash Price |
$2,545.00
|
| Rate for Payer: Cigna Commercial |
$4,224.70
|
| Rate for Payer: First Health Commercial |
$4,835.50
|
| Rate for Payer: Humana Commercial |
$4,326.50
|
| Rate for Payer: Humana KY Medicaid |
$1,750.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,768.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,173.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,756.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,527.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,785.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,479.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,817.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,428.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.10
|
| Rate for Payer: PHCS Commercial |
$4,886.40
|
| Rate for Payer: United Healthcare All Payer |
$4,479.20
|
|
|
GII PS HI FLEX INSRT SZ 1-2 13
|
Facility
|
IP
|
$5,090.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,527.00 |
| Max. Negotiated Rate |
$4,886.40 |
| Rate for Payer: Aetna Commercial |
$3,919.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,970.20
|
| Rate for Payer: Cash Price |
$2,545.00
|
| Rate for Payer: Cigna Commercial |
$4,224.70
|
| Rate for Payer: First Health Commercial |
$4,835.50
|
| Rate for Payer: Humana Commercial |
$4,326.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,173.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,756.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,527.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,479.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,817.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,428.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.10
|
| Rate for Payer: PHCS Commercial |
$4,886.40
|
| Rate for Payer: United Healthcare All Payer |
$4,479.20
|
|
