|
GII PS INSERT SZ 1-2 15MM
|
Facility
|
IP
|
$5,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,545.00 |
| Max. Negotiated Rate |
$4,944.00 |
| Rate for Payer: Aetna Commercial |
$3,965.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,017.00
|
| Rate for Payer: Cash Price |
$2,575.00
|
| Rate for Payer: Cigna Commercial |
$4,274.50
|
| Rate for Payer: First Health Commercial |
$4,892.50
|
| Rate for Payer: Humana Commercial |
$4,377.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,223.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,545.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,532.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,480.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,553.50
|
| Rate for Payer: PHCS Commercial |
$4,944.00
|
| Rate for Payer: United Healthcare All Payer |
$4,532.00
|
|
|
GII PS INSERT SZ 1-2 18MM
|
Facility
|
IP
|
$5,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,545.00 |
| Max. Negotiated Rate |
$4,944.00 |
| Rate for Payer: Aetna Commercial |
$3,965.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,017.00
|
| Rate for Payer: Cash Price |
$2,575.00
|
| Rate for Payer: Cigna Commercial |
$4,274.50
|
| Rate for Payer: First Health Commercial |
$4,892.50
|
| Rate for Payer: Humana Commercial |
$4,377.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,223.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,545.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,532.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,480.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,553.50
|
| Rate for Payer: PHCS Commercial |
$4,944.00
|
| Rate for Payer: United Healthcare All Payer |
$4,532.00
|
|
|
GII PS INSERT SZ 1-2 18MM
|
Facility
|
OP
|
$5,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,545.00 |
| Max. Negotiated Rate |
$4,944.00 |
| Rate for Payer: Aetna Commercial |
$3,965.50
|
| Rate for Payer: Anthem Medicaid |
$1,771.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,017.00
|
| Rate for Payer: Cash Price |
$2,575.00
|
| Rate for Payer: Cigna Commercial |
$4,274.50
|
| Rate for Payer: First Health Commercial |
$4,892.50
|
| Rate for Payer: Humana Commercial |
$4,377.50
|
| Rate for Payer: Humana KY Medicaid |
$1,771.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,789.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,223.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,545.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,806.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,532.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,480.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,553.50
|
| Rate for Payer: PHCS Commercial |
$4,944.00
|
| Rate for Payer: United Healthcare All Payer |
$4,532.00
|
|
|
GII PS INSERT SZ 1-2 21MM
|
Facility
|
IP
|
$5,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,545.00 |
| Max. Negotiated Rate |
$4,944.00 |
| Rate for Payer: Aetna Commercial |
$3,965.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,017.00
|
| Rate for Payer: Cash Price |
$2,575.00
|
| Rate for Payer: Cigna Commercial |
$4,274.50
|
| Rate for Payer: First Health Commercial |
$4,892.50
|
| Rate for Payer: Humana Commercial |
$4,377.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,223.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,545.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,532.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,480.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,553.50
|
| Rate for Payer: PHCS Commercial |
$4,944.00
|
| Rate for Payer: United Healthcare All Payer |
$4,532.00
|
|
|
GII PS INSERT SZ 1-2 21MM
|
Facility
|
OP
|
$5,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,545.00 |
| Max. Negotiated Rate |
$4,944.00 |
| Rate for Payer: Aetna Commercial |
$3,965.50
|
| Rate for Payer: Anthem Medicaid |
$1,771.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,017.00
|
| Rate for Payer: Cash Price |
$2,575.00
|
| Rate for Payer: Cigna Commercial |
$4,274.50
|
| Rate for Payer: First Health Commercial |
$4,892.50
|
| Rate for Payer: Humana Commercial |
$4,377.50
|
| Rate for Payer: Humana KY Medicaid |
$1,771.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,789.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,223.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,545.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,806.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,532.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,480.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,553.50
|
| Rate for Payer: PHCS Commercial |
$4,944.00
|
| Rate for Payer: United Healthcare All Payer |
$4,532.00
|
|
|
GII PS INSERT SZ 1-2 25MM
|
Facility
|
OP
|
$5,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,545.00 |
| Max. Negotiated Rate |
$4,944.00 |
| Rate for Payer: Aetna Commercial |
$3,965.50
|
| Rate for Payer: Anthem Medicaid |
$1,771.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,017.00
|
| Rate for Payer: Cash Price |
$2,575.00
|
| Rate for Payer: Cigna Commercial |
$4,274.50
|
| Rate for Payer: First Health Commercial |
$4,892.50
|
| Rate for Payer: Humana Commercial |
$4,377.50
|
| Rate for Payer: Humana KY Medicaid |
$1,771.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,789.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,223.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,545.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,806.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,532.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,480.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,553.50
|
| Rate for Payer: PHCS Commercial |
$4,944.00
|
| Rate for Payer: United Healthcare All Payer |
$4,532.00
|
|
|
GII PS INSERT SZ 1-2 25MM
|
Facility
|
IP
|
$5,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,545.00 |
| Max. Negotiated Rate |
$4,944.00 |
| Rate for Payer: Aetna Commercial |
$3,965.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,017.00
|
| Rate for Payer: Cash Price |
$2,575.00
|
| Rate for Payer: Cigna Commercial |
$4,274.50
|
| Rate for Payer: First Health Commercial |
$4,892.50
|
| Rate for Payer: Humana Commercial |
$4,377.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,223.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,545.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,532.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,480.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,553.50
|
| Rate for Payer: PHCS Commercial |
$4,944.00
|
| Rate for Payer: United Healthcare All Payer |
$4,532.00
|
|
|
GII PS INSERT SZ 1-2 9MM
|
Facility
|
IP
|
$5,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,545.00 |
| Max. Negotiated Rate |
$4,944.00 |
| Rate for Payer: Aetna Commercial |
$3,965.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,017.00
|
| Rate for Payer: Cash Price |
$2,575.00
|
| Rate for Payer: Cigna Commercial |
$4,274.50
|
| Rate for Payer: First Health Commercial |
$4,892.50
|
| Rate for Payer: Humana Commercial |
$4,377.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,223.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,545.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,532.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,480.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,553.50
|
| Rate for Payer: PHCS Commercial |
$4,944.00
|
| Rate for Payer: United Healthcare All Payer |
$4,532.00
|
|
|
GII PS INSERT SZ 1-2 9MM
|
Facility
|
OP
|
$5,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,545.00 |
| Max. Negotiated Rate |
$4,944.00 |
| Rate for Payer: Aetna Commercial |
$3,965.50
|
| Rate for Payer: Anthem Medicaid |
$1,771.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,017.00
|
| Rate for Payer: Cash Price |
$2,575.00
|
| Rate for Payer: Cigna Commercial |
$4,274.50
|
| Rate for Payer: First Health Commercial |
$4,892.50
|
| Rate for Payer: Humana Commercial |
$4,377.50
|
| Rate for Payer: Humana KY Medicaid |
$1,771.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,789.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,223.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,545.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,806.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,532.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,480.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,553.50
|
| Rate for Payer: PHCS Commercial |
$4,944.00
|
| Rate for Payer: United Healthcare All Payer |
$4,532.00
|
|
|
GII PS INSERT SZ 3-4 11MM
|
Facility
|
IP
|
$4,662.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,398.75 |
| Max. Negotiated Rate |
$4,476.00 |
| Rate for Payer: Aetna Commercial |
$3,590.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,636.75
|
| Rate for Payer: Cash Price |
$2,331.25
|
| Rate for Payer: Cigna Commercial |
$3,869.88
|
| Rate for Payer: First Health Commercial |
$4,429.38
|
| Rate for Payer: Humana Commercial |
$3,963.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,823.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,440.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,398.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,103.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,496.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,730.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,056.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,217.12
|
| Rate for Payer: PHCS Commercial |
$4,476.00
|
| Rate for Payer: United Healthcare All Payer |
$4,103.00
|
|
|
GII PS INSERT SZ 3-4 11MM
|
Facility
|
OP
|
$4,662.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,398.75 |
| Max. Negotiated Rate |
$4,476.00 |
| Rate for Payer: Aetna Commercial |
$3,590.12
|
| Rate for Payer: Anthem Medicaid |
$1,603.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,636.75
|
| Rate for Payer: Cash Price |
$2,331.25
|
| Rate for Payer: Cigna Commercial |
$3,869.88
|
| Rate for Payer: First Health Commercial |
$4,429.38
|
| Rate for Payer: Humana Commercial |
$3,963.12
|
| Rate for Payer: Humana KY Medicaid |
$1,603.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,619.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,823.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,440.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,398.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,635.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,103.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,496.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,730.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,056.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,217.12
|
| Rate for Payer: PHCS Commercial |
$4,476.00
|
| Rate for Payer: United Healthcare All Payer |
$4,103.00
|
|
|
GII PS INSERT SZ 3-4 13MM
|
Facility
|
OP
|
$4,760.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,428.00 |
| Max. Negotiated Rate |
$4,569.60 |
| Rate for Payer: Aetna Commercial |
$3,665.20
|
| Rate for Payer: Anthem Medicaid |
$1,636.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,712.80
|
| Rate for Payer: Cash Price |
$2,380.00
|
| Rate for Payer: Cigna Commercial |
$3,950.80
|
| Rate for Payer: First Health Commercial |
$4,522.00
|
| Rate for Payer: Humana Commercial |
$4,046.00
|
| Rate for Payer: Humana KY Medicaid |
$1,636.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,653.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,903.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,512.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,428.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,669.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,188.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,570.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,808.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,141.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,284.40
|
| Rate for Payer: PHCS Commercial |
$4,569.60
|
| Rate for Payer: United Healthcare All Payer |
$4,188.80
|
|
|
GII PS INSERT SZ 3-4 13MM
|
Facility
|
IP
|
$4,760.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,428.00 |
| Max. Negotiated Rate |
$4,569.60 |
| Rate for Payer: Aetna Commercial |
$3,665.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,712.80
|
| Rate for Payer: Cash Price |
$2,380.00
|
| Rate for Payer: Cigna Commercial |
$3,950.80
|
| Rate for Payer: First Health Commercial |
$4,522.00
|
| Rate for Payer: Humana Commercial |
$4,046.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,903.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,512.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,428.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,188.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,570.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,808.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,141.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,284.40
|
| Rate for Payer: PHCS Commercial |
$4,569.60
|
| Rate for Payer: United Healthcare All Payer |
$4,188.80
|
|
|
GII PS INSERT SZ 3-4 18MM
|
Facility
|
IP
|
$4,760.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,428.00 |
| Max. Negotiated Rate |
$4,569.60 |
| Rate for Payer: Aetna Commercial |
$3,665.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,712.80
|
| Rate for Payer: Cash Price |
$2,380.00
|
| Rate for Payer: Cigna Commercial |
$3,950.80
|
| Rate for Payer: First Health Commercial |
$4,522.00
|
| Rate for Payer: Humana Commercial |
$4,046.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,903.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,512.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,428.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,188.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,570.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,808.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,141.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,284.40
|
| Rate for Payer: PHCS Commercial |
$4,569.60
|
| Rate for Payer: United Healthcare All Payer |
$4,188.80
|
|
|
GII PS INSERT SZ 3-4 18MM
|
Facility
|
OP
|
$4,760.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,428.00 |
| Max. Negotiated Rate |
$4,569.60 |
| Rate for Payer: Aetna Commercial |
$3,665.20
|
| Rate for Payer: Anthem Medicaid |
$1,636.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,712.80
|
| Rate for Payer: Cash Price |
$2,380.00
|
| Rate for Payer: Cigna Commercial |
$3,950.80
|
| Rate for Payer: First Health Commercial |
$4,522.00
|
| Rate for Payer: Humana Commercial |
$4,046.00
|
| Rate for Payer: Humana KY Medicaid |
$1,636.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,653.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,903.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,512.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,428.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,669.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,188.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,570.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,808.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,141.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,284.40
|
| Rate for Payer: PHCS Commercial |
$4,569.60
|
| Rate for Payer: United Healthcare All Payer |
$4,188.80
|
|
|
GII PS INSERT SZ 3-4 21MM
|
Facility
|
IP
|
$5,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,545.00 |
| Max. Negotiated Rate |
$4,944.00 |
| Rate for Payer: Aetna Commercial |
$3,965.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,017.00
|
| Rate for Payer: Cash Price |
$2,575.00
|
| Rate for Payer: Cigna Commercial |
$4,274.50
|
| Rate for Payer: First Health Commercial |
$4,892.50
|
| Rate for Payer: Humana Commercial |
$4,377.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,223.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,545.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,532.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,480.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,553.50
|
| Rate for Payer: PHCS Commercial |
$4,944.00
|
| Rate for Payer: United Healthcare All Payer |
$4,532.00
|
|
|
GII PS INSERT SZ 3-4 21MM
|
Facility
|
OP
|
$5,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,545.00 |
| Max. Negotiated Rate |
$4,944.00 |
| Rate for Payer: Aetna Commercial |
$3,965.50
|
| Rate for Payer: Anthem Medicaid |
$1,771.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,017.00
|
| Rate for Payer: Cash Price |
$2,575.00
|
| Rate for Payer: Cigna Commercial |
$4,274.50
|
| Rate for Payer: First Health Commercial |
$4,892.50
|
| Rate for Payer: Humana Commercial |
$4,377.50
|
| Rate for Payer: Humana KY Medicaid |
$1,771.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,789.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,223.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,545.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,806.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,532.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,480.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,553.50
|
| Rate for Payer: PHCS Commercial |
$4,944.00
|
| Rate for Payer: United Healthcare All Payer |
$4,532.00
|
|
|
GII PS INSERT SZ 3-4 25MM
|
Facility
|
OP
|
$5,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,545.00 |
| Max. Negotiated Rate |
$4,944.00 |
| Rate for Payer: Aetna Commercial |
$3,965.50
|
| Rate for Payer: Anthem Medicaid |
$1,771.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,017.00
|
| Rate for Payer: Cash Price |
$2,575.00
|
| Rate for Payer: Cigna Commercial |
$4,274.50
|
| Rate for Payer: First Health Commercial |
$4,892.50
|
| Rate for Payer: Humana Commercial |
$4,377.50
|
| Rate for Payer: Humana KY Medicaid |
$1,771.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,789.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,223.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,545.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,806.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,532.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,480.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,553.50
|
| Rate for Payer: PHCS Commercial |
$4,944.00
|
| Rate for Payer: United Healthcare All Payer |
$4,532.00
|
|
|
GII PS INSERT SZ 3-4 25MM
|
Facility
|
IP
|
$5,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,545.00 |
| Max. Negotiated Rate |
$4,944.00 |
| Rate for Payer: Aetna Commercial |
$3,965.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,017.00
|
| Rate for Payer: Cash Price |
$2,575.00
|
| Rate for Payer: Cigna Commercial |
$4,274.50
|
| Rate for Payer: First Health Commercial |
$4,892.50
|
| Rate for Payer: Humana Commercial |
$4,377.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,223.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,545.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,532.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,480.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,553.50
|
| Rate for Payer: PHCS Commercial |
$4,944.00
|
| Rate for Payer: United Healthcare All Payer |
$4,532.00
|
|
|
GII PS INSERT SZ 3-4 9MM
|
Facility
|
IP
|
$5,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,545.00 |
| Max. Negotiated Rate |
$4,944.00 |
| Rate for Payer: Aetna Commercial |
$3,965.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,017.00
|
| Rate for Payer: Cash Price |
$2,575.00
|
| Rate for Payer: Cigna Commercial |
$4,274.50
|
| Rate for Payer: First Health Commercial |
$4,892.50
|
| Rate for Payer: Humana Commercial |
$4,377.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,223.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,545.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,532.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,480.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,553.50
|
| Rate for Payer: PHCS Commercial |
$4,944.00
|
| Rate for Payer: United Healthcare All Payer |
$4,532.00
|
|
|
GII PS INSERT SZ 3-4 9MM
|
Facility
|
OP
|
$5,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,545.00 |
| Max. Negotiated Rate |
$4,944.00 |
| Rate for Payer: Aetna Commercial |
$3,965.50
|
| Rate for Payer: Anthem Medicaid |
$1,771.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,017.00
|
| Rate for Payer: Cash Price |
$2,575.00
|
| Rate for Payer: Cigna Commercial |
$4,274.50
|
| Rate for Payer: First Health Commercial |
$4,892.50
|
| Rate for Payer: Humana Commercial |
$4,377.50
|
| Rate for Payer: Humana KY Medicaid |
$1,771.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,789.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,223.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,545.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,806.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,532.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,480.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,553.50
|
| Rate for Payer: PHCS Commercial |
$4,944.00
|
| Rate for Payer: United Healthcare All Payer |
$4,532.00
|
|
|
GII PS INSERT SZ 5-6 11MM
|
Facility
|
IP
|
$4,760.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,428.00 |
| Max. Negotiated Rate |
$4,569.60 |
| Rate for Payer: Aetna Commercial |
$3,665.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,712.80
|
| Rate for Payer: Cash Price |
$2,380.00
|
| Rate for Payer: Cigna Commercial |
$3,950.80
|
| Rate for Payer: First Health Commercial |
$4,522.00
|
| Rate for Payer: Humana Commercial |
$4,046.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,903.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,512.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,428.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,188.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,570.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,808.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,141.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,284.40
|
| Rate for Payer: PHCS Commercial |
$4,569.60
|
| Rate for Payer: United Healthcare All Payer |
$4,188.80
|
|
|
GII PS INSERT SZ 5-6 11MM
|
Facility
|
OP
|
$4,760.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,428.00 |
| Max. Negotiated Rate |
$4,569.60 |
| Rate for Payer: Aetna Commercial |
$3,665.20
|
| Rate for Payer: Anthem Medicaid |
$1,636.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,712.80
|
| Rate for Payer: Cash Price |
$2,380.00
|
| Rate for Payer: Cigna Commercial |
$3,950.80
|
| Rate for Payer: First Health Commercial |
$4,522.00
|
| Rate for Payer: Humana Commercial |
$4,046.00
|
| Rate for Payer: Humana KY Medicaid |
$1,636.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,653.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,903.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,512.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,428.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,669.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,188.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,570.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,808.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,141.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,284.40
|
| Rate for Payer: PHCS Commercial |
$4,569.60
|
| Rate for Payer: United Healthcare All Payer |
$4,188.80
|
|
|
GII PS INSERT SZ 5-6 13MM
|
Facility
|
IP
|
$4,760.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,428.00 |
| Max. Negotiated Rate |
$4,569.60 |
| Rate for Payer: Aetna Commercial |
$3,665.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,712.80
|
| Rate for Payer: Cash Price |
$2,380.00
|
| Rate for Payer: Cigna Commercial |
$3,950.80
|
| Rate for Payer: First Health Commercial |
$4,522.00
|
| Rate for Payer: Humana Commercial |
$4,046.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,903.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,512.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,428.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,188.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,570.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,808.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,141.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,284.40
|
| Rate for Payer: PHCS Commercial |
$4,569.60
|
| Rate for Payer: United Healthcare All Payer |
$4,188.80
|
|
|
GII PS INSERT SZ 5-6 13MM
|
Facility
|
OP
|
$4,760.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,428.00 |
| Max. Negotiated Rate |
$4,569.60 |
| Rate for Payer: Aetna Commercial |
$3,665.20
|
| Rate for Payer: Anthem Medicaid |
$1,636.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,712.80
|
| Rate for Payer: Cash Price |
$2,380.00
|
| Rate for Payer: Cigna Commercial |
$3,950.80
|
| Rate for Payer: First Health Commercial |
$4,522.00
|
| Rate for Payer: Humana Commercial |
$4,046.00
|
| Rate for Payer: Humana KY Medicaid |
$1,636.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,653.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,903.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,512.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,428.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,669.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,188.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,570.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,808.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,141.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,284.40
|
| Rate for Payer: PHCS Commercial |
$4,569.60
|
| Rate for Payer: United Healthcare All Payer |
$4,188.80
|
|
