|
GII PS INSERT SZ 5-6 15MM
|
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 15MM
|
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 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 5-6 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 5-6 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 5-6 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 5-6 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 5-6 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 5-6 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 5-6 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 7-8 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 7-8 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 7-8 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 7-8 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 7-8 15MM
|
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 7-8 15MM
|
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 7-8 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 7-8 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 7-8 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 7-8 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 7-8 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 7-8 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 7-8 9MM
|
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 7-8 9MM
|
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
|
|
|
GI LEVEL 1
|
Facility
|
OP
|
$1,699.00
|
|
| Hospital Charge Code |
36001238
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$509.70 |
| Max. Negotiated Rate |
$1,631.04 |
| Rate for Payer: Aetna Commercial |
$1,308.23
|
| Rate for Payer: Anthem Medicaid |
$584.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,325.22
|
| Rate for Payer: Cash Price |
$849.50
|
| Rate for Payer: Cigna Commercial |
$1,410.17
|
| Rate for Payer: First Health Commercial |
$1,614.05
|
| Rate for Payer: Humana Commercial |
$1,444.15
|
| Rate for Payer: Humana KY Medicaid |
$584.29
|
| Rate for Payer: Kentucky WC Medicaid |
$590.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,393.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,253.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$509.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,495.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,274.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,359.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,478.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,172.31
|
| Rate for Payer: PHCS Commercial |
$1,631.04
|
| Rate for Payer: United Healthcare All Payer |
$1,495.12
|
|
