|
GMRS FLUTD STEM EXT 19MM*155MM
|
Facility
|
OP
|
$4,994.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,498.20 |
| Max. Negotiated Rate |
$4,794.24 |
| Rate for Payer: Aetna Commercial |
$3,845.38
|
| Rate for Payer: Anthem Medicaid |
$1,717.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,895.32
|
| Rate for Payer: Cash Price |
$2,497.00
|
| Rate for Payer: Cigna Commercial |
$4,145.02
|
| Rate for Payer: First Health Commercial |
$4,744.30
|
| Rate for Payer: Humana Commercial |
$4,244.90
|
| Rate for Payer: Humana KY Medicaid |
$1,717.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,734.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,095.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,685.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,498.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,751.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,394.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,745.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,995.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,344.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.86
|
| Rate for Payer: PHCS Commercial |
$4,794.24
|
| Rate for Payer: United Healthcare All Payer |
$4,394.72
|
|
|
GMRS FLUTD STEM EXT 19MM*155MM
|
Facility
|
IP
|
$4,994.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,498.20 |
| Max. Negotiated Rate |
$4,794.24 |
| Rate for Payer: Aetna Commercial |
$3,845.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,895.32
|
| Rate for Payer: Cash Price |
$2,497.00
|
| Rate for Payer: Cigna Commercial |
$4,145.02
|
| Rate for Payer: First Health Commercial |
$4,744.30
|
| Rate for Payer: Humana Commercial |
$4,244.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,095.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,685.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,498.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,394.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,745.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,995.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,344.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.86
|
| Rate for Payer: PHCS Commercial |
$4,794.24
|
| Rate for Payer: United Healthcare All Payer |
$4,394.72
|
|
|
GMRS FLUTD STEM EXT 21MM*155MM
|
Facility
|
OP
|
$4,994.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,498.20 |
| Max. Negotiated Rate |
$4,794.24 |
| Rate for Payer: Aetna Commercial |
$3,845.38
|
| Rate for Payer: Anthem Medicaid |
$1,717.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,895.32
|
| Rate for Payer: Cash Price |
$2,497.00
|
| Rate for Payer: Cigna Commercial |
$4,145.02
|
| Rate for Payer: First Health Commercial |
$4,744.30
|
| Rate for Payer: Humana Commercial |
$4,244.90
|
| Rate for Payer: Humana KY Medicaid |
$1,717.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,734.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,095.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,685.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,498.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,751.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,394.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,745.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,995.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,344.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.86
|
| Rate for Payer: PHCS Commercial |
$4,794.24
|
| Rate for Payer: United Healthcare All Payer |
$4,394.72
|
|
|
GMRS FLUTD STEM EXT 21MM*155MM
|
Facility
|
IP
|
$4,994.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,498.20 |
| Max. Negotiated Rate |
$4,794.24 |
| Rate for Payer: Aetna Commercial |
$3,845.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,895.32
|
| Rate for Payer: Cash Price |
$2,497.00
|
| Rate for Payer: Cigna Commercial |
$4,145.02
|
| Rate for Payer: First Health Commercial |
$4,744.30
|
| Rate for Payer: Humana Commercial |
$4,244.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,095.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,685.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,498.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,394.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,745.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,995.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,344.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.86
|
| Rate for Payer: PHCS Commercial |
$4,794.24
|
| Rate for Payer: United Healthcare All Payer |
$4,394.72
|
|
|
GMRS FLUTD STEM EXT 23MM*155MM
|
Facility
|
IP
|
$4,994.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,498.20 |
| Max. Negotiated Rate |
$4,794.24 |
| Rate for Payer: Aetna Commercial |
$3,845.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,895.32
|
| Rate for Payer: Cash Price |
$2,497.00
|
| Rate for Payer: Cigna Commercial |
$4,145.02
|
| Rate for Payer: First Health Commercial |
$4,744.30
|
| Rate for Payer: Humana Commercial |
$4,244.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,095.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,685.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,498.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,394.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,745.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,995.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,344.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.86
|
| Rate for Payer: PHCS Commercial |
$4,794.24
|
| Rate for Payer: United Healthcare All Payer |
$4,394.72
|
|
|
GMRS FLUTD STEM EXT 23MM*155MM
|
Facility
|
OP
|
$4,994.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,498.20 |
| Max. Negotiated Rate |
$4,794.24 |
| Rate for Payer: Aetna Commercial |
$3,845.38
|
| Rate for Payer: Anthem Medicaid |
$1,717.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,895.32
|
| Rate for Payer: Cash Price |
$2,497.00
|
| Rate for Payer: Cigna Commercial |
$4,145.02
|
| Rate for Payer: First Health Commercial |
$4,744.30
|
| Rate for Payer: Humana Commercial |
$4,244.90
|
| Rate for Payer: Humana KY Medicaid |
$1,717.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,734.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,095.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,685.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,498.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,751.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,394.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,745.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,995.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,344.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.86
|
| Rate for Payer: PHCS Commercial |
$4,794.24
|
| Rate for Payer: United Healthcare All Payer |
$4,394.72
|
|
|
GMRS FLUTED STEM EXT 10MM*80MM
|
Facility
|
IP
|
$4,994.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,498.20 |
| Max. Negotiated Rate |
$4,794.24 |
| Rate for Payer: Aetna Commercial |
$3,845.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,895.32
|
| Rate for Payer: Cash Price |
$2,497.00
|
| Rate for Payer: Cigna Commercial |
$4,145.02
|
| Rate for Payer: First Health Commercial |
$4,744.30
|
| Rate for Payer: Humana Commercial |
$4,244.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,095.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,685.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,498.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,394.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,745.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,995.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,344.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.86
|
| Rate for Payer: PHCS Commercial |
$4,794.24
|
| Rate for Payer: United Healthcare All Payer |
$4,394.72
|
|
|
GMRS FLUTED STEM EXT 10MM*80MM
|
Facility
|
OP
|
$4,994.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,498.20 |
| Max. Negotiated Rate |
$4,794.24 |
| Rate for Payer: Aetna Commercial |
$3,845.38
|
| Rate for Payer: Anthem Medicaid |
$1,717.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,895.32
|
| Rate for Payer: Cash Price |
$2,497.00
|
| Rate for Payer: Cigna Commercial |
$4,145.02
|
| Rate for Payer: First Health Commercial |
$4,744.30
|
| Rate for Payer: Humana Commercial |
$4,244.90
|
| Rate for Payer: Humana KY Medicaid |
$1,717.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,734.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,095.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,685.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,498.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,751.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,394.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,745.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,995.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,344.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.86
|
| Rate for Payer: PHCS Commercial |
$4,794.24
|
| Rate for Payer: United Healthcare All Payer |
$4,394.72
|
|
|
GMRS FLUTED STEM EXT 11MM*80MM
|
Facility
|
OP
|
$4,994.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,498.20 |
| Max. Negotiated Rate |
$4,794.24 |
| Rate for Payer: Aetna Commercial |
$3,845.38
|
| Rate for Payer: Anthem Medicaid |
$1,717.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,895.32
|
| Rate for Payer: Cash Price |
$2,497.00
|
| Rate for Payer: Cigna Commercial |
$4,145.02
|
| Rate for Payer: First Health Commercial |
$4,744.30
|
| Rate for Payer: Humana Commercial |
$4,244.90
|
| Rate for Payer: Humana KY Medicaid |
$1,717.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,734.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,095.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,685.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,498.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,751.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,394.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,745.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,995.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,344.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.86
|
| Rate for Payer: PHCS Commercial |
$4,794.24
|
| Rate for Payer: United Healthcare All Payer |
$4,394.72
|
|
|
GMRS FLUTED STEM EXT 11MM*80MM
|
Facility
|
IP
|
$4,994.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,498.20 |
| Max. Negotiated Rate |
$4,794.24 |
| Rate for Payer: Aetna Commercial |
$3,845.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,895.32
|
| Rate for Payer: Cash Price |
$2,497.00
|
| Rate for Payer: Cigna Commercial |
$4,145.02
|
| Rate for Payer: First Health Commercial |
$4,744.30
|
| Rate for Payer: Humana Commercial |
$4,244.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,095.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,685.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,498.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,394.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,745.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,995.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,344.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.86
|
| Rate for Payer: PHCS Commercial |
$4,794.24
|
| Rate for Payer: United Healthcare All Payer |
$4,394.72
|
|
|
GMRS FLUTED STEM EXT 12MM*80MM
|
Facility
|
OP
|
$5,558.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,667.40 |
| Max. Negotiated Rate |
$5,335.68 |
| Rate for Payer: Aetna Commercial |
$4,279.66
|
| Rate for Payer: Anthem Medicaid |
$1,911.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,335.24
|
| Rate for Payer: Cash Price |
$2,779.00
|
| Rate for Payer: Cigna Commercial |
$4,613.14
|
| Rate for Payer: First Health Commercial |
$5,280.10
|
| Rate for Payer: Humana Commercial |
$4,724.30
|
| Rate for Payer: Humana KY Medicaid |
$1,911.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,930.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,557.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,101.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,949.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,891.04
|
| Rate for Payer: Ohio Health Group HMO |
$4,168.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,446.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,835.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,835.02
|
| Rate for Payer: PHCS Commercial |
$5,335.68
|
| Rate for Payer: United Healthcare All Payer |
$4,891.04
|
|
|
GMRS FLUTED STEM EXT 12MM*80MM
|
Facility
|
IP
|
$5,558.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,667.40 |
| Max. Negotiated Rate |
$5,335.68 |
| Rate for Payer: Aetna Commercial |
$4,279.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,335.24
|
| Rate for Payer: Cash Price |
$2,779.00
|
| Rate for Payer: Cigna Commercial |
$4,613.14
|
| Rate for Payer: First Health Commercial |
$5,280.10
|
| Rate for Payer: Humana Commercial |
$4,724.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,557.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,101.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,891.04
|
| Rate for Payer: Ohio Health Group HMO |
$4,168.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,446.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,835.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,835.02
|
| Rate for Payer: PHCS Commercial |
$5,335.68
|
| Rate for Payer: United Healthcare All Payer |
$4,891.04
|
|
|
GMRS FLUTED STEM EXT 13MM*80MM
|
Facility
|
OP
|
$7,374.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,212.25 |
| Max. Negotiated Rate |
$7,079.19 |
| Rate for Payer: Aetna Commercial |
$5,678.10
|
| Rate for Payer: Anthem Medicaid |
$2,535.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,751.84
|
| Rate for Payer: Cash Price |
$3,687.08
|
| Rate for Payer: Cigna Commercial |
$6,120.55
|
| Rate for Payer: First Health Commercial |
$7,005.45
|
| Rate for Payer: Humana Commercial |
$6,268.04
|
| Rate for Payer: Humana KY Medicaid |
$2,535.97
|
| Rate for Payer: Kentucky WC Medicaid |
$2,561.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,046.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,442.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,212.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,586.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,489.26
|
| Rate for Payer: Ohio Health Group HMO |
$5,530.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,899.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,415.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,088.17
|
| Rate for Payer: PHCS Commercial |
$7,079.19
|
| Rate for Payer: United Healthcare All Payer |
$6,489.26
|
|
|
GMRS FLUTED STEM EXT 13MM*80MM
|
Facility
|
IP
|
$7,374.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,212.25 |
| Max. Negotiated Rate |
$7,079.19 |
| Rate for Payer: Aetna Commercial |
$5,678.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,751.84
|
| Rate for Payer: Cash Price |
$3,687.08
|
| Rate for Payer: Cigna Commercial |
$6,120.55
|
| Rate for Payer: First Health Commercial |
$7,005.45
|
| Rate for Payer: Humana Commercial |
$6,268.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,046.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,442.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,212.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,489.26
|
| Rate for Payer: Ohio Health Group HMO |
$5,530.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,899.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,415.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,088.17
|
| Rate for Payer: PHCS Commercial |
$7,079.19
|
| Rate for Payer: United Healthcare All Payer |
$6,489.26
|
|
|
GMRS FLUTED STEM EXT 14MM*80MM
|
Facility
|
IP
|
$7,204.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,161.44 |
| Max. Negotiated Rate |
$6,916.61 |
| Rate for Payer: Aetna Commercial |
$5,547.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,619.74
|
| Rate for Payer: Cash Price |
$3,602.40
|
| Rate for Payer: Cigna Commercial |
$5,979.98
|
| Rate for Payer: First Health Commercial |
$6,844.56
|
| Rate for Payer: Humana Commercial |
$6,124.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,907.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,317.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,161.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,340.22
|
| Rate for Payer: Ohio Health Group HMO |
$5,403.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,763.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,268.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,971.31
|
| Rate for Payer: PHCS Commercial |
$6,916.61
|
| Rate for Payer: United Healthcare All Payer |
$6,340.22
|
|
|
GMRS FLUTED STEM EXT 14MM*80MM
|
Facility
|
OP
|
$7,204.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,161.44 |
| Max. Negotiated Rate |
$6,916.61 |
| Rate for Payer: Aetna Commercial |
$5,547.70
|
| Rate for Payer: Anthem Medicaid |
$2,477.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,619.74
|
| Rate for Payer: Cash Price |
$3,602.40
|
| Rate for Payer: Cigna Commercial |
$5,979.98
|
| Rate for Payer: First Health Commercial |
$6,844.56
|
| Rate for Payer: Humana Commercial |
$6,124.08
|
| Rate for Payer: Humana KY Medicaid |
$2,477.73
|
| Rate for Payer: Kentucky WC Medicaid |
$2,502.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,907.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,317.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,161.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,527.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,340.22
|
| Rate for Payer: Ohio Health Group HMO |
$5,403.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,763.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,268.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,971.31
|
| Rate for Payer: PHCS Commercial |
$6,916.61
|
| Rate for Payer: United Healthcare All Payer |
$6,340.22
|
|
|
GMRS FLUTED STEM EXT 15MM*80MM
|
Facility
|
OP
|
$7,204.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,161.44 |
| Max. Negotiated Rate |
$6,916.61 |
| Rate for Payer: Aetna Commercial |
$5,547.70
|
| Rate for Payer: Anthem Medicaid |
$2,477.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,619.74
|
| Rate for Payer: Cash Price |
$3,602.40
|
| Rate for Payer: Cigna Commercial |
$5,979.98
|
| Rate for Payer: First Health Commercial |
$6,844.56
|
| Rate for Payer: Humana Commercial |
$6,124.08
|
| Rate for Payer: Humana KY Medicaid |
$2,477.73
|
| Rate for Payer: Kentucky WC Medicaid |
$2,502.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,907.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,317.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,161.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,527.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,340.22
|
| Rate for Payer: Ohio Health Group HMO |
$5,403.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,763.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,268.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,971.31
|
| Rate for Payer: PHCS Commercial |
$6,916.61
|
| Rate for Payer: United Healthcare All Payer |
$6,340.22
|
|
|
GMRS FLUTED STEM EXT 15MM*80MM
|
Facility
|
IP
|
$7,204.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,161.44 |
| Max. Negotiated Rate |
$6,916.61 |
| Rate for Payer: Aetna Commercial |
$5,547.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,619.74
|
| Rate for Payer: Cash Price |
$3,602.40
|
| Rate for Payer: Cigna Commercial |
$5,979.98
|
| Rate for Payer: First Health Commercial |
$6,844.56
|
| Rate for Payer: Humana Commercial |
$6,124.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,907.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,317.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,161.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,340.22
|
| Rate for Payer: Ohio Health Group HMO |
$5,403.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,763.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,268.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,971.31
|
| Rate for Payer: PHCS Commercial |
$6,916.61
|
| Rate for Payer: United Healthcare All Payer |
$6,340.22
|
|
|
GMRS FLUTED STEM EXT 16MM*80MM
|
Facility
|
OP
|
$6,670.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,001.13 |
| Max. Negotiated Rate |
$6,403.62 |
| Rate for Payer: Aetna Commercial |
$5,136.24
|
| Rate for Payer: Anthem Medicaid |
$2,293.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,202.94
|
| Rate for Payer: Cash Price |
$3,335.22
|
| Rate for Payer: Cigna Commercial |
$5,536.47
|
| Rate for Payer: First Health Commercial |
$6,336.92
|
| Rate for Payer: Humana Commercial |
$5,669.87
|
| Rate for Payer: Humana KY Medicaid |
$2,293.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,317.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,469.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,922.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,001.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,339.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,869.99
|
| Rate for Payer: Ohio Health Group HMO |
$5,002.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,336.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,803.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,602.60
|
| Rate for Payer: PHCS Commercial |
$6,403.62
|
| Rate for Payer: United Healthcare All Payer |
$5,869.99
|
|
|
GMRS FLUTED STEM EXT 16MM*80MM
|
Facility
|
IP
|
$6,670.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,001.13 |
| Max. Negotiated Rate |
$6,403.62 |
| Rate for Payer: Aetna Commercial |
$5,136.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,202.94
|
| Rate for Payer: Cash Price |
$3,335.22
|
| Rate for Payer: Cigna Commercial |
$5,536.47
|
| Rate for Payer: First Health Commercial |
$6,336.92
|
| Rate for Payer: Humana Commercial |
$5,669.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,469.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,922.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,001.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,869.99
|
| Rate for Payer: Ohio Health Group HMO |
$5,002.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,336.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,803.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,602.60
|
| Rate for Payer: PHCS Commercial |
$6,403.62
|
| Rate for Payer: United Healthcare All Payer |
$5,869.99
|
|
|
GMRS FLUTED STEM EXT 17MM*80MM
|
Facility
|
OP
|
$4,994.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,498.20 |
| Max. Negotiated Rate |
$4,794.24 |
| Rate for Payer: Aetna Commercial |
$3,845.38
|
| Rate for Payer: Anthem Medicaid |
$1,717.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,895.32
|
| Rate for Payer: Cash Price |
$2,497.00
|
| Rate for Payer: Cigna Commercial |
$4,145.02
|
| Rate for Payer: First Health Commercial |
$4,744.30
|
| Rate for Payer: Humana Commercial |
$4,244.90
|
| Rate for Payer: Humana KY Medicaid |
$1,717.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,734.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,095.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,685.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,498.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,751.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,394.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,745.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,995.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,344.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.86
|
| Rate for Payer: PHCS Commercial |
$4,794.24
|
| Rate for Payer: United Healthcare All Payer |
$4,394.72
|
|
|
GMRS FLUTED STEM EXT 17MM*80MM
|
Facility
|
IP
|
$4,994.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,498.20 |
| Max. Negotiated Rate |
$4,794.24 |
| Rate for Payer: Aetna Commercial |
$3,845.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,895.32
|
| Rate for Payer: Cash Price |
$2,497.00
|
| Rate for Payer: Cigna Commercial |
$4,145.02
|
| Rate for Payer: First Health Commercial |
$4,744.30
|
| Rate for Payer: Humana Commercial |
$4,244.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,095.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,685.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,498.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,394.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,745.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,995.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,344.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,445.86
|
| Rate for Payer: PHCS Commercial |
$4,794.24
|
| Rate for Payer: United Healthcare All Payer |
$4,394.72
|
|
|
GMRS FLUTED STEM EXT 18MM*80MM
|
Facility
|
OP
|
$6,670.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,001.13 |
| Max. Negotiated Rate |
$6,403.62 |
| Rate for Payer: Aetna Commercial |
$5,136.24
|
| Rate for Payer: Anthem Medicaid |
$2,293.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,202.94
|
| Rate for Payer: Cash Price |
$3,335.22
|
| Rate for Payer: Cigna Commercial |
$5,536.47
|
| Rate for Payer: First Health Commercial |
$6,336.92
|
| Rate for Payer: Humana Commercial |
$5,669.87
|
| Rate for Payer: Humana KY Medicaid |
$2,293.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,317.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,469.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,922.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,001.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,339.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,869.99
|
| Rate for Payer: Ohio Health Group HMO |
$5,002.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,336.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,803.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,602.60
|
| Rate for Payer: PHCS Commercial |
$6,403.62
|
| Rate for Payer: United Healthcare All Payer |
$5,869.99
|
|
|
GMRS FLUTED STEM EXT 18MM*80MM
|
Facility
|
IP
|
$6,670.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,001.13 |
| Max. Negotiated Rate |
$6,403.62 |
| Rate for Payer: Aetna Commercial |
$5,136.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,202.94
|
| Rate for Payer: Cash Price |
$3,335.22
|
| Rate for Payer: Cigna Commercial |
$5,536.47
|
| Rate for Payer: First Health Commercial |
$6,336.92
|
| Rate for Payer: Humana Commercial |
$5,669.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,469.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,922.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,001.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,869.99
|
| Rate for Payer: Ohio Health Group HMO |
$5,002.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,336.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,803.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,602.60
|
| Rate for Payer: PHCS Commercial |
$6,403.62
|
| Rate for Payer: United Healthcare All Payer |
$5,869.99
|
|
|
GMRS FLUTED STEM EXT 19MM*80MM
|
Facility
|
OP
|
$6,670.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,001.13 |
| Max. Negotiated Rate |
$6,403.62 |
| Rate for Payer: Aetna Commercial |
$5,136.24
|
| Rate for Payer: Anthem Medicaid |
$2,293.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,202.94
|
| Rate for Payer: Cash Price |
$3,335.22
|
| Rate for Payer: Cigna Commercial |
$5,536.47
|
| Rate for Payer: First Health Commercial |
$6,336.92
|
| Rate for Payer: Humana Commercial |
$5,669.87
|
| Rate for Payer: Humana KY Medicaid |
$2,293.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,317.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,469.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,922.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,001.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,339.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,869.99
|
| Rate for Payer: Ohio Health Group HMO |
$5,002.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,336.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,803.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,602.60
|
| Rate for Payer: PHCS Commercial |
$6,403.62
|
| Rate for Payer: United Healthcare All Payer |
$5,869.99
|
|
