|
GMRS FLUTED STEM EXT 19MM*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 21MM*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 21MM*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 23MM*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 23MM*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 FULL FLAT BLOCK 10MM L 2
|
Facility
|
IP
|
$8,171.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,451.40 |
| Max. Negotiated Rate |
$7,844.47 |
| Rate for Payer: Aetna Commercial |
$6,291.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,373.63
|
| Rate for Payer: Cash Price |
$4,085.66
|
| Rate for Payer: Cigna Commercial |
$6,782.20
|
| Rate for Payer: First Health Commercial |
$7,762.75
|
| Rate for Payer: Humana Commercial |
$6,945.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,700.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,030.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,451.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,190.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,128.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,537.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,109.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,638.21
|
| Rate for Payer: PHCS Commercial |
$7,844.47
|
| Rate for Payer: United Healthcare All Payer |
$7,190.76
|
|
|
GMRS FULL FLAT BLOCK 10MM L 2
|
Facility
|
OP
|
$8,171.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,451.40 |
| Max. Negotiated Rate |
$7,844.47 |
| Rate for Payer: Aetna Commercial |
$6,291.92
|
| Rate for Payer: Anthem Medicaid |
$2,810.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,373.63
|
| Rate for Payer: Cash Price |
$4,085.66
|
| Rate for Payer: Cigna Commercial |
$6,782.20
|
| Rate for Payer: First Health Commercial |
$7,762.75
|
| Rate for Payer: Humana Commercial |
$6,945.62
|
| Rate for Payer: Humana KY Medicaid |
$2,810.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,838.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,700.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,030.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,451.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,866.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,190.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,128.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,537.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,109.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,638.21
|
| Rate for Payer: PHCS Commercial |
$7,844.47
|
| Rate for Payer: United Healthcare All Payer |
$7,190.76
|
|
|
GMRS FULL FLAT BLOCK 10MM M 2
|
Facility
|
IP
|
$8,171.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,451.40 |
| Max. Negotiated Rate |
$7,844.47 |
| Rate for Payer: Aetna Commercial |
$6,291.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,373.63
|
| Rate for Payer: Cash Price |
$4,085.66
|
| Rate for Payer: Cigna Commercial |
$6,782.20
|
| Rate for Payer: First Health Commercial |
$7,762.75
|
| Rate for Payer: Humana Commercial |
$6,945.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,700.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,030.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,451.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,190.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,128.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,537.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,109.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,638.21
|
| Rate for Payer: PHCS Commercial |
$7,844.47
|
| Rate for Payer: United Healthcare All Payer |
$7,190.76
|
|
|
GMRS FULL FLAT BLOCK 10MM M 2
|
Facility
|
OP
|
$8,171.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,451.40 |
| Max. Negotiated Rate |
$7,844.47 |
| Rate for Payer: Aetna Commercial |
$6,291.92
|
| Rate for Payer: Anthem Medicaid |
$2,810.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,373.63
|
| Rate for Payer: Cash Price |
$4,085.66
|
| Rate for Payer: Cigna Commercial |
$6,782.20
|
| Rate for Payer: First Health Commercial |
$7,762.75
|
| Rate for Payer: Humana Commercial |
$6,945.62
|
| Rate for Payer: Humana KY Medicaid |
$2,810.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,838.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,700.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,030.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,451.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,866.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,190.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,128.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,537.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,109.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,638.21
|
| Rate for Payer: PHCS Commercial |
$7,844.47
|
| Rate for Payer: United Healthcare All Payer |
$7,190.76
|
|
|
GMRS FULL FLAT BLOCK 10MM SM 2
|
Facility
|
OP
|
$8,171.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,451.40 |
| Max. Negotiated Rate |
$7,844.47 |
| Rate for Payer: Aetna Commercial |
$6,291.92
|
| Rate for Payer: Anthem Medicaid |
$2,810.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,373.63
|
| Rate for Payer: Cash Price |
$4,085.66
|
| Rate for Payer: Cigna Commercial |
$6,782.20
|
| Rate for Payer: First Health Commercial |
$7,762.75
|
| Rate for Payer: Humana Commercial |
$6,945.62
|
| Rate for Payer: Humana KY Medicaid |
$2,810.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,838.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,700.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,030.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,451.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,866.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,190.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,128.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,537.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,109.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,638.21
|
| Rate for Payer: PHCS Commercial |
$7,844.47
|
| Rate for Payer: United Healthcare All Payer |
$7,190.76
|
|
|
GMRS FULL FLAT BLOCK 10MM SM 2
|
Facility
|
IP
|
$8,171.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,451.40 |
| Max. Negotiated Rate |
$7,844.47 |
| Rate for Payer: Aetna Commercial |
$6,291.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,373.63
|
| Rate for Payer: Cash Price |
$4,085.66
|
| Rate for Payer: Cigna Commercial |
$6,782.20
|
| Rate for Payer: First Health Commercial |
$7,762.75
|
| Rate for Payer: Humana Commercial |
$6,945.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,700.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,030.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,451.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,190.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,128.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,537.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,109.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,638.21
|
| Rate for Payer: PHCS Commercial |
$7,844.47
|
| Rate for Payer: United Healthcare All Payer |
$7,190.76
|
|
|
GMRS HEMI FLAT WDG LFT 5MM L 2
|
Facility
|
IP
|
$5,186.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,555.80 |
| Max. Negotiated Rate |
$4,978.56 |
| Rate for Payer: Aetna Commercial |
$3,993.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,045.08
|
| Rate for Payer: Cash Price |
$2,593.00
|
| Rate for Payer: Cigna Commercial |
$4,304.38
|
| Rate for Payer: First Health Commercial |
$4,926.70
|
| Rate for Payer: Humana Commercial |
$4,408.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,252.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,827.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,555.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,563.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,889.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,511.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,578.34
|
| Rate for Payer: PHCS Commercial |
$4,978.56
|
| Rate for Payer: United Healthcare All Payer |
$4,563.68
|
|
|
GMRS HEMI FLAT WDG LFT 5MM L 2
|
Facility
|
OP
|
$5,186.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,555.80 |
| Max. Negotiated Rate |
$4,978.56 |
| Rate for Payer: Aetna Commercial |
$3,993.22
|
| Rate for Payer: Anthem Medicaid |
$1,783.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,045.08
|
| Rate for Payer: Cash Price |
$2,593.00
|
| Rate for Payer: Cigna Commercial |
$4,304.38
|
| Rate for Payer: First Health Commercial |
$4,926.70
|
| Rate for Payer: Humana Commercial |
$4,408.10
|
| Rate for Payer: Humana KY Medicaid |
$1,783.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,801.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,252.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,827.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,555.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,819.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,563.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,889.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,511.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,578.34
|
| Rate for Payer: PHCS Commercial |
$4,978.56
|
| Rate for Payer: United Healthcare All Payer |
$4,563.68
|
|
|
GMRS HEMI FLAT WDG LFT 5MM M 2
|
Facility
|
OP
|
$5,186.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,555.80 |
| Max. Negotiated Rate |
$4,978.56 |
| Rate for Payer: Aetna Commercial |
$3,993.22
|
| Rate for Payer: Anthem Medicaid |
$1,783.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,045.08
|
| Rate for Payer: Cash Price |
$2,593.00
|
| Rate for Payer: Cigna Commercial |
$4,304.38
|
| Rate for Payer: First Health Commercial |
$4,926.70
|
| Rate for Payer: Humana Commercial |
$4,408.10
|
| Rate for Payer: Humana KY Medicaid |
$1,783.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,801.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,252.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,827.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,555.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,819.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,563.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,889.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,511.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,578.34
|
| Rate for Payer: PHCS Commercial |
$4,978.56
|
| Rate for Payer: United Healthcare All Payer |
$4,563.68
|
|
|
GMRS HEMI FLAT WDG LFT 5MM M 2
|
Facility
|
IP
|
$5,186.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,555.80 |
| Max. Negotiated Rate |
$4,978.56 |
| Rate for Payer: Aetna Commercial |
$3,993.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,045.08
|
| Rate for Payer: Cash Price |
$2,593.00
|
| Rate for Payer: Cigna Commercial |
$4,304.38
|
| Rate for Payer: First Health Commercial |
$4,926.70
|
| Rate for Payer: Humana Commercial |
$4,408.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,252.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,827.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,555.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,563.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,889.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,511.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,578.34
|
| Rate for Payer: PHCS Commercial |
$4,978.56
|
| Rate for Payer: United Healthcare All Payer |
$4,563.68
|
|
|
GMRS HEMI FLAT WDG LT 10MM L 2
|
Facility
|
OP
|
$5,186.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,555.80 |
| Max. Negotiated Rate |
$4,978.56 |
| Rate for Payer: Aetna Commercial |
$3,993.22
|
| Rate for Payer: Anthem Medicaid |
$1,783.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,045.08
|
| Rate for Payer: Cash Price |
$2,593.00
|
| Rate for Payer: Cigna Commercial |
$4,304.38
|
| Rate for Payer: First Health Commercial |
$4,926.70
|
| Rate for Payer: Humana Commercial |
$4,408.10
|
| Rate for Payer: Humana KY Medicaid |
$1,783.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,801.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,252.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,827.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,555.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,819.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,563.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,889.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,511.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,578.34
|
| Rate for Payer: PHCS Commercial |
$4,978.56
|
| Rate for Payer: United Healthcare All Payer |
$4,563.68
|
|
|
GMRS HEMI FLAT WDG LT 10MM L 2
|
Facility
|
IP
|
$5,186.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,555.80 |
| Max. Negotiated Rate |
$4,978.56 |
| Rate for Payer: Aetna Commercial |
$3,993.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,045.08
|
| Rate for Payer: Cash Price |
$2,593.00
|
| Rate for Payer: Cigna Commercial |
$4,304.38
|
| Rate for Payer: First Health Commercial |
$4,926.70
|
| Rate for Payer: Humana Commercial |
$4,408.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,252.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,827.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,555.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,563.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,889.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,511.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,578.34
|
| Rate for Payer: PHCS Commercial |
$4,978.56
|
| Rate for Payer: United Healthcare All Payer |
$4,563.68
|
|
|
GMRS HEMI FLAT WDG LT 10MM M 2
|
Facility
|
IP
|
$5,186.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,555.80 |
| Max. Negotiated Rate |
$4,978.56 |
| Rate for Payer: Aetna Commercial |
$3,993.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,045.08
|
| Rate for Payer: Cash Price |
$2,593.00
|
| Rate for Payer: Cigna Commercial |
$4,304.38
|
| Rate for Payer: First Health Commercial |
$4,926.70
|
| Rate for Payer: Humana Commercial |
$4,408.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,252.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,827.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,555.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,563.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,889.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,511.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,578.34
|
| Rate for Payer: PHCS Commercial |
$4,978.56
|
| Rate for Payer: United Healthcare All Payer |
$4,563.68
|
|
|
GMRS HEMI FLAT WDG LT 10MM M 2
|
Facility
|
OP
|
$5,186.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,555.80 |
| Max. Negotiated Rate |
$4,978.56 |
| Rate for Payer: Aetna Commercial |
$3,993.22
|
| Rate for Payer: Anthem Medicaid |
$1,783.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,045.08
|
| Rate for Payer: Cash Price |
$2,593.00
|
| Rate for Payer: Cigna Commercial |
$4,304.38
|
| Rate for Payer: First Health Commercial |
$4,926.70
|
| Rate for Payer: Humana Commercial |
$4,408.10
|
| Rate for Payer: Humana KY Medicaid |
$1,783.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,801.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,252.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,827.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,555.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,819.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,563.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,889.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,511.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,578.34
|
| Rate for Payer: PHCS Commercial |
$4,978.56
|
| Rate for Payer: United Healthcare All Payer |
$4,563.68
|
|
|
GMRS HEMI FLAT WDG LT 10MM SM1
|
Facility
|
IP
|
$5,186.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,555.80 |
| Max. Negotiated Rate |
$4,978.56 |
| Rate for Payer: Aetna Commercial |
$3,993.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,045.08
|
| Rate for Payer: Cash Price |
$2,593.00
|
| Rate for Payer: Cigna Commercial |
$4,304.38
|
| Rate for Payer: First Health Commercial |
$4,926.70
|
| Rate for Payer: Humana Commercial |
$4,408.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,252.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,827.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,555.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,563.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,889.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,511.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,578.34
|
| Rate for Payer: PHCS Commercial |
$4,978.56
|
| Rate for Payer: United Healthcare All Payer |
$4,563.68
|
|
|
GMRS HEMI FLAT WDG LT 10MM SM1
|
Facility
|
OP
|
$5,186.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,555.80 |
| Max. Negotiated Rate |
$4,978.56 |
| Rate for Payer: Aetna Commercial |
$3,993.22
|
| Rate for Payer: Anthem Medicaid |
$1,783.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,045.08
|
| Rate for Payer: Cash Price |
$2,593.00
|
| Rate for Payer: Cigna Commercial |
$4,304.38
|
| Rate for Payer: First Health Commercial |
$4,926.70
|
| Rate for Payer: Humana Commercial |
$4,408.10
|
| Rate for Payer: Humana KY Medicaid |
$1,783.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,801.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,252.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,827.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,555.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,819.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,563.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,889.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,511.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,578.34
|
| Rate for Payer: PHCS Commercial |
$4,978.56
|
| Rate for Payer: United Healthcare All Payer |
$4,563.68
|
|
|
GMRS HEMI FLAT WDG LT 10MM SM2
|
Facility
|
IP
|
$5,186.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,555.80 |
| Max. Negotiated Rate |
$4,978.56 |
| Rate for Payer: Aetna Commercial |
$3,993.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,045.08
|
| Rate for Payer: Cash Price |
$2,593.00
|
| Rate for Payer: Cigna Commercial |
$4,304.38
|
| Rate for Payer: First Health Commercial |
$4,926.70
|
| Rate for Payer: Humana Commercial |
$4,408.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,252.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,827.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,555.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,563.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,889.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,511.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,578.34
|
| Rate for Payer: PHCS Commercial |
$4,978.56
|
| Rate for Payer: United Healthcare All Payer |
$4,563.68
|
|
|
GMRS HEMI FLAT WDG LT 10MM SM2
|
Facility
|
OP
|
$5,186.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,555.80 |
| Max. Negotiated Rate |
$4,978.56 |
| Rate for Payer: Aetna Commercial |
$3,993.22
|
| Rate for Payer: Anthem Medicaid |
$1,783.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,045.08
|
| Rate for Payer: Cash Price |
$2,593.00
|
| Rate for Payer: Cigna Commercial |
$4,304.38
|
| Rate for Payer: First Health Commercial |
$4,926.70
|
| Rate for Payer: Humana Commercial |
$4,408.10
|
| Rate for Payer: Humana KY Medicaid |
$1,783.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,801.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,252.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,827.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,555.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,819.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,563.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,889.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,511.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,578.34
|
| Rate for Payer: PHCS Commercial |
$4,978.56
|
| Rate for Payer: United Healthcare All Payer |
$4,563.68
|
|
|
GMRS HEMI FLAT WDG LT 5MM SM 1
|
Facility
|
IP
|
$5,186.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,555.80 |
| Max. Negotiated Rate |
$4,978.56 |
| Rate for Payer: Aetna Commercial |
$3,993.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,045.08
|
| Rate for Payer: Cash Price |
$2,593.00
|
| Rate for Payer: Cigna Commercial |
$4,304.38
|
| Rate for Payer: First Health Commercial |
$4,926.70
|
| Rate for Payer: Humana Commercial |
$4,408.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,252.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,827.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,555.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,563.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,889.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,511.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,578.34
|
| Rate for Payer: PHCS Commercial |
$4,978.56
|
| Rate for Payer: United Healthcare All Payer |
$4,563.68
|
|
|
GMRS HEMI FLAT WDG LT 5MM SM 1
|
Facility
|
OP
|
$5,186.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,555.80 |
| Max. Negotiated Rate |
$4,978.56 |
| Rate for Payer: Aetna Commercial |
$3,993.22
|
| Rate for Payer: Anthem Medicaid |
$1,783.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,045.08
|
| Rate for Payer: Cash Price |
$2,593.00
|
| Rate for Payer: Cigna Commercial |
$4,304.38
|
| Rate for Payer: First Health Commercial |
$4,926.70
|
| Rate for Payer: Humana Commercial |
$4,408.10
|
| Rate for Payer: Humana KY Medicaid |
$1,783.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,801.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,252.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,827.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,555.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,819.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,563.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,889.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,511.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,578.34
|
| Rate for Payer: PHCS Commercial |
$4,978.56
|
| Rate for Payer: United Healthcare All Payer |
$4,563.68
|
|
