|
GMRS PRESS FIT EXT 10MM*80MM
|
Facility
|
OP
|
$5,081.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,524.30 |
| Max. Negotiated Rate |
$4,877.76 |
| Rate for Payer: Aetna Commercial |
$3,912.37
|
| Rate for Payer: Anthem Medicaid |
$1,747.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,963.18
|
| Rate for Payer: Cash Price |
$2,540.50
|
| Rate for Payer: Cigna Commercial |
$4,217.23
|
| Rate for Payer: First Health Commercial |
$4,826.95
|
| Rate for Payer: Humana Commercial |
$4,318.85
|
| Rate for Payer: Humana KY Medicaid |
$1,747.36
|
| Rate for Payer: Kentucky WC Medicaid |
$1,765.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,166.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,749.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,524.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,782.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,471.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,810.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,064.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,420.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,505.89
|
| Rate for Payer: PHCS Commercial |
$4,877.76
|
| Rate for Payer: United Healthcare All Payer |
$4,471.28
|
|
|
GMRS PRESS FIT EXT 10MM*80MM
|
Facility
|
IP
|
$5,081.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,524.30 |
| Max. Negotiated Rate |
$4,877.76 |
| Rate for Payer: Aetna Commercial |
$3,912.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,963.18
|
| Rate for Payer: Cash Price |
$2,540.50
|
| Rate for Payer: Cigna Commercial |
$4,217.23
|
| Rate for Payer: First Health Commercial |
$4,826.95
|
| Rate for Payer: Humana Commercial |
$4,318.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,166.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,749.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,524.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,471.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,810.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,064.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,420.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,505.89
|
| Rate for Payer: PHCS Commercial |
$4,877.76
|
| Rate for Payer: United Healthcare All Payer |
$4,471.28
|
|
|
GMRS PRESS FIT EXT 11MM*155MM
|
Facility
|
OP
|
$4,448.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,334.40 |
| Max. Negotiated Rate |
$4,270.08 |
| Rate for Payer: Aetna Commercial |
$3,424.96
|
| Rate for Payer: Anthem Medicaid |
$1,529.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,469.44
|
| Rate for Payer: Cash Price |
$2,224.00
|
| Rate for Payer: Cigna Commercial |
$3,691.84
|
| Rate for Payer: First Health Commercial |
$4,225.60
|
| Rate for Payer: Humana Commercial |
$3,780.80
|
| Rate for Payer: Humana KY Medicaid |
$1,529.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,545.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,647.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,282.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,334.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,560.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,914.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,336.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,558.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,869.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,069.12
|
| Rate for Payer: PHCS Commercial |
$4,270.08
|
| Rate for Payer: United Healthcare All Payer |
$3,914.24
|
|
|
GMRS PRESS FIT EXT 11MM*155MM
|
Facility
|
IP
|
$4,448.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,334.40 |
| Max. Negotiated Rate |
$4,270.08 |
| Rate for Payer: Aetna Commercial |
$3,424.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,469.44
|
| Rate for Payer: Cash Price |
$2,224.00
|
| Rate for Payer: Cigna Commercial |
$3,691.84
|
| Rate for Payer: First Health Commercial |
$4,225.60
|
| Rate for Payer: Humana Commercial |
$3,780.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,647.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,282.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,334.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,914.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,336.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,558.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,869.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,069.12
|
| Rate for Payer: PHCS Commercial |
$4,270.08
|
| Rate for Payer: United Healthcare All Payer |
$3,914.24
|
|
|
GMRS PRESS FIT EXT 11MM*80MM
|
Facility
|
IP
|
$5,081.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,524.30 |
| Max. Negotiated Rate |
$4,877.76 |
| Rate for Payer: Aetna Commercial |
$3,912.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,963.18
|
| Rate for Payer: Cash Price |
$2,540.50
|
| Rate for Payer: Cigna Commercial |
$4,217.23
|
| Rate for Payer: First Health Commercial |
$4,826.95
|
| Rate for Payer: Humana Commercial |
$4,318.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,166.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,749.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,524.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,471.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,810.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,064.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,420.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,505.89
|
| Rate for Payer: PHCS Commercial |
$4,877.76
|
| Rate for Payer: United Healthcare All Payer |
$4,471.28
|
|
|
GMRS PRESS FIT EXT 11MM*80MM
|
Facility
|
OP
|
$5,081.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,524.30 |
| Max. Negotiated Rate |
$4,877.76 |
| Rate for Payer: Aetna Commercial |
$3,912.37
|
| Rate for Payer: Anthem Medicaid |
$1,747.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,963.18
|
| Rate for Payer: Cash Price |
$2,540.50
|
| Rate for Payer: Cigna Commercial |
$4,217.23
|
| Rate for Payer: First Health Commercial |
$4,826.95
|
| Rate for Payer: Humana Commercial |
$4,318.85
|
| Rate for Payer: Humana KY Medicaid |
$1,747.36
|
| Rate for Payer: Kentucky WC Medicaid |
$1,765.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,166.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,749.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,524.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,782.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,471.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,810.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,064.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,420.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,505.89
|
| Rate for Payer: PHCS Commercial |
$4,877.76
|
| Rate for Payer: United Healthcare All Payer |
$4,471.28
|
|
|
GMRS PRESS FIT EXT 12MM*155MM
|
Facility
|
OP
|
$4,448.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,334.40 |
| Max. Negotiated Rate |
$4,270.08 |
| Rate for Payer: Aetna Commercial |
$3,424.96
|
| Rate for Payer: Anthem Medicaid |
$1,529.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,469.44
|
| Rate for Payer: Cash Price |
$2,224.00
|
| Rate for Payer: Cigna Commercial |
$3,691.84
|
| Rate for Payer: First Health Commercial |
$4,225.60
|
| Rate for Payer: Humana Commercial |
$3,780.80
|
| Rate for Payer: Humana KY Medicaid |
$1,529.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,545.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,647.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,282.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,334.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,560.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,914.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,336.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,558.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,869.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,069.12
|
| Rate for Payer: PHCS Commercial |
$4,270.08
|
| Rate for Payer: United Healthcare All Payer |
$3,914.24
|
|
|
GMRS PRESS FIT EXT 12MM*155MM
|
Facility
|
IP
|
$4,448.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,334.40 |
| Max. Negotiated Rate |
$4,270.08 |
| Rate for Payer: Aetna Commercial |
$3,424.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,469.44
|
| Rate for Payer: Cash Price |
$2,224.00
|
| Rate for Payer: Cigna Commercial |
$3,691.84
|
| Rate for Payer: First Health Commercial |
$4,225.60
|
| Rate for Payer: Humana Commercial |
$3,780.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,647.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,282.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,334.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,914.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,336.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,558.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,869.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,069.12
|
| Rate for Payer: PHCS Commercial |
$4,270.08
|
| Rate for Payer: United Healthcare All Payer |
$3,914.24
|
|
|
GMRS PRESS FIT EXT 12MM*80MM
|
Facility
|
IP
|
$4,448.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,334.40 |
| Max. Negotiated Rate |
$4,270.08 |
| Rate for Payer: Aetna Commercial |
$3,424.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,469.44
|
| Rate for Payer: Cash Price |
$2,224.00
|
| Rate for Payer: Cigna Commercial |
$3,691.84
|
| Rate for Payer: First Health Commercial |
$4,225.60
|
| Rate for Payer: Humana Commercial |
$3,780.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,647.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,282.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,334.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,914.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,336.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,558.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,869.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,069.12
|
| Rate for Payer: PHCS Commercial |
$4,270.08
|
| Rate for Payer: United Healthcare All Payer |
$3,914.24
|
|
|
GMRS PRESS FIT EXT 12MM*80MM
|
Facility
|
OP
|
$4,448.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,334.40 |
| Max. Negotiated Rate |
$4,270.08 |
| Rate for Payer: Aetna Commercial |
$3,424.96
|
| Rate for Payer: Anthem Medicaid |
$1,529.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,469.44
|
| Rate for Payer: Cash Price |
$2,224.00
|
| Rate for Payer: Cigna Commercial |
$3,691.84
|
| Rate for Payer: First Health Commercial |
$4,225.60
|
| Rate for Payer: Humana Commercial |
$3,780.80
|
| Rate for Payer: Humana KY Medicaid |
$1,529.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,545.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,647.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,282.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,334.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,560.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,914.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,336.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,558.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,869.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,069.12
|
| Rate for Payer: PHCS Commercial |
$4,270.08
|
| Rate for Payer: United Healthcare All Payer |
$3,914.24
|
|
|
GMRS PRESS FIT EXT 13MM*155MM
|
Facility
|
OP
|
$4,448.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,334.40 |
| Max. Negotiated Rate |
$4,270.08 |
| Rate for Payer: Aetna Commercial |
$3,424.96
|
| Rate for Payer: Anthem Medicaid |
$1,529.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,469.44
|
| Rate for Payer: Cash Price |
$2,224.00
|
| Rate for Payer: Cigna Commercial |
$3,691.84
|
| Rate for Payer: First Health Commercial |
$4,225.60
|
| Rate for Payer: Humana Commercial |
$3,780.80
|
| Rate for Payer: Humana KY Medicaid |
$1,529.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,545.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,647.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,282.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,334.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,560.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,914.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,336.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,558.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,869.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,069.12
|
| Rate for Payer: PHCS Commercial |
$4,270.08
|
| Rate for Payer: United Healthcare All Payer |
$3,914.24
|
|
|
GMRS PRESS FIT EXT 13MM*155MM
|
Facility
|
IP
|
$4,448.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,334.40 |
| Max. Negotiated Rate |
$4,270.08 |
| Rate for Payer: Aetna Commercial |
$3,424.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,469.44
|
| Rate for Payer: Cash Price |
$2,224.00
|
| Rate for Payer: Cigna Commercial |
$3,691.84
|
| Rate for Payer: First Health Commercial |
$4,225.60
|
| Rate for Payer: Humana Commercial |
$3,780.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,647.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,282.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,334.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,914.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,336.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,558.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,869.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,069.12
|
| Rate for Payer: PHCS Commercial |
$4,270.08
|
| Rate for Payer: United Healthcare All Payer |
$3,914.24
|
|
|
GMRS PRESS FIT EXT 13MM*80MM
|
Facility
|
IP
|
$5,081.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,524.30 |
| Max. Negotiated Rate |
$4,877.76 |
| Rate for Payer: Aetna Commercial |
$3,912.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,963.18
|
| Rate for Payer: Cash Price |
$2,540.50
|
| Rate for Payer: Cigna Commercial |
$4,217.23
|
| Rate for Payer: First Health Commercial |
$4,826.95
|
| Rate for Payer: Humana Commercial |
$4,318.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,166.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,749.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,524.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,471.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,810.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,064.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,420.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,505.89
|
| Rate for Payer: PHCS Commercial |
$4,877.76
|
| Rate for Payer: United Healthcare All Payer |
$4,471.28
|
|
|
GMRS PRESS FIT EXT 13MM*80MM
|
Facility
|
OP
|
$5,081.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,524.30 |
| Max. Negotiated Rate |
$4,877.76 |
| Rate for Payer: Aetna Commercial |
$3,912.37
|
| Rate for Payer: Anthem Medicaid |
$1,747.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,963.18
|
| Rate for Payer: Cash Price |
$2,540.50
|
| Rate for Payer: Cigna Commercial |
$4,217.23
|
| Rate for Payer: First Health Commercial |
$4,826.95
|
| Rate for Payer: Humana Commercial |
$4,318.85
|
| Rate for Payer: Humana KY Medicaid |
$1,747.36
|
| Rate for Payer: Kentucky WC Medicaid |
$1,765.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,166.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,749.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,524.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,782.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,471.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,810.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,064.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,420.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,505.89
|
| Rate for Payer: PHCS Commercial |
$4,877.76
|
| Rate for Payer: United Healthcare All Payer |
$4,471.28
|
|
|
GMRS PRESS FIT EXT 14MM*155MM
|
Facility
|
IP
|
$5,573.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,671.90 |
| Max. Negotiated Rate |
$5,350.08 |
| Rate for Payer: Aetna Commercial |
$4,291.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,346.94
|
| Rate for Payer: Cash Price |
$2,786.50
|
| Rate for Payer: Cigna Commercial |
$4,625.59
|
| Rate for Payer: First Health Commercial |
$5,294.35
|
| Rate for Payer: Humana Commercial |
$4,737.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,569.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,112.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,671.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,904.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,179.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,458.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,848.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,845.37
|
| Rate for Payer: PHCS Commercial |
$5,350.08
|
| Rate for Payer: United Healthcare All Payer |
$4,904.24
|
|
|
GMRS PRESS FIT EXT 14MM*155MM
|
Facility
|
OP
|
$5,573.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,671.90 |
| Max. Negotiated Rate |
$5,350.08 |
| Rate for Payer: Aetna Commercial |
$4,291.21
|
| Rate for Payer: Anthem Medicaid |
$1,916.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,346.94
|
| Rate for Payer: Cash Price |
$2,786.50
|
| Rate for Payer: Cigna Commercial |
$4,625.59
|
| Rate for Payer: First Health Commercial |
$5,294.35
|
| Rate for Payer: Humana Commercial |
$4,737.05
|
| Rate for Payer: Humana KY Medicaid |
$1,916.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,936.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,569.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,112.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,671.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,955.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,904.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,179.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,458.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,848.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,845.37
|
| Rate for Payer: PHCS Commercial |
$5,350.08
|
| Rate for Payer: United Healthcare All Payer |
$4,904.24
|
|
|
GMRS PRESS FIT EXT 14MM*80MM
|
Facility
|
OP
|
$5,081.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,524.30 |
| Max. Negotiated Rate |
$4,877.76 |
| Rate for Payer: Aetna Commercial |
$3,912.37
|
| Rate for Payer: Anthem Medicaid |
$1,747.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,963.18
|
| Rate for Payer: Cash Price |
$2,540.50
|
| Rate for Payer: Cigna Commercial |
$4,217.23
|
| Rate for Payer: First Health Commercial |
$4,826.95
|
| Rate for Payer: Humana Commercial |
$4,318.85
|
| Rate for Payer: Humana KY Medicaid |
$1,747.36
|
| Rate for Payer: Kentucky WC Medicaid |
$1,765.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,166.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,749.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,524.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,782.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,471.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,810.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,064.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,420.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,505.89
|
| Rate for Payer: PHCS Commercial |
$4,877.76
|
| Rate for Payer: United Healthcare All Payer |
$4,471.28
|
|
|
GMRS PRESS FIT EXT 14MM*80MM
|
Facility
|
IP
|
$5,081.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,524.30 |
| Max. Negotiated Rate |
$4,877.76 |
| Rate for Payer: Aetna Commercial |
$3,912.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,963.18
|
| Rate for Payer: Cash Price |
$2,540.50
|
| Rate for Payer: Cigna Commercial |
$4,217.23
|
| Rate for Payer: First Health Commercial |
$4,826.95
|
| Rate for Payer: Humana Commercial |
$4,318.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,166.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,749.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,524.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,471.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,810.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,064.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,420.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,505.89
|
| Rate for Payer: PHCS Commercial |
$4,877.76
|
| Rate for Payer: United Healthcare All Payer |
$4,471.28
|
|
|
GMRS PRESS FIT EXT 15MM*155MM
|
Facility
|
OP
|
$4,448.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,334.40 |
| Max. Negotiated Rate |
$4,270.08 |
| Rate for Payer: Aetna Commercial |
$3,424.96
|
| Rate for Payer: Anthem Medicaid |
$1,529.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,469.44
|
| Rate for Payer: Cash Price |
$2,224.00
|
| Rate for Payer: Cigna Commercial |
$3,691.84
|
| Rate for Payer: First Health Commercial |
$4,225.60
|
| Rate for Payer: Humana Commercial |
$3,780.80
|
| Rate for Payer: Humana KY Medicaid |
$1,529.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,545.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,647.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,282.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,334.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,560.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,914.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,336.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,558.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,869.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,069.12
|
| Rate for Payer: PHCS Commercial |
$4,270.08
|
| Rate for Payer: United Healthcare All Payer |
$3,914.24
|
|
|
GMRS PRESS FIT EXT 15MM*155MM
|
Facility
|
IP
|
$4,448.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,334.40 |
| Max. Negotiated Rate |
$4,270.08 |
| Rate for Payer: Aetna Commercial |
$3,424.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,469.44
|
| Rate for Payer: Cash Price |
$2,224.00
|
| Rate for Payer: Cigna Commercial |
$3,691.84
|
| Rate for Payer: First Health Commercial |
$4,225.60
|
| Rate for Payer: Humana Commercial |
$3,780.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,647.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,282.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,334.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,914.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,336.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,558.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,869.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,069.12
|
| Rate for Payer: PHCS Commercial |
$4,270.08
|
| Rate for Payer: United Healthcare All Payer |
$3,914.24
|
|
|
GMRS PRESS FIT EXT 15MM*80MM
|
Facility
|
OP
|
$4,907.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.10 |
| Max. Negotiated Rate |
$4,710.72 |
| Rate for Payer: Aetna Commercial |
$3,778.39
|
| Rate for Payer: Anthem Medicaid |
$1,687.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,827.46
|
| Rate for Payer: Cash Price |
$2,453.50
|
| Rate for Payer: Cigna Commercial |
$4,072.81
|
| Rate for Payer: First Health Commercial |
$4,661.65
|
| Rate for Payer: Humana Commercial |
$4,170.95
|
| Rate for Payer: Humana KY Medicaid |
$1,687.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1,704.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,621.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,472.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,721.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,318.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,680.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,269.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.83
|
| Rate for Payer: PHCS Commercial |
$4,710.72
|
| Rate for Payer: United Healthcare All Payer |
$4,318.16
|
|
|
GMRS PRESS FIT EXT 15MM*80MM
|
Facility
|
IP
|
$4,907.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.10 |
| Max. Negotiated Rate |
$4,710.72 |
| Rate for Payer: Aetna Commercial |
$3,778.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,827.46
|
| Rate for Payer: Cash Price |
$2,453.50
|
| Rate for Payer: Cigna Commercial |
$4,072.81
|
| Rate for Payer: First Health Commercial |
$4,661.65
|
| Rate for Payer: Humana Commercial |
$4,170.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,621.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,472.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,318.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,680.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,269.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.83
|
| Rate for Payer: PHCS Commercial |
$4,710.72
|
| Rate for Payer: United Healthcare All Payer |
$4,318.16
|
|
|
GMRS PRESS FIT EXT 16MM*155MM
|
Facility
|
IP
|
$4,448.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,334.40 |
| Max. Negotiated Rate |
$4,270.08 |
| Rate for Payer: Aetna Commercial |
$3,424.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,469.44
|
| Rate for Payer: Cash Price |
$2,224.00
|
| Rate for Payer: Cigna Commercial |
$3,691.84
|
| Rate for Payer: First Health Commercial |
$4,225.60
|
| Rate for Payer: Humana Commercial |
$3,780.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,647.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,282.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,334.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,914.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,336.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,558.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,869.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,069.12
|
| Rate for Payer: PHCS Commercial |
$4,270.08
|
| Rate for Payer: United Healthcare All Payer |
$3,914.24
|
|
|
GMRS PRESS FIT EXT 16MM*155MM
|
Facility
|
OP
|
$4,448.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,334.40 |
| Max. Negotiated Rate |
$4,270.08 |
| Rate for Payer: Aetna Commercial |
$3,424.96
|
| Rate for Payer: Anthem Medicaid |
$1,529.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,469.44
|
| Rate for Payer: Cash Price |
$2,224.00
|
| Rate for Payer: Cigna Commercial |
$3,691.84
|
| Rate for Payer: First Health Commercial |
$4,225.60
|
| Rate for Payer: Humana Commercial |
$3,780.80
|
| Rate for Payer: Humana KY Medicaid |
$1,529.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,545.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,647.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,282.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,334.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,560.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,914.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,336.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,558.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,869.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,069.12
|
| Rate for Payer: PHCS Commercial |
$4,270.08
|
| Rate for Payer: United Healthcare All Payer |
$3,914.24
|
|
|
GMRS PRESS FIT EXT 17MM*155MM
|
Facility
|
IP
|
$4,448.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,334.40 |
| Max. Negotiated Rate |
$4,270.08 |
| Rate for Payer: Aetna Commercial |
$3,424.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,469.44
|
| Rate for Payer: Cash Price |
$2,224.00
|
| Rate for Payer: Cigna Commercial |
$3,691.84
|
| Rate for Payer: First Health Commercial |
$4,225.60
|
| Rate for Payer: Humana Commercial |
$3,780.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,647.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,282.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,334.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,914.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,336.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,558.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,869.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,069.12
|
| Rate for Payer: PHCS Commercial |
$4,270.08
|
| Rate for Payer: United Healthcare All Payer |
$3,914.24
|
|
