|
GMRS PRESS FIT EXT 17MM*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*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 17MM*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 18MM*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 18MM*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 18MM*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 18MM*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 19MM*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 19MM*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 21MM*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 21MM*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 21MM*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 21MM*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 23MM*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 23MM*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 23MM*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 23MM*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 PROX FEM COMPONENT RT
|
Facility
|
OP
|
$23,795.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,138.50 |
| Max. Negotiated Rate |
$22,843.20 |
| Rate for Payer: Aetna Commercial |
$18,322.15
|
| Rate for Payer: Anthem Medicaid |
$8,183.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,560.10
|
| Rate for Payer: Cash Price |
$11,897.50
|
| Rate for Payer: Cigna Commercial |
$19,749.85
|
| Rate for Payer: First Health Commercial |
$22,605.25
|
| Rate for Payer: Humana Commercial |
$20,225.75
|
| Rate for Payer: Humana KY Medicaid |
$8,183.10
|
| Rate for Payer: Kentucky WC Medicaid |
$8,266.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,511.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,560.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,138.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,347.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,939.60
|
| Rate for Payer: Ohio Health Group HMO |
$17,846.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,036.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,701.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,418.55
|
| Rate for Payer: PHCS Commercial |
$22,843.20
|
| Rate for Payer: United Healthcare All Payer |
$20,939.60
|
|
|
GMRS PROX FEM COMPONENT RT
|
Facility
|
IP
|
$23,795.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,138.50 |
| Max. Negotiated Rate |
$22,843.20 |
| Rate for Payer: Aetna Commercial |
$18,322.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,560.10
|
| Rate for Payer: Cash Price |
$11,897.50
|
| Rate for Payer: Cigna Commercial |
$19,749.85
|
| Rate for Payer: First Health Commercial |
$22,605.25
|
| Rate for Payer: Humana Commercial |
$20,225.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,511.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,560.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,138.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,939.60
|
| Rate for Payer: Ohio Health Group HMO |
$17,846.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,036.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,701.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,418.55
|
| Rate for Payer: PHCS Commercial |
$22,843.20
|
| Rate for Payer: United Healthcare All Payer |
$20,939.60
|
|
|
GMRS PROX FEM COMP TPR V40
|
Facility
|
IP
|
$25,616.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,685.02 |
| Max. Negotiated Rate |
$24,592.08 |
| Rate for Payer: Aetna Commercial |
$19,724.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,981.06
|
| Rate for Payer: Cash Price |
$12,808.38
|
| Rate for Payer: Cigna Commercial |
$21,261.90
|
| Rate for Payer: First Health Commercial |
$24,335.91
|
| Rate for Payer: Humana Commercial |
$21,774.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,005.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,905.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,685.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,542.74
|
| Rate for Payer: Ohio Health Group HMO |
$19,212.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,493.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,286.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,675.56
|
| Rate for Payer: PHCS Commercial |
$24,592.08
|
| Rate for Payer: United Healthcare All Payer |
$22,542.74
|
|
|
GMRS PROX FEM COMP TPR V40
|
Facility
|
OP
|
$25,616.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,685.02 |
| Max. Negotiated Rate |
$24,592.08 |
| Rate for Payer: Aetna Commercial |
$19,724.90
|
| Rate for Payer: Anthem Medicaid |
$8,809.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,981.06
|
| Rate for Payer: Cash Price |
$12,808.38
|
| Rate for Payer: Cigna Commercial |
$21,261.90
|
| Rate for Payer: First Health Commercial |
$24,335.91
|
| Rate for Payer: Humana Commercial |
$21,774.24
|
| Rate for Payer: Humana KY Medicaid |
$8,809.60
|
| Rate for Payer: Kentucky WC Medicaid |
$8,899.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,005.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,905.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,685.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,986.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,542.74
|
| Rate for Payer: Ohio Health Group HMO |
$19,212.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,493.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,286.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,675.56
|
| Rate for Payer: PHCS Commercial |
$24,592.08
|
| Rate for Payer: United Healthcare All Payer |
$22,542.74
|
|
|
GMRS SMALL BUSHING
|
Facility
|
OP
|
$3,230.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$969.00 |
| Max. Negotiated Rate |
$3,100.80 |
| Rate for Payer: Aetna Commercial |
$2,487.10
|
| Rate for Payer: Anthem Medicaid |
$1,110.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,519.40
|
| Rate for Payer: Cash Price |
$1,615.00
|
| Rate for Payer: Cigna Commercial |
$2,680.90
|
| Rate for Payer: First Health Commercial |
$3,068.50
|
| Rate for Payer: Humana Commercial |
$2,745.50
|
| Rate for Payer: Humana KY Medicaid |
$1,110.80
|
| Rate for Payer: Kentucky WC Medicaid |
$1,122.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,648.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,383.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$969.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,133.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,842.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,422.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,584.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,810.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,228.70
|
| Rate for Payer: PHCS Commercial |
$3,100.80
|
| Rate for Payer: United Healthcare All Payer |
$2,842.40
|
|
|
GMRS SMALL BUSHING
|
Facility
|
IP
|
$3,230.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$969.00 |
| Max. Negotiated Rate |
$3,100.80 |
| Rate for Payer: Aetna Commercial |
$2,487.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,519.40
|
| Rate for Payer: Cash Price |
$1,615.00
|
| Rate for Payer: Cigna Commercial |
$2,680.90
|
| Rate for Payer: First Health Commercial |
$3,068.50
|
| Rate for Payer: Humana Commercial |
$2,745.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,648.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,383.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$969.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,842.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,422.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,584.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,810.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,228.70
|
| Rate for Payer: PHCS Commercial |
$3,100.80
|
| Rate for Payer: United Healthcare All Payer |
$2,842.40
|
|
|
GMRS SM PROX TIBIA 80MM
|
Facility
|
IP
|
$34,121.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,236.30 |
| Max. Negotiated Rate |
$32,756.16 |
| Rate for Payer: Aetna Commercial |
$26,273.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,614.38
|
| Rate for Payer: Cash Price |
$17,060.50
|
| Rate for Payer: Cigna Commercial |
$28,320.43
|
| Rate for Payer: First Health Commercial |
$32,414.95
|
| Rate for Payer: Humana Commercial |
$29,002.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,979.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,181.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,236.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,026.48
|
| Rate for Payer: Ohio Health Group HMO |
$25,590.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27,296.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,685.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,543.49
|
| Rate for Payer: PHCS Commercial |
$32,756.16
|
| Rate for Payer: United Healthcare All Payer |
$30,026.48
|
|
|
GMRS SM PROX TIBIA 80MM
|
Facility
|
OP
|
$34,121.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,236.30 |
| Max. Negotiated Rate |
$32,756.16 |
| Rate for Payer: Aetna Commercial |
$26,273.17
|
| Rate for Payer: Anthem Medicaid |
$11,734.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,614.38
|
| Rate for Payer: Cash Price |
$17,060.50
|
| Rate for Payer: Cigna Commercial |
$28,320.43
|
| Rate for Payer: First Health Commercial |
$32,414.95
|
| Rate for Payer: Humana Commercial |
$29,002.85
|
| Rate for Payer: Humana KY Medicaid |
$11,734.21
|
| Rate for Payer: Kentucky WC Medicaid |
$11,853.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,979.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25,181.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,236.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,969.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$30,026.48
|
| Rate for Payer: Ohio Health Group HMO |
$25,590.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27,296.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,685.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,543.49
|
| Rate for Payer: PHCS Commercial |
$32,756.16
|
| Rate for Payer: United Healthcare All Payer |
$30,026.48
|
|
