|
NESTER COIL 6MM
|
Facility
|
OP
|
$1,723.66
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$517.10 |
| Max. Negotiated Rate |
$1,654.71 |
| Rate for Payer: Aetna Commercial |
$1,327.22
|
| Rate for Payer: Anthem Medicaid |
$592.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,344.45
|
| Rate for Payer: Cash Price |
$861.83
|
| Rate for Payer: Cigna Commercial |
$1,430.64
|
| Rate for Payer: First Health Commercial |
$1,637.48
|
| Rate for Payer: Humana Commercial |
$1,465.11
|
| Rate for Payer: Humana KY Medicaid |
$592.77
|
| Rate for Payer: Kentucky WC Medicaid |
$598.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,413.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,272.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$517.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$604.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,516.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,292.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,378.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,499.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,189.33
|
| Rate for Payer: PHCS Commercial |
$1,654.71
|
| Rate for Payer: United Healthcare All Payer |
$1,516.82
|
|
|
NESTER COIL 6MM
|
Facility
|
IP
|
$1,723.66
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$517.10 |
| Max. Negotiated Rate |
$1,654.71 |
| Rate for Payer: Aetna Commercial |
$1,327.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,344.45
|
| Rate for Payer: Cash Price |
$861.83
|
| Rate for Payer: Cigna Commercial |
$1,430.64
|
| Rate for Payer: First Health Commercial |
$1,637.48
|
| Rate for Payer: Humana Commercial |
$1,465.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,413.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,272.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$517.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,516.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,292.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,378.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,499.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,189.33
|
| Rate for Payer: PHCS Commercial |
$1,654.71
|
| Rate for Payer: United Healthcare All Payer |
$1,516.82
|
|
|
NESTER COIL 8MM
|
Facility
|
OP
|
$1,701.58
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$510.47 |
| Max. Negotiated Rate |
$1,633.52 |
| Rate for Payer: Aetna Commercial |
$1,310.22
|
| Rate for Payer: Anthem Medicaid |
$585.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,327.23
|
| Rate for Payer: Cash Price |
$850.79
|
| Rate for Payer: Cigna Commercial |
$1,412.31
|
| Rate for Payer: First Health Commercial |
$1,616.50
|
| Rate for Payer: Humana Commercial |
$1,446.34
|
| Rate for Payer: Humana KY Medicaid |
$585.17
|
| Rate for Payer: Kentucky WC Medicaid |
$591.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,395.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,255.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,497.39
|
| Rate for Payer: Ohio Health Group HMO |
$1,276.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,361.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,480.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,174.09
|
| Rate for Payer: PHCS Commercial |
$1,633.52
|
| Rate for Payer: United Healthcare All Payer |
$1,497.39
|
|
|
NESTER COIL 8MM
|
Facility
|
IP
|
$1,701.58
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$510.47 |
| Max. Negotiated Rate |
$1,633.52 |
| Rate for Payer: Aetna Commercial |
$1,310.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,327.23
|
| Rate for Payer: Cash Price |
$850.79
|
| Rate for Payer: Cigna Commercial |
$1,412.31
|
| Rate for Payer: First Health Commercial |
$1,616.50
|
| Rate for Payer: Humana Commercial |
$1,446.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,395.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,255.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,497.39
|
| Rate for Payer: Ohio Health Group HMO |
$1,276.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,361.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,480.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,174.09
|
| Rate for Payer: PHCS Commercial |
$1,633.52
|
| Rate for Payer: United Healthcare All Payer |
$1,497.39
|
|
|
NEUFLEX MCP IMPLANT SZ 0
|
Facility
|
OP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem Medicaid |
$1,713.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Humana KY Medicaid |
$1,713.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
NEUFLEX MCP IMPLANT SZ 0
|
Facility
|
IP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
NEUFLEX MCP IMPLANT SZ 10
|
Facility
|
IP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
NEUFLEX MCP IMPLANT SZ 10
|
Facility
|
OP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem Medicaid |
$1,713.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Humana KY Medicaid |
$1,713.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
NEUFLEX MCP IMPLANT SZ 20
|
Facility
|
IP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
NEUFLEX MCP IMPLANT SZ 20
|
Facility
|
OP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem Medicaid |
$1,713.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Humana KY Medicaid |
$1,713.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
NEUFLEX MCP IMPLANT SZ 30
|
Facility
|
IP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
NEUFLEX MCP IMPLANT SZ 30
|
Facility
|
OP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem Medicaid |
$1,713.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Humana KY Medicaid |
$1,713.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
NEUFLEX MCP IMPLANT SZ 40
|
Facility
|
IP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
NEUFLEX MCP IMPLANT SZ 40
|
Facility
|
OP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem Medicaid |
$1,713.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Humana KY Medicaid |
$1,713.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
NEUFLEX MCP IMPLANT SZ 50
|
Facility
|
IP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
NEUFLEX MCP IMPLANT SZ 50
|
Facility
|
OP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem Medicaid |
$1,713.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Humana KY Medicaid |
$1,713.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
NEUFLEX MCP IMPLANT SZ 60
|
Facility
|
OP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem Medicaid |
$1,713.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Humana KY Medicaid |
$1,713.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
NEUFLEX MCP IMPLANT SZ 60
|
Facility
|
IP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
NEUFLEX PIP IMPLANT SZ 1
|
Facility
|
IP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
NEUFLEX PIP IMPLANT SZ 1
|
Facility
|
OP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem Medicaid |
$1,713.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Humana KY Medicaid |
$1,713.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
NEUFLEX PIP IMPLANT SZ 2
|
Facility
|
OP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem Medicaid |
$1,713.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Humana KY Medicaid |
$1,713.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
NEUFLEX PIP IMPLANT SZ 2
|
Facility
|
IP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
NEUFLEX PIP IMPLANT SZ 3
|
Facility
|
OP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem Medicaid |
$1,713.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Humana KY Medicaid |
$1,713.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
NEUFLEX PIP IMPLANT SZ 3
|
Facility
|
IP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
NEUFLEX PIP IMPLANT SZ 4
|
Facility
|
OP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem Medicaid |
$1,713.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Humana KY Medicaid |
$1,713.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
