|
OMNIFIT CMT HIP STEM 132^ 35*1
|
Facility
|
IP
|
$12,638.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,791.49 |
| Max. Negotiated Rate |
$12,132.77 |
| Rate for Payer: Aetna Commercial |
$9,731.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,857.87
|
| Rate for Payer: Cash Price |
$6,319.15
|
| Rate for Payer: Cigna Commercial |
$10,489.79
|
| Rate for Payer: First Health Commercial |
$12,006.39
|
| Rate for Payer: Humana Commercial |
$10,742.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,363.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,327.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,791.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,121.70
|
| Rate for Payer: Ohio Health Group HMO |
$9,478.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,110.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,995.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,720.43
|
| Rate for Payer: PHCS Commercial |
$12,132.77
|
| Rate for Payer: United Healthcare All Payer |
$11,121.70
|
|
|
OMNIFIT CMT HIP STEM 132^ 35*1
|
Facility
|
OP
|
$12,638.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,791.49 |
| Max. Negotiated Rate |
$12,132.77 |
| Rate for Payer: Aetna Commercial |
$9,731.49
|
| Rate for Payer: Anthem Medicaid |
$4,346.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,857.87
|
| Rate for Payer: Cash Price |
$6,319.15
|
| Rate for Payer: Cigna Commercial |
$10,489.79
|
| Rate for Payer: First Health Commercial |
$12,006.39
|
| Rate for Payer: Humana Commercial |
$10,742.56
|
| Rate for Payer: Humana KY Medicaid |
$4,346.31
|
| Rate for Payer: Kentucky WC Medicaid |
$4,390.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,363.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,327.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,791.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,433.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,121.70
|
| Rate for Payer: Ohio Health Group HMO |
$9,478.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,110.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,995.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,720.43
|
| Rate for Payer: PHCS Commercial |
$12,132.77
|
| Rate for Payer: United Healthcare All Payer |
$11,121.70
|
|
|
OMNIFIT EON PLUS STEM 10*40MM
|
Facility
|
IP
|
$12,102.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,630.74 |
| Max. Negotiated Rate |
$11,618.38 |
| Rate for Payer: Aetna Commercial |
$9,318.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,439.93
|
| Rate for Payer: Cash Price |
$6,051.24
|
| Rate for Payer: Cigna Commercial |
$10,045.06
|
| Rate for Payer: First Health Commercial |
$11,497.36
|
| Rate for Payer: Humana Commercial |
$10,287.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,924.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,931.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,630.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,650.18
|
| Rate for Payer: Ohio Health Group HMO |
$9,076.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,681.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,529.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,350.71
|
| Rate for Payer: PHCS Commercial |
$11,618.38
|
| Rate for Payer: United Healthcare All Payer |
$10,650.18
|
|
|
OMNIFIT EON PLUS STEM 10*40MM
|
Facility
|
OP
|
$12,102.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,630.74 |
| Max. Negotiated Rate |
$11,618.38 |
| Rate for Payer: Aetna Commercial |
$9,318.91
|
| Rate for Payer: Anthem Medicaid |
$4,162.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,439.93
|
| Rate for Payer: Cash Price |
$6,051.24
|
| Rate for Payer: Cigna Commercial |
$10,045.06
|
| Rate for Payer: First Health Commercial |
$11,497.36
|
| Rate for Payer: Humana Commercial |
$10,287.11
|
| Rate for Payer: Humana KY Medicaid |
$4,162.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,204.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,924.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,931.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,630.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,245.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,650.18
|
| Rate for Payer: Ohio Health Group HMO |
$9,076.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,681.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,529.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,350.71
|
| Rate for Payer: PHCS Commercial |
$11,618.38
|
| Rate for Payer: United Healthcare All Payer |
$10,650.18
|
|
|
OMNIFIT EON PLUS STEM 11*40MM
|
Facility
|
IP
|
$15,547.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,664.21 |
| Max. Negotiated Rate |
$14,925.47 |
| Rate for Payer: Aetna Commercial |
$11,971.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,126.94
|
| Rate for Payer: Cash Price |
$7,773.68
|
| Rate for Payer: Cigna Commercial |
$12,904.31
|
| Rate for Payer: First Health Commercial |
$14,769.99
|
| Rate for Payer: Humana Commercial |
$13,215.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,748.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,473.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,664.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,681.68
|
| Rate for Payer: Ohio Health Group HMO |
$11,660.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,437.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,526.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,727.68
|
| Rate for Payer: PHCS Commercial |
$14,925.47
|
| Rate for Payer: United Healthcare All Payer |
$13,681.68
|
|
|
OMNIFIT EON PLUS STEM 11*40MM
|
Facility
|
OP
|
$15,547.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,664.21 |
| Max. Negotiated Rate |
$14,925.47 |
| Rate for Payer: Aetna Commercial |
$11,971.47
|
| Rate for Payer: Anthem Medicaid |
$5,346.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,126.94
|
| Rate for Payer: Cash Price |
$7,773.68
|
| Rate for Payer: Cigna Commercial |
$12,904.31
|
| Rate for Payer: First Health Commercial |
$14,769.99
|
| Rate for Payer: Humana Commercial |
$13,215.26
|
| Rate for Payer: Humana KY Medicaid |
$5,346.74
|
| Rate for Payer: Kentucky WC Medicaid |
$5,401.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,748.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,473.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,664.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,454.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,681.68
|
| Rate for Payer: Ohio Health Group HMO |
$11,660.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,437.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,526.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,727.68
|
| Rate for Payer: PHCS Commercial |
$14,925.47
|
| Rate for Payer: United Healthcare All Payer |
$13,681.68
|
|
|
OMNIFIT EON PLUS STEM 4*25MM
|
Facility
|
IP
|
$15,547.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,664.21 |
| Max. Negotiated Rate |
$14,925.47 |
| Rate for Payer: Aetna Commercial |
$11,971.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,126.94
|
| Rate for Payer: Cash Price |
$7,773.68
|
| Rate for Payer: Cigna Commercial |
$12,904.31
|
| Rate for Payer: First Health Commercial |
$14,769.99
|
| Rate for Payer: Humana Commercial |
$13,215.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,748.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,473.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,664.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,681.68
|
| Rate for Payer: Ohio Health Group HMO |
$11,660.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,437.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,526.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,727.68
|
| Rate for Payer: PHCS Commercial |
$14,925.47
|
| Rate for Payer: United Healthcare All Payer |
$13,681.68
|
|
|
OMNIFIT EON PLUS STEM 4*25MM
|
Facility
|
OP
|
$15,547.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,664.21 |
| Max. Negotiated Rate |
$14,925.47 |
| Rate for Payer: Aetna Commercial |
$11,971.47
|
| Rate for Payer: Anthem Medicaid |
$5,346.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,126.94
|
| Rate for Payer: Cash Price |
$7,773.68
|
| Rate for Payer: Cigna Commercial |
$12,904.31
|
| Rate for Payer: First Health Commercial |
$14,769.99
|
| Rate for Payer: Humana Commercial |
$13,215.26
|
| Rate for Payer: Humana KY Medicaid |
$5,346.74
|
| Rate for Payer: Kentucky WC Medicaid |
$5,401.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,748.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,473.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,664.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,454.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,681.68
|
| Rate for Payer: Ohio Health Group HMO |
$11,660.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,437.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,526.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,727.68
|
| Rate for Payer: PHCS Commercial |
$14,925.47
|
| Rate for Payer: United Healthcare All Payer |
$13,681.68
|
|
|
OMNIFIT EON PLUS STEM 5*30MM
|
Facility
|
OP
|
$15,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,672.20 |
| Max. Negotiated Rate |
$14,951.04 |
| Rate for Payer: Aetna Commercial |
$11,991.98
|
| Rate for Payer: Anthem Medicaid |
$5,355.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,147.72
|
| Rate for Payer: Cash Price |
$7,787.00
|
| Rate for Payer: Cigna Commercial |
$12,926.42
|
| Rate for Payer: First Health Commercial |
$14,795.30
|
| Rate for Payer: Humana Commercial |
$13,237.90
|
| Rate for Payer: Humana KY Medicaid |
$5,355.90
|
| Rate for Payer: Kentucky WC Medicaid |
$5,410.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,770.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,493.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,672.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,463.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,705.12
|
| Rate for Payer: Ohio Health Group HMO |
$11,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,459.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,549.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,746.06
|
| Rate for Payer: PHCS Commercial |
$14,951.04
|
| Rate for Payer: United Healthcare All Payer |
$13,705.12
|
|
|
OMNIFIT EON PLUS STEM 5*30MM
|
Facility
|
IP
|
$15,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,672.20 |
| Max. Negotiated Rate |
$14,951.04 |
| Rate for Payer: Aetna Commercial |
$11,991.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,147.72
|
| Rate for Payer: Cash Price |
$7,787.00
|
| Rate for Payer: Cigna Commercial |
$12,926.42
|
| Rate for Payer: First Health Commercial |
$14,795.30
|
| Rate for Payer: Humana Commercial |
$13,237.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,770.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,493.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,672.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,705.12
|
| Rate for Payer: Ohio Health Group HMO |
$11,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,459.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,549.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,746.06
|
| Rate for Payer: PHCS Commercial |
$14,951.04
|
| Rate for Payer: United Healthcare All Payer |
$13,705.12
|
|
|
OMNIFIT EON PLUS STEM 6*30MM
|
Facility
|
IP
|
$15,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,672.20 |
| Max. Negotiated Rate |
$14,951.04 |
| Rate for Payer: Aetna Commercial |
$11,991.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,147.72
|
| Rate for Payer: Cash Price |
$7,787.00
|
| Rate for Payer: Cigna Commercial |
$12,926.42
|
| Rate for Payer: First Health Commercial |
$14,795.30
|
| Rate for Payer: Humana Commercial |
$13,237.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,770.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,493.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,672.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,705.12
|
| Rate for Payer: Ohio Health Group HMO |
$11,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,459.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,549.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,746.06
|
| Rate for Payer: PHCS Commercial |
$14,951.04
|
| Rate for Payer: United Healthcare All Payer |
$13,705.12
|
|
|
OMNIFIT EON PLUS STEM 6*30MM
|
Facility
|
OP
|
$15,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,672.20 |
| Max. Negotiated Rate |
$14,951.04 |
| Rate for Payer: Aetna Commercial |
$11,991.98
|
| Rate for Payer: Anthem Medicaid |
$5,355.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,147.72
|
| Rate for Payer: Cash Price |
$7,787.00
|
| Rate for Payer: Cigna Commercial |
$12,926.42
|
| Rate for Payer: First Health Commercial |
$14,795.30
|
| Rate for Payer: Humana Commercial |
$13,237.90
|
| Rate for Payer: Humana KY Medicaid |
$5,355.90
|
| Rate for Payer: Kentucky WC Medicaid |
$5,410.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,770.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,493.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,672.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,463.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,705.12
|
| Rate for Payer: Ohio Health Group HMO |
$11,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,459.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,549.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,746.06
|
| Rate for Payer: PHCS Commercial |
$14,951.04
|
| Rate for Payer: United Healthcare All Payer |
$13,705.12
|
|
|
OMNIFIT EON PLUS STEM 7*35MM
|
Facility
|
IP
|
$16,248.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,874.66 |
| Max. Negotiated Rate |
$15,598.92 |
| Rate for Payer: Aetna Commercial |
$12,511.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,674.13
|
| Rate for Payer: Cash Price |
$8,124.44
|
| Rate for Payer: Cigna Commercial |
$13,486.57
|
| Rate for Payer: First Health Commercial |
$15,436.44
|
| Rate for Payer: Humana Commercial |
$13,811.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,324.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,991.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,874.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,299.01
|
| Rate for Payer: Ohio Health Group HMO |
$12,186.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,999.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,136.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,211.73
|
| Rate for Payer: PHCS Commercial |
$15,598.92
|
| Rate for Payer: United Healthcare All Payer |
$14,299.01
|
|
|
OMNIFIT EON PLUS STEM 7*35MM
|
Facility
|
OP
|
$16,248.88
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,874.66 |
| Max. Negotiated Rate |
$15,598.92 |
| Rate for Payer: Aetna Commercial |
$12,511.64
|
| Rate for Payer: Anthem Medicaid |
$5,587.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,674.13
|
| Rate for Payer: Cash Price |
$8,124.44
|
| Rate for Payer: Cigna Commercial |
$13,486.57
|
| Rate for Payer: First Health Commercial |
$15,436.44
|
| Rate for Payer: Humana Commercial |
$13,811.55
|
| Rate for Payer: Humana KY Medicaid |
$5,587.99
|
| Rate for Payer: Kentucky WC Medicaid |
$5,644.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,324.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,991.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,874.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,700.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,299.01
|
| Rate for Payer: Ohio Health Group HMO |
$12,186.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,999.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,136.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,211.73
|
| Rate for Payer: PHCS Commercial |
$15,598.92
|
| Rate for Payer: United Healthcare All Payer |
$14,299.01
|
|
|
OMNIFIT EON PLUS STEM 8*35MM
|
Facility
|
OP
|
$15,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,672.20 |
| Max. Negotiated Rate |
$14,951.04 |
| Rate for Payer: Aetna Commercial |
$11,991.98
|
| Rate for Payer: Anthem Medicaid |
$5,355.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,147.72
|
| Rate for Payer: Cash Price |
$7,787.00
|
| Rate for Payer: Cigna Commercial |
$12,926.42
|
| Rate for Payer: First Health Commercial |
$14,795.30
|
| Rate for Payer: Humana Commercial |
$13,237.90
|
| Rate for Payer: Humana KY Medicaid |
$5,355.90
|
| Rate for Payer: Kentucky WC Medicaid |
$5,410.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,770.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,493.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,672.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,463.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,705.12
|
| Rate for Payer: Ohio Health Group HMO |
$11,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,459.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,549.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,746.06
|
| Rate for Payer: PHCS Commercial |
$14,951.04
|
| Rate for Payer: United Healthcare All Payer |
$13,705.12
|
|
|
OMNIFIT EON PLUS STEM 8*35MM
|
Facility
|
IP
|
$15,574.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,672.20 |
| Max. Negotiated Rate |
$14,951.04 |
| Rate for Payer: Aetna Commercial |
$11,991.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,147.72
|
| Rate for Payer: Cash Price |
$7,787.00
|
| Rate for Payer: Cigna Commercial |
$12,926.42
|
| Rate for Payer: First Health Commercial |
$14,795.30
|
| Rate for Payer: Humana Commercial |
$13,237.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,770.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,493.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,672.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,705.12
|
| Rate for Payer: Ohio Health Group HMO |
$11,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,459.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,549.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,746.06
|
| Rate for Payer: PHCS Commercial |
$14,951.04
|
| Rate for Payer: United Healthcare All Payer |
$13,705.12
|
|
|
OMNIFIT EON PLUS STEM 9*40MM
|
Facility
|
OP
|
$12,102.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,630.74 |
| Max. Negotiated Rate |
$11,618.38 |
| Rate for Payer: Aetna Commercial |
$9,318.91
|
| Rate for Payer: Anthem Medicaid |
$4,162.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,439.93
|
| Rate for Payer: Cash Price |
$6,051.24
|
| Rate for Payer: Cigna Commercial |
$10,045.06
|
| Rate for Payer: First Health Commercial |
$11,497.36
|
| Rate for Payer: Humana Commercial |
$10,287.11
|
| Rate for Payer: Humana KY Medicaid |
$4,162.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,204.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,924.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,931.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,630.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,245.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,650.18
|
| Rate for Payer: Ohio Health Group HMO |
$9,076.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,681.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,529.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,350.71
|
| Rate for Payer: PHCS Commercial |
$11,618.38
|
| Rate for Payer: United Healthcare All Payer |
$10,650.18
|
|
|
OMNIFIT EON PLUS STEM 9*40MM
|
Facility
|
IP
|
$12,102.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,630.74 |
| Max. Negotiated Rate |
$11,618.38 |
| Rate for Payer: Aetna Commercial |
$9,318.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,439.93
|
| Rate for Payer: Cash Price |
$6,051.24
|
| Rate for Payer: Cigna Commercial |
$10,045.06
|
| Rate for Payer: First Health Commercial |
$11,497.36
|
| Rate for Payer: Humana Commercial |
$10,287.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,924.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,931.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,630.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,650.18
|
| Rate for Payer: Ohio Health Group HMO |
$9,076.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,681.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,529.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,350.71
|
| Rate for Payer: PHCS Commercial |
$11,618.38
|
| Rate for Payer: United Healthcare All Payer |
$10,650.18
|
|
|
OMNIFIT EON STEM 5*30MM
|
Facility
|
IP
|
$12,638.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,791.49 |
| Max. Negotiated Rate |
$12,132.77 |
| Rate for Payer: Aetna Commercial |
$9,731.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,857.87
|
| Rate for Payer: Cash Price |
$6,319.15
|
| Rate for Payer: Cigna Commercial |
$10,489.79
|
| Rate for Payer: First Health Commercial |
$12,006.39
|
| Rate for Payer: Humana Commercial |
$10,742.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,363.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,327.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,791.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,121.70
|
| Rate for Payer: Ohio Health Group HMO |
$9,478.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,110.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,995.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,720.43
|
| Rate for Payer: PHCS Commercial |
$12,132.77
|
| Rate for Payer: United Healthcare All Payer |
$11,121.70
|
|
|
OMNIFIT EON STEM 5*30MM
|
Facility
|
OP
|
$12,638.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,791.49 |
| Max. Negotiated Rate |
$12,132.77 |
| Rate for Payer: Aetna Commercial |
$9,731.49
|
| Rate for Payer: Anthem Medicaid |
$4,346.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,857.87
|
| Rate for Payer: Cash Price |
$6,319.15
|
| Rate for Payer: Cigna Commercial |
$10,489.79
|
| Rate for Payer: First Health Commercial |
$12,006.39
|
| Rate for Payer: Humana Commercial |
$10,742.56
|
| Rate for Payer: Humana KY Medicaid |
$4,346.31
|
| Rate for Payer: Kentucky WC Medicaid |
$4,390.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,363.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,327.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,791.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,433.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,121.70
|
| Rate for Payer: Ohio Health Group HMO |
$9,478.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,110.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,995.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,720.43
|
| Rate for Payer: PHCS Commercial |
$12,132.77
|
| Rate for Payer: United Healthcare All Payer |
$11,121.70
|
|
|
OMNI FLUSH CATH 5F 65CM
|
Facility
|
OP
|
$2,128.40
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$638.52 |
| Max. Negotiated Rate |
$2,043.26 |
| Rate for Payer: Aetna Commercial |
$1,638.87
|
| Rate for Payer: Anthem Medicaid |
$731.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,660.15
|
| Rate for Payer: Cash Price |
$1,064.20
|
| Rate for Payer: Cigna Commercial |
$1,766.57
|
| Rate for Payer: First Health Commercial |
$2,021.98
|
| Rate for Payer: Humana Commercial |
$1,809.14
|
| Rate for Payer: Humana KY Medicaid |
$731.96
|
| Rate for Payer: Kentucky WC Medicaid |
$739.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,745.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,570.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$638.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$746.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,872.99
|
| Rate for Payer: Ohio Health Group HMO |
$1,596.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,702.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,851.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,468.60
|
| Rate for Payer: PHCS Commercial |
$2,043.26
|
| Rate for Payer: United Healthcare All Payer |
$1,872.99
|
|
|
OMNI FLUSH CATH 5F 65CM
|
Facility
|
IP
|
$2,128.40
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$638.52 |
| Max. Negotiated Rate |
$2,043.26 |
| Rate for Payer: Aetna Commercial |
$1,638.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,660.15
|
| Rate for Payer: Cash Price |
$1,064.20
|
| Rate for Payer: Cigna Commercial |
$1,766.57
|
| Rate for Payer: First Health Commercial |
$2,021.98
|
| Rate for Payer: Humana Commercial |
$1,809.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,745.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,570.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$638.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,872.99
|
| Rate for Payer: Ohio Health Group HMO |
$1,596.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,702.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,851.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,468.60
|
| Rate for Payer: PHCS Commercial |
$2,043.26
|
| Rate for Payer: United Healthcare All Payer |
$1,872.99
|
|
|
OMNI FLUSH CATH 5F 90CM
|
Facility
|
IP
|
$437.22
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.17 |
| Max. Negotiated Rate |
$419.73 |
| Rate for Payer: Aetna Commercial |
$336.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$341.03
|
| Rate for Payer: Cash Price |
$218.61
|
| Rate for Payer: Cigna Commercial |
$362.89
|
| Rate for Payer: First Health Commercial |
$415.36
|
| Rate for Payer: Humana Commercial |
$371.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$358.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$322.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$131.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$384.75
|
| Rate for Payer: Ohio Health Group HMO |
$327.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$380.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$301.68
|
| Rate for Payer: PHCS Commercial |
$419.73
|
| Rate for Payer: United Healthcare All Payer |
$384.75
|
|
|
OMNI FLUSH CATH 5F 90CM
|
Facility
|
OP
|
$437.22
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.17 |
| Max. Negotiated Rate |
$419.73 |
| Rate for Payer: Aetna Commercial |
$336.66
|
| Rate for Payer: Anthem Medicaid |
$150.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$341.03
|
| Rate for Payer: Cash Price |
$218.61
|
| Rate for Payer: Cigna Commercial |
$362.89
|
| Rate for Payer: First Health Commercial |
$415.36
|
| Rate for Payer: Humana Commercial |
$371.64
|
| Rate for Payer: Humana KY Medicaid |
$150.36
|
| Rate for Payer: Kentucky WC Medicaid |
$151.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$358.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$322.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$131.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$153.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$384.75
|
| Rate for Payer: Ohio Health Group HMO |
$327.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$380.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$301.68
|
| Rate for Payer: PHCS Commercial |
$419.73
|
| Rate for Payer: United Healthcare All Payer |
$384.75
|
|
|
OMNIPAQUE 240MG PERM 10X10MLVL
|
Facility
|
IP
|
$82.04
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
25003313
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.61 |
| Max. Negotiated Rate |
$78.76 |
| Rate for Payer: Aetna Commercial |
$63.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.99
|
| Rate for Payer: Cash Price |
$41.02
|
| Rate for Payer: Cigna Commercial |
$68.09
|
| Rate for Payer: First Health Commercial |
$77.94
|
| Rate for Payer: Humana Commercial |
$69.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.20
|
| Rate for Payer: Ohio Health Group HMO |
$61.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.61
|
| Rate for Payer: PHCS Commercial |
$78.76
|
| Rate for Payer: United Healthcare All Payer |
$72.20
|
|
