|
OXINIUM UNIPOLAR HEAD 47MM OD
|
Facility
|
IP
|
$5,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,556.25 |
| Max. Negotiated Rate |
$4,980.00 |
| Rate for Payer: Aetna Commercial |
$3,994.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,046.25
|
| Rate for Payer: Cash Price |
$2,593.75
|
| Rate for Payer: Cigna Commercial |
$4,305.62
|
| Rate for Payer: First Health Commercial |
$4,928.12
|
| Rate for Payer: Humana Commercial |
$4,409.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,253.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,828.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,556.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,565.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,513.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,579.38
|
| Rate for Payer: PHCS Commercial |
$4,980.00
|
| Rate for Payer: United Healthcare All Payer |
$4,565.00
|
|
|
OXINIUM UNIPOLAR HEAD 48MM OD
|
Facility
|
IP
|
$5,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,556.25 |
| Max. Negotiated Rate |
$4,980.00 |
| Rate for Payer: Aetna Commercial |
$3,994.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,046.25
|
| Rate for Payer: Cash Price |
$2,593.75
|
| Rate for Payer: Cigna Commercial |
$4,305.62
|
| Rate for Payer: First Health Commercial |
$4,928.12
|
| Rate for Payer: Humana Commercial |
$4,409.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,253.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,828.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,556.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,565.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,513.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,579.38
|
| Rate for Payer: PHCS Commercial |
$4,980.00
|
| Rate for Payer: United Healthcare All Payer |
$4,565.00
|
|
|
OXINIUM UNIPOLAR HEAD 48MM OD
|
Facility
|
OP
|
$5,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,556.25 |
| Max. Negotiated Rate |
$4,980.00 |
| Rate for Payer: Aetna Commercial |
$3,994.38
|
| Rate for Payer: Anthem Medicaid |
$1,783.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,046.25
|
| Rate for Payer: Cash Price |
$2,593.75
|
| Rate for Payer: Cigna Commercial |
$4,305.62
|
| Rate for Payer: First Health Commercial |
$4,928.12
|
| Rate for Payer: Humana Commercial |
$4,409.38
|
| Rate for Payer: Humana KY Medicaid |
$1,783.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,802.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,253.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,828.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,556.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,819.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,565.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,513.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,579.38
|
| Rate for Payer: PHCS Commercial |
$4,980.00
|
| Rate for Payer: United Healthcare All Payer |
$4,565.00
|
|
|
OXINIUM UNIPOLAR HEAD 49MM OD
|
Facility
|
IP
|
$5,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,556.25 |
| Max. Negotiated Rate |
$4,980.00 |
| Rate for Payer: Aetna Commercial |
$3,994.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,046.25
|
| Rate for Payer: Cash Price |
$2,593.75
|
| Rate for Payer: Cigna Commercial |
$4,305.62
|
| Rate for Payer: First Health Commercial |
$4,928.12
|
| Rate for Payer: Humana Commercial |
$4,409.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,253.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,828.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,556.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,565.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,513.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,579.38
|
| Rate for Payer: PHCS Commercial |
$4,980.00
|
| Rate for Payer: United Healthcare All Payer |
$4,565.00
|
|
|
OXINIUM UNIPOLAR HEAD 49MM OD
|
Facility
|
OP
|
$5,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,556.25 |
| Max. Negotiated Rate |
$4,980.00 |
| Rate for Payer: Aetna Commercial |
$3,994.38
|
| Rate for Payer: Anthem Medicaid |
$1,783.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,046.25
|
| Rate for Payer: Cash Price |
$2,593.75
|
| Rate for Payer: Cigna Commercial |
$4,305.62
|
| Rate for Payer: First Health Commercial |
$4,928.12
|
| Rate for Payer: Humana Commercial |
$4,409.38
|
| Rate for Payer: Humana KY Medicaid |
$1,783.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,802.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,253.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,828.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,556.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,819.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,565.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,513.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,579.38
|
| Rate for Payer: PHCS Commercial |
$4,980.00
|
| Rate for Payer: United Healthcare All Payer |
$4,565.00
|
|
|
OXINIUM UNIPOLAR HEAD 50MM OD
|
Facility
|
OP
|
$5,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,556.25 |
| Max. Negotiated Rate |
$4,980.00 |
| Rate for Payer: Aetna Commercial |
$3,994.38
|
| Rate for Payer: Anthem Medicaid |
$1,783.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,046.25
|
| Rate for Payer: Cash Price |
$2,593.75
|
| Rate for Payer: Cigna Commercial |
$4,305.62
|
| Rate for Payer: First Health Commercial |
$4,928.12
|
| Rate for Payer: Humana Commercial |
$4,409.38
|
| Rate for Payer: Humana KY Medicaid |
$1,783.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,802.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,253.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,828.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,556.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,819.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,565.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,513.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,579.38
|
| Rate for Payer: PHCS Commercial |
$4,980.00
|
| Rate for Payer: United Healthcare All Payer |
$4,565.00
|
|
|
OXINIUM UNIPOLAR HEAD 50MM OD
|
Facility
|
IP
|
$5,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,556.25 |
| Max. Negotiated Rate |
$4,980.00 |
| Rate for Payer: Aetna Commercial |
$3,994.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,046.25
|
| Rate for Payer: Cash Price |
$2,593.75
|
| Rate for Payer: Cigna Commercial |
$4,305.62
|
| Rate for Payer: First Health Commercial |
$4,928.12
|
| Rate for Payer: Humana Commercial |
$4,409.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,253.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,828.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,556.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,565.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,513.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,579.38
|
| Rate for Payer: PHCS Commercial |
$4,980.00
|
| Rate for Payer: United Healthcare All Payer |
$4,565.00
|
|
|
OXINIUM UNIPOLAR HEAD 51MM OD
|
Facility
|
OP
|
$5,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,556.25 |
| Max. Negotiated Rate |
$4,980.00 |
| Rate for Payer: Aetna Commercial |
$3,994.38
|
| Rate for Payer: Anthem Medicaid |
$1,783.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,046.25
|
| Rate for Payer: Cash Price |
$2,593.75
|
| Rate for Payer: Cigna Commercial |
$4,305.62
|
| Rate for Payer: First Health Commercial |
$4,928.12
|
| Rate for Payer: Humana Commercial |
$4,409.38
|
| Rate for Payer: Humana KY Medicaid |
$1,783.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,802.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,253.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,828.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,556.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,819.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,565.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,513.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,579.38
|
| Rate for Payer: PHCS Commercial |
$4,980.00
|
| Rate for Payer: United Healthcare All Payer |
$4,565.00
|
|
|
OXINIUM UNIPOLAR HEAD 51MM OD
|
Facility
|
IP
|
$5,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,556.25 |
| Max. Negotiated Rate |
$4,980.00 |
| Rate for Payer: Aetna Commercial |
$3,994.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,046.25
|
| Rate for Payer: Cash Price |
$2,593.75
|
| Rate for Payer: Cigna Commercial |
$4,305.62
|
| Rate for Payer: First Health Commercial |
$4,928.12
|
| Rate for Payer: Humana Commercial |
$4,409.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,253.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,828.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,556.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,565.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,513.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,579.38
|
| Rate for Payer: PHCS Commercial |
$4,980.00
|
| Rate for Payer: United Healthcare All Payer |
$4,565.00
|
|
|
OXINIUM UNIPOLAR HEAD 52MM OD
|
Facility
|
IP
|
$5,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,556.25 |
| Max. Negotiated Rate |
$4,980.00 |
| Rate for Payer: Aetna Commercial |
$3,994.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,046.25
|
| Rate for Payer: Cash Price |
$2,593.75
|
| Rate for Payer: Cigna Commercial |
$4,305.62
|
| Rate for Payer: First Health Commercial |
$4,928.12
|
| Rate for Payer: Humana Commercial |
$4,409.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,253.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,828.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,556.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,565.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,513.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,579.38
|
| Rate for Payer: PHCS Commercial |
$4,980.00
|
| Rate for Payer: United Healthcare All Payer |
$4,565.00
|
|
|
OXINIUM UNIPOLAR HEAD 52MM OD
|
Facility
|
OP
|
$5,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,556.25 |
| Max. Negotiated Rate |
$4,980.00 |
| Rate for Payer: Aetna Commercial |
$3,994.38
|
| Rate for Payer: Anthem Medicaid |
$1,783.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,046.25
|
| Rate for Payer: Cash Price |
$2,593.75
|
| Rate for Payer: Cigna Commercial |
$4,305.62
|
| Rate for Payer: First Health Commercial |
$4,928.12
|
| Rate for Payer: Humana Commercial |
$4,409.38
|
| Rate for Payer: Humana KY Medicaid |
$1,783.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,802.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,253.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,828.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,556.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,819.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,565.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,513.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,579.38
|
| Rate for Payer: PHCS Commercial |
$4,980.00
|
| Rate for Payer: United Healthcare All Payer |
$4,565.00
|
|
|
OXINIUM UNIPOLAR HEAD 53MM OD
|
Facility
|
OP
|
$5,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,556.25 |
| Max. Negotiated Rate |
$4,980.00 |
| Rate for Payer: Aetna Commercial |
$3,994.38
|
| Rate for Payer: Anthem Medicaid |
$1,783.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,046.25
|
| Rate for Payer: Cash Price |
$2,593.75
|
| Rate for Payer: Cigna Commercial |
$4,305.62
|
| Rate for Payer: First Health Commercial |
$4,928.12
|
| Rate for Payer: Humana Commercial |
$4,409.38
|
| Rate for Payer: Humana KY Medicaid |
$1,783.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,802.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,253.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,828.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,556.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,819.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,565.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,513.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,579.38
|
| Rate for Payer: PHCS Commercial |
$4,980.00
|
| Rate for Payer: United Healthcare All Payer |
$4,565.00
|
|
|
OXINIUM UNIPOLAR HEAD 53MM OD
|
Facility
|
IP
|
$5,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,556.25 |
| Max. Negotiated Rate |
$4,980.00 |
| Rate for Payer: Aetna Commercial |
$3,994.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,046.25
|
| Rate for Payer: Cash Price |
$2,593.75
|
| Rate for Payer: Cigna Commercial |
$4,305.62
|
| Rate for Payer: First Health Commercial |
$4,928.12
|
| Rate for Payer: Humana Commercial |
$4,409.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,253.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,828.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,556.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,565.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,513.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,579.38
|
| Rate for Payer: PHCS Commercial |
$4,980.00
|
| Rate for Payer: United Healthcare All Payer |
$4,565.00
|
|
|
OXINIUM UNIPOLAR HEAD 54MM OD
|
Facility
|
IP
|
$5,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,556.25 |
| Max. Negotiated Rate |
$4,980.00 |
| Rate for Payer: Aetna Commercial |
$3,994.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,046.25
|
| Rate for Payer: Cash Price |
$2,593.75
|
| Rate for Payer: Cigna Commercial |
$4,305.62
|
| Rate for Payer: First Health Commercial |
$4,928.12
|
| Rate for Payer: Humana Commercial |
$4,409.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,253.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,828.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,556.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,565.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,513.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,579.38
|
| Rate for Payer: PHCS Commercial |
$4,980.00
|
| Rate for Payer: United Healthcare All Payer |
$4,565.00
|
|
|
OXINIUM UNIPOLAR HEAD 54MM OD
|
Facility
|
OP
|
$5,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,556.25 |
| Max. Negotiated Rate |
$4,980.00 |
| Rate for Payer: Aetna Commercial |
$3,994.38
|
| Rate for Payer: Anthem Medicaid |
$1,783.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,046.25
|
| Rate for Payer: Cash Price |
$2,593.75
|
| Rate for Payer: Cigna Commercial |
$4,305.62
|
| Rate for Payer: First Health Commercial |
$4,928.12
|
| Rate for Payer: Humana Commercial |
$4,409.38
|
| Rate for Payer: Humana KY Medicaid |
$1,783.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,802.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,253.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,828.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,556.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,819.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,565.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,513.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,579.38
|
| Rate for Payer: PHCS Commercial |
$4,980.00
|
| Rate for Payer: United Healthcare All Payer |
$4,565.00
|
|
|
OXINIUM UNIPOLAR HEAD 55MM OD
|
Facility
|
OP
|
$5,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,556.25 |
| Max. Negotiated Rate |
$4,980.00 |
| Rate for Payer: Aetna Commercial |
$3,994.38
|
| Rate for Payer: Anthem Medicaid |
$1,783.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,046.25
|
| Rate for Payer: Cash Price |
$2,593.75
|
| Rate for Payer: Cigna Commercial |
$4,305.62
|
| Rate for Payer: First Health Commercial |
$4,928.12
|
| Rate for Payer: Humana Commercial |
$4,409.38
|
| Rate for Payer: Humana KY Medicaid |
$1,783.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,802.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,253.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,828.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,556.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,819.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,565.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,513.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,579.38
|
| Rate for Payer: PHCS Commercial |
$4,980.00
|
| Rate for Payer: United Healthcare All Payer |
$4,565.00
|
|
|
OXINIUM UNIPOLAR HEAD 55MM OD
|
Facility
|
IP
|
$5,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,556.25 |
| Max. Negotiated Rate |
$4,980.00 |
| Rate for Payer: Aetna Commercial |
$3,994.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,046.25
|
| Rate for Payer: Cash Price |
$2,593.75
|
| Rate for Payer: Cigna Commercial |
$4,305.62
|
| Rate for Payer: First Health Commercial |
$4,928.12
|
| Rate for Payer: Humana Commercial |
$4,409.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,253.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,828.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,556.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,565.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,513.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,579.38
|
| Rate for Payer: PHCS Commercial |
$4,980.00
|
| Rate for Payer: United Healthcare All Payer |
$4,565.00
|
|
|
OX KNEE ANA MEN BEAR SM 5MM T
|
Facility
|
IP
|
$8,256.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.80 |
| Max. Negotiated Rate |
$7,925.76 |
| Rate for Payer: Aetna Commercial |
$6,357.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,439.68
|
| Rate for Payer: Cash Price |
$4,128.00
|
| Rate for Payer: Cigna Commercial |
$6,852.48
|
| Rate for Payer: First Health Commercial |
$7,843.20
|
| Rate for Payer: Humana Commercial |
$7,017.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,769.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,092.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,476.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,182.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.64
|
| Rate for Payer: PHCS Commercial |
$7,925.76
|
| Rate for Payer: United Healthcare All Payer |
$7,265.28
|
|
|
OX KNEE ANA MEN BEAR SM 5MM T
|
Facility
|
OP
|
$8,256.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.80 |
| Max. Negotiated Rate |
$7,925.76 |
| Rate for Payer: Aetna Commercial |
$6,357.12
|
| Rate for Payer: Anthem Medicaid |
$2,839.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,439.68
|
| Rate for Payer: Cash Price |
$4,128.00
|
| Rate for Payer: Cigna Commercial |
$6,852.48
|
| Rate for Payer: First Health Commercial |
$7,843.20
|
| Rate for Payer: Humana Commercial |
$7,017.60
|
| Rate for Payer: Humana KY Medicaid |
$2,839.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,868.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,769.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,092.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,476.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,896.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,182.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.64
|
| Rate for Payer: PHCS Commercial |
$7,925.76
|
| Rate for Payer: United Healthcare All Payer |
$7,265.28
|
|
|
OX LG RT MENISICAL BEARNG 5MM
|
Facility
|
IP
|
$5,307.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,592.25 |
| Max. Negotiated Rate |
$5,095.20 |
| Rate for Payer: Aetna Commercial |
$4,086.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,139.85
|
| Rate for Payer: Cash Price |
$2,653.75
|
| Rate for Payer: Cigna Commercial |
$4,405.23
|
| Rate for Payer: First Health Commercial |
$5,042.12
|
| Rate for Payer: Humana Commercial |
$4,511.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,352.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,916.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,592.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,670.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,980.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,246.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,617.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,662.18
|
| Rate for Payer: PHCS Commercial |
$5,095.20
|
| Rate for Payer: United Healthcare All Payer |
$4,670.60
|
|
|
OX LG RT MENISICAL BEARNG 5MM
|
Facility
|
OP
|
$5,307.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,592.25 |
| Max. Negotiated Rate |
$5,095.20 |
| Rate for Payer: Aetna Commercial |
$4,086.78
|
| Rate for Payer: Anthem Medicaid |
$1,825.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,139.85
|
| Rate for Payer: Cash Price |
$2,653.75
|
| Rate for Payer: Cigna Commercial |
$4,405.23
|
| Rate for Payer: First Health Commercial |
$5,042.12
|
| Rate for Payer: Humana Commercial |
$4,511.38
|
| Rate for Payer: Humana KY Medicaid |
$1,825.25
|
| Rate for Payer: Kentucky WC Medicaid |
$1,843.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,352.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,916.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,592.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,861.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,670.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,980.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,246.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,617.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,662.18
|
| Rate for Payer: PHCS Commercial |
$5,095.20
|
| Rate for Payer: United Healthcare All Payer |
$4,670.60
|
|
|
OX PART KNEE TWIN PEG FEM LG
|
Facility
|
IP
|
$12,296.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,689.10 |
| Max. Negotiated Rate |
$11,805.11 |
| Rate for Payer: Aetna Commercial |
$9,468.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,591.65
|
| Rate for Payer: Cash Price |
$6,148.50
|
| Rate for Payer: Cigna Commercial |
$10,206.50
|
| Rate for Payer: First Health Commercial |
$11,682.14
|
| Rate for Payer: Humana Commercial |
$10,452.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,083.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,075.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,689.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,821.35
|
| Rate for Payer: Ohio Health Group HMO |
$9,222.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,837.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,698.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,484.92
|
| Rate for Payer: PHCS Commercial |
$11,805.11
|
| Rate for Payer: United Healthcare All Payer |
$10,821.35
|
|
|
OX PART KNEE TWIN PEG FEM LG
|
Facility
|
OP
|
$12,296.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,689.10 |
| Max. Negotiated Rate |
$11,805.11 |
| Rate for Payer: Aetna Commercial |
$9,468.68
|
| Rate for Payer: Anthem Medicaid |
$4,228.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,591.65
|
| Rate for Payer: Cash Price |
$6,148.50
|
| Rate for Payer: Cigna Commercial |
$10,206.50
|
| Rate for Payer: First Health Commercial |
$11,682.14
|
| Rate for Payer: Humana Commercial |
$10,452.44
|
| Rate for Payer: Humana KY Medicaid |
$4,228.93
|
| Rate for Payer: Kentucky WC Medicaid |
$4,271.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,083.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,075.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,689.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,313.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,821.35
|
| Rate for Payer: Ohio Health Group HMO |
$9,222.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,837.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,698.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,484.92
|
| Rate for Payer: PHCS Commercial |
$11,805.11
|
| Rate for Payer: United Healthcare All Payer |
$10,821.35
|
|
|
OX PART KNEE TWIN PEG FEM MED
|
Facility
|
OP
|
$12,296.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,689.10 |
| Max. Negotiated Rate |
$11,805.11 |
| Rate for Payer: Aetna Commercial |
$9,468.68
|
| Rate for Payer: Anthem Medicaid |
$4,228.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,591.65
|
| Rate for Payer: Cash Price |
$6,148.50
|
| Rate for Payer: Cigna Commercial |
$10,206.50
|
| Rate for Payer: First Health Commercial |
$11,682.14
|
| Rate for Payer: Humana Commercial |
$10,452.44
|
| Rate for Payer: Humana KY Medicaid |
$4,228.93
|
| Rate for Payer: Kentucky WC Medicaid |
$4,271.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,083.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,075.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,689.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,313.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,821.35
|
| Rate for Payer: Ohio Health Group HMO |
$9,222.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,837.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,698.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,484.92
|
| Rate for Payer: PHCS Commercial |
$11,805.11
|
| Rate for Payer: United Healthcare All Payer |
$10,821.35
|
|
|
OX PART KNEE TWIN PEG FEM MED
|
Facility
|
IP
|
$12,296.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,689.10 |
| Max. Negotiated Rate |
$11,805.11 |
| Rate for Payer: Aetna Commercial |
$9,468.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,591.65
|
| Rate for Payer: Cash Price |
$6,148.50
|
| Rate for Payer: Cigna Commercial |
$10,206.50
|
| Rate for Payer: First Health Commercial |
$11,682.14
|
| Rate for Payer: Humana Commercial |
$10,452.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,083.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,075.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,689.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,821.35
|
| Rate for Payer: Ohio Health Group HMO |
$9,222.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,837.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,698.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,484.92
|
| Rate for Payer: PHCS Commercial |
$11,805.11
|
| Rate for Payer: United Healthcare All Payer |
$10,821.35
|
|
