|
BIOLOX DELTA FEM HEAD PHA04420
|
Facility
|
OP
|
$8,092.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,052.02 |
| Max. Negotiated Rate |
$7,768.80 |
| Rate for Payer: Aetna Commercial |
$6,231.22
|
| Rate for Payer: Anthem Medicaid |
$2,783.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,312.15
|
| Rate for Payer: Cash Price |
$4,046.25
|
| Rate for Payer: Cigna Commercial |
$6,716.78
|
| Rate for Payer: First Health Commercial |
$7,687.88
|
| Rate for Payer: Humana Commercial |
$6,878.62
|
| Rate for Payer: Humana KY Medicaid |
$2,783.01
|
| Rate for Payer: Kentucky WC Medicaid |
$2,811.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,635.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,972.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,427.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,838.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,121.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,069.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,618.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,052.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,508.68
|
| Rate for Payer: PHCS Commercial |
$7,768.80
|
| Rate for Payer: United Healthcare All Payer |
$7,121.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04420
|
Facility
|
IP
|
$8,092.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,052.02 |
| Max. Negotiated Rate |
$7,768.80 |
| Rate for Payer: Aetna Commercial |
$6,231.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,312.15
|
| Rate for Payer: Cash Price |
$4,046.25
|
| Rate for Payer: Cigna Commercial |
$6,716.78
|
| Rate for Payer: First Health Commercial |
$7,687.88
|
| Rate for Payer: Humana Commercial |
$6,878.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,635.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,972.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,427.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,121.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,069.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,618.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,052.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,508.68
|
| Rate for Payer: PHCS Commercial |
$7,768.80
|
| Rate for Payer: United Healthcare All Payer |
$7,121.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04422
|
Facility
|
OP
|
$8,092.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,052.02 |
| Max. Negotiated Rate |
$7,768.80 |
| Rate for Payer: Aetna Commercial |
$6,231.22
|
| Rate for Payer: Anthem Medicaid |
$2,783.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,312.15
|
| Rate for Payer: Cash Price |
$4,046.25
|
| Rate for Payer: Cigna Commercial |
$6,716.78
|
| Rate for Payer: First Health Commercial |
$7,687.88
|
| Rate for Payer: Humana Commercial |
$6,878.62
|
| Rate for Payer: Humana KY Medicaid |
$2,783.01
|
| Rate for Payer: Kentucky WC Medicaid |
$2,811.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,635.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,972.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,427.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,838.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,121.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,069.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,618.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,052.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,508.68
|
| Rate for Payer: PHCS Commercial |
$7,768.80
|
| Rate for Payer: United Healthcare All Payer |
$7,121.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04422
|
Facility
|
IP
|
$8,092.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,052.02 |
| Max. Negotiated Rate |
$7,768.80 |
| Rate for Payer: Aetna Commercial |
$6,231.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,312.15
|
| Rate for Payer: Cash Price |
$4,046.25
|
| Rate for Payer: Cigna Commercial |
$6,716.78
|
| Rate for Payer: First Health Commercial |
$7,687.88
|
| Rate for Payer: Humana Commercial |
$6,878.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,635.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,972.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,427.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,121.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,069.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,618.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,052.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,508.68
|
| Rate for Payer: PHCS Commercial |
$7,768.80
|
| Rate for Payer: United Healthcare All Payer |
$7,121.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04424
|
Facility
|
IP
|
$8,092.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,052.02 |
| Max. Negotiated Rate |
$7,768.80 |
| Rate for Payer: Aetna Commercial |
$6,231.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,312.15
|
| Rate for Payer: Cash Price |
$4,046.25
|
| Rate for Payer: Cigna Commercial |
$6,716.78
|
| Rate for Payer: First Health Commercial |
$7,687.88
|
| Rate for Payer: Humana Commercial |
$6,878.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,635.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,972.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,427.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,121.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,069.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,618.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,052.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,508.68
|
| Rate for Payer: PHCS Commercial |
$7,768.80
|
| Rate for Payer: United Healthcare All Payer |
$7,121.40
|
|
|
BIOLOX DELTA FEM HEAD PHA04424
|
Facility
|
OP
|
$8,092.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,052.02 |
| Max. Negotiated Rate |
$7,768.80 |
| Rate for Payer: Aetna Commercial |
$6,231.22
|
| Rate for Payer: Anthem Medicaid |
$2,783.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,312.15
|
| Rate for Payer: Cash Price |
$4,046.25
|
| Rate for Payer: Cigna Commercial |
$6,716.78
|
| Rate for Payer: First Health Commercial |
$7,687.88
|
| Rate for Payer: Humana Commercial |
$6,878.62
|
| Rate for Payer: Humana KY Medicaid |
$2,783.01
|
| Rate for Payer: Kentucky WC Medicaid |
$2,811.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,635.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,972.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,427.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,838.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,121.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,069.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,618.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,052.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,508.68
|
| Rate for Payer: PHCS Commercial |
$7,768.80
|
| Rate for Payer: United Healthcare All Payer |
$7,121.40
|
|
|
BIOLOXDELTAHEADMD+4 12/14 40MM
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
BIOLOXDELTAHEADMD+4 12/14 40MM
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
BIOLOXDELTAHEADSH+0 12/14 40MM
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
BIOLOXDELTAHEADSH+0 12/14 40MM
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
BIOLOX DELTAHEDLG+8 12/14 40MM
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
BIOLOX DELTAHEDLG+8 12/14 40MM
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
BIOLOX TAPER SLEEVE 1*-3 NECK
|
Facility
|
OP
|
$2,064.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$268.32 |
| Max. Negotiated Rate |
$1,981.44 |
| Rate for Payer: Aetna Commercial |
$1,589.28
|
| Rate for Payer: Anthem Medicaid |
$709.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,609.92
|
| Rate for Payer: Cash Price |
$1,032.00
|
| Rate for Payer: Cigna Commercial |
$1,713.12
|
| Rate for Payer: First Health Commercial |
$1,960.80
|
| Rate for Payer: Humana Commercial |
$1,754.40
|
| Rate for Payer: Humana KY Medicaid |
$709.81
|
| Rate for Payer: Kentucky WC Medicaid |
$717.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,692.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,523.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$619.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$724.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,816.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,548.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$412.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$268.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$639.84
|
| Rate for Payer: PHCS Commercial |
$1,981.44
|
| Rate for Payer: United Healthcare All Payer |
$1,816.32
|
|
|
BIOLOX TAPER SLEEVE 1*-3 NECK
|
Facility
|
IP
|
$2,064.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$268.32 |
| Max. Negotiated Rate |
$1,981.44 |
| Rate for Payer: Aetna Commercial |
$1,589.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,609.92
|
| Rate for Payer: Cash Price |
$1,032.00
|
| Rate for Payer: Cigna Commercial |
$1,713.12
|
| Rate for Payer: First Health Commercial |
$1,960.80
|
| Rate for Payer: Humana Commercial |
$1,754.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,692.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,523.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$619.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,816.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,548.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$412.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$268.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$639.84
|
| Rate for Payer: PHCS Commercial |
$1,981.44
|
| Rate for Payer: United Healthcare All Payer |
$1,816.32
|
|
|
BIO-MOD 40*15MM EAS HD
|
Facility
|
OP
|
$9,848.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.26 |
| Max. Negotiated Rate |
$9,454.22 |
| Rate for Payer: Aetna Commercial |
$7,583.08
|
| Rate for Payer: Anthem Medicaid |
$3,386.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,681.56
|
| Rate for Payer: Cash Price |
$4,924.08
|
| Rate for Payer: Cigna Commercial |
$8,173.96
|
| Rate for Payer: First Health Commercial |
$9,355.74
|
| Rate for Payer: Humana Commercial |
$8,370.93
|
| Rate for Payer: Humana KY Medicaid |
$3,386.78
|
| Rate for Payer: Kentucky WC Medicaid |
$3,421.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,075.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,267.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,954.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,454.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,666.37
|
| Rate for Payer: Ohio Health Group HMO |
$7,386.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,969.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,052.93
|
| Rate for Payer: PHCS Commercial |
$9,454.22
|
| Rate for Payer: United Healthcare All Payer |
$8,666.37
|
|
|
BIO-MOD 40*15MM EAS HD
|
Facility
|
IP
|
$9,848.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.26 |
| Max. Negotiated Rate |
$9,454.22 |
| Rate for Payer: Aetna Commercial |
$7,583.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,681.56
|
| Rate for Payer: Cash Price |
$4,924.08
|
| Rate for Payer: Cigna Commercial |
$8,173.96
|
| Rate for Payer: First Health Commercial |
$9,355.74
|
| Rate for Payer: Humana Commercial |
$8,370.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,075.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,267.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,954.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,666.37
|
| Rate for Payer: Ohio Health Group HMO |
$7,386.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,969.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,052.93
|
| Rate for Payer: PHCS Commercial |
$9,454.22
|
| Rate for Payer: United Healthcare All Payer |
$8,666.37
|
|
|
BIO-MOD 40*20MM EAS HD
|
Facility
|
OP
|
$9,848.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.26 |
| Max. Negotiated Rate |
$9,454.22 |
| Rate for Payer: Aetna Commercial |
$7,583.08
|
| Rate for Payer: Anthem Medicaid |
$3,386.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,681.56
|
| Rate for Payer: Cash Price |
$4,924.08
|
| Rate for Payer: Cigna Commercial |
$8,173.96
|
| Rate for Payer: First Health Commercial |
$9,355.74
|
| Rate for Payer: Humana Commercial |
$8,370.93
|
| Rate for Payer: Humana KY Medicaid |
$3,386.78
|
| Rate for Payer: Kentucky WC Medicaid |
$3,421.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,075.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,267.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,954.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,454.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,666.37
|
| Rate for Payer: Ohio Health Group HMO |
$7,386.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,969.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,052.93
|
| Rate for Payer: PHCS Commercial |
$9,454.22
|
| Rate for Payer: United Healthcare All Payer |
$8,666.37
|
|
|
BIO-MOD 40*20MM EAS HD
|
Facility
|
IP
|
$9,848.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.26 |
| Max. Negotiated Rate |
$9,454.22 |
| Rate for Payer: Aetna Commercial |
$7,583.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,681.56
|
| Rate for Payer: Cash Price |
$4,924.08
|
| Rate for Payer: Cigna Commercial |
$8,173.96
|
| Rate for Payer: First Health Commercial |
$9,355.74
|
| Rate for Payer: Humana Commercial |
$8,370.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,075.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,267.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,954.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,666.37
|
| Rate for Payer: Ohio Health Group HMO |
$7,386.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,969.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,052.93
|
| Rate for Payer: PHCS Commercial |
$9,454.22
|
| Rate for Payer: United Healthcare All Payer |
$8,666.37
|
|
|
BIO-MOD 44*17MM EAS HD
|
Facility
|
OP
|
$9,848.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.26 |
| Max. Negotiated Rate |
$9,454.22 |
| Rate for Payer: Aetna Commercial |
$7,583.08
|
| Rate for Payer: Anthem Medicaid |
$3,386.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,681.56
|
| Rate for Payer: Cash Price |
$4,924.08
|
| Rate for Payer: Cigna Commercial |
$8,173.96
|
| Rate for Payer: First Health Commercial |
$9,355.74
|
| Rate for Payer: Humana Commercial |
$8,370.93
|
| Rate for Payer: Humana KY Medicaid |
$3,386.78
|
| Rate for Payer: Kentucky WC Medicaid |
$3,421.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,075.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,267.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,954.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,454.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,666.37
|
| Rate for Payer: Ohio Health Group HMO |
$7,386.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,969.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,052.93
|
| Rate for Payer: PHCS Commercial |
$9,454.22
|
| Rate for Payer: United Healthcare All Payer |
$8,666.37
|
|
|
BIO-MOD 44*17MM EAS HD
|
Facility
|
IP
|
$9,848.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.26 |
| Max. Negotiated Rate |
$9,454.22 |
| Rate for Payer: Aetna Commercial |
$7,583.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,681.56
|
| Rate for Payer: Cash Price |
$4,924.08
|
| Rate for Payer: Cigna Commercial |
$8,173.96
|
| Rate for Payer: First Health Commercial |
$9,355.74
|
| Rate for Payer: Humana Commercial |
$8,370.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,075.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,267.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,954.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,666.37
|
| Rate for Payer: Ohio Health Group HMO |
$7,386.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,969.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,052.93
|
| Rate for Payer: PHCS Commercial |
$9,454.22
|
| Rate for Payer: United Healthcare All Payer |
$8,666.37
|
|
|
BIO-MOD 44*22MM EAS HD
|
Facility
|
IP
|
$9,848.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.26 |
| Max. Negotiated Rate |
$9,454.22 |
| Rate for Payer: Aetna Commercial |
$7,583.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,681.56
|
| Rate for Payer: Cash Price |
$4,924.08
|
| Rate for Payer: Cigna Commercial |
$8,173.96
|
| Rate for Payer: First Health Commercial |
$9,355.74
|
| Rate for Payer: Humana Commercial |
$8,370.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,075.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,267.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,954.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,666.37
|
| Rate for Payer: Ohio Health Group HMO |
$7,386.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,969.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,052.93
|
| Rate for Payer: PHCS Commercial |
$9,454.22
|
| Rate for Payer: United Healthcare All Payer |
$8,666.37
|
|
|
BIO-MOD 44*22MM EAS HD
|
Facility
|
OP
|
$9,848.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.26 |
| Max. Negotiated Rate |
$9,454.22 |
| Rate for Payer: Aetna Commercial |
$7,583.08
|
| Rate for Payer: Anthem Medicaid |
$3,386.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,681.56
|
| Rate for Payer: Cash Price |
$4,924.08
|
| Rate for Payer: Cigna Commercial |
$8,173.96
|
| Rate for Payer: First Health Commercial |
$9,355.74
|
| Rate for Payer: Humana Commercial |
$8,370.93
|
| Rate for Payer: Humana KY Medicaid |
$3,386.78
|
| Rate for Payer: Kentucky WC Medicaid |
$3,421.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,075.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,267.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,954.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,454.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,666.37
|
| Rate for Payer: Ohio Health Group HMO |
$7,386.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,969.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,052.93
|
| Rate for Payer: PHCS Commercial |
$9,454.22
|
| Rate for Payer: United Healthcare All Payer |
$8,666.37
|
|
|
BIO-MOD 44*27MM EAS HD
|
Facility
|
IP
|
$9,848.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.26 |
| Max. Negotiated Rate |
$9,454.22 |
| Rate for Payer: Aetna Commercial |
$7,583.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,681.56
|
| Rate for Payer: Cash Price |
$4,924.08
|
| Rate for Payer: Cigna Commercial |
$8,173.96
|
| Rate for Payer: First Health Commercial |
$9,355.74
|
| Rate for Payer: Humana Commercial |
$8,370.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,075.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,267.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,954.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,666.37
|
| Rate for Payer: Ohio Health Group HMO |
$7,386.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,969.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,052.93
|
| Rate for Payer: PHCS Commercial |
$9,454.22
|
| Rate for Payer: United Healthcare All Payer |
$8,666.37
|
|
|
BIO-MOD 44*27MM EAS HD
|
Facility
|
OP
|
$9,848.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.26 |
| Max. Negotiated Rate |
$9,454.22 |
| Rate for Payer: Aetna Commercial |
$7,583.08
|
| Rate for Payer: Anthem Medicaid |
$3,386.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,681.56
|
| Rate for Payer: Cash Price |
$4,924.08
|
| Rate for Payer: Cigna Commercial |
$8,173.96
|
| Rate for Payer: First Health Commercial |
$9,355.74
|
| Rate for Payer: Humana Commercial |
$8,370.93
|
| Rate for Payer: Humana KY Medicaid |
$3,386.78
|
| Rate for Payer: Kentucky WC Medicaid |
$3,421.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,075.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,267.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,954.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,454.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,666.37
|
| Rate for Payer: Ohio Health Group HMO |
$7,386.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,969.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,052.93
|
| Rate for Payer: PHCS Commercial |
$9,454.22
|
| Rate for Payer: United Healthcare All Payer |
$8,666.37
|
|
|
BIO-MOD 48*19MM EAS HD
|
Facility
|
IP
|
$9,848.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.26 |
| Max. Negotiated Rate |
$9,454.22 |
| Rate for Payer: Aetna Commercial |
$7,583.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,681.56
|
| Rate for Payer: Cash Price |
$4,924.08
|
| Rate for Payer: Cigna Commercial |
$8,173.96
|
| Rate for Payer: First Health Commercial |
$9,355.74
|
| Rate for Payer: Humana Commercial |
$8,370.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,075.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,267.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,954.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,666.37
|
| Rate for Payer: Ohio Health Group HMO |
$7,386.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,969.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,052.93
|
| Rate for Payer: PHCS Commercial |
$9,454.22
|
| Rate for Payer: United Healthcare All Payer |
$8,666.37
|
|
