|
SLEEVE TI MOD HEAD 12/14 TPR +
|
Facility
|
IP
|
$1,737.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$521.10 |
| Max. Negotiated Rate |
$1,667.52 |
| Rate for Payer: Aetna Commercial |
$1,337.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,354.86
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cigna Commercial |
$1,441.71
|
| Rate for Payer: First Health Commercial |
$1,650.15
|
| Rate for Payer: Humana Commercial |
$1,476.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,424.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,281.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,528.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,302.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,389.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,511.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,198.53
|
| Rate for Payer: PHCS Commercial |
$1,667.52
|
| Rate for Payer: United Healthcare All Payer |
$1,528.56
|
|
|
SLEEVE TI MOD HEAD 12/14 TPR+0
|
Facility
|
OP
|
$1,737.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$521.10 |
| Max. Negotiated Rate |
$1,667.52 |
| Rate for Payer: Aetna Commercial |
$1,337.49
|
| Rate for Payer: Anthem Medicaid |
$597.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,354.86
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cigna Commercial |
$1,441.71
|
| Rate for Payer: First Health Commercial |
$1,650.15
|
| Rate for Payer: Humana Commercial |
$1,476.45
|
| Rate for Payer: Humana KY Medicaid |
$597.35
|
| Rate for Payer: Kentucky WC Medicaid |
$603.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,424.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,281.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$609.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,528.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,302.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,389.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,511.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,198.53
|
| Rate for Payer: PHCS Commercial |
$1,667.52
|
| Rate for Payer: United Healthcare All Payer |
$1,528.56
|
|
|
SLEEVE TI MOD HEAD 12/14 TPR+0
|
Facility
|
IP
|
$1,737.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$521.10 |
| Max. Negotiated Rate |
$1,667.52 |
| Rate for Payer: Aetna Commercial |
$1,337.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,354.86
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cigna Commercial |
$1,441.71
|
| Rate for Payer: First Health Commercial |
$1,650.15
|
| Rate for Payer: Humana Commercial |
$1,476.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,424.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,281.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,528.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,302.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,389.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,511.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,198.53
|
| Rate for Payer: PHCS Commercial |
$1,667.52
|
| Rate for Payer: United Healthcare All Payer |
$1,528.56
|
|
|
SLEEVE TI MOD HEAD 12/14 TPR+4
|
Facility
|
IP
|
$1,737.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$521.10 |
| Max. Negotiated Rate |
$1,667.52 |
| Rate for Payer: Aetna Commercial |
$1,337.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,354.86
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cigna Commercial |
$1,441.71
|
| Rate for Payer: First Health Commercial |
$1,650.15
|
| Rate for Payer: Humana Commercial |
$1,476.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,424.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,281.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,528.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,302.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,389.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,511.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,198.53
|
| Rate for Payer: PHCS Commercial |
$1,667.52
|
| Rate for Payer: United Healthcare All Payer |
$1,528.56
|
|
|
SLEEVE TI MOD HEAD 12/14 TPR+4
|
Facility
|
OP
|
$1,737.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$521.10 |
| Max. Negotiated Rate |
$1,667.52 |
| Rate for Payer: Aetna Commercial |
$1,337.49
|
| Rate for Payer: Anthem Medicaid |
$597.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,354.86
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cigna Commercial |
$1,441.71
|
| Rate for Payer: First Health Commercial |
$1,650.15
|
| Rate for Payer: Humana Commercial |
$1,476.45
|
| Rate for Payer: Humana KY Medicaid |
$597.35
|
| Rate for Payer: Kentucky WC Medicaid |
$603.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,424.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,281.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$609.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,528.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,302.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,389.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,511.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,198.53
|
| Rate for Payer: PHCS Commercial |
$1,667.52
|
| Rate for Payer: United Healthcare All Payer |
$1,528.56
|
|
|
SLEEVE TI MOD HEAD 12/14 TPR-4
|
Facility
|
OP
|
$1,737.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$521.10 |
| Max. Negotiated Rate |
$1,667.52 |
| Rate for Payer: Aetna Commercial |
$1,337.49
|
| Rate for Payer: Anthem Medicaid |
$597.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,354.86
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cigna Commercial |
$1,441.71
|
| Rate for Payer: First Health Commercial |
$1,650.15
|
| Rate for Payer: Humana Commercial |
$1,476.45
|
| Rate for Payer: Humana KY Medicaid |
$597.35
|
| Rate for Payer: Kentucky WC Medicaid |
$603.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,424.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,281.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$609.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,528.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,302.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,389.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,511.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,198.53
|
| Rate for Payer: PHCS Commercial |
$1,667.52
|
| Rate for Payer: United Healthcare All Payer |
$1,528.56
|
|
|
SLEEVE TI MOD HEAD 12/14 TPR-4
|
Facility
|
IP
|
$1,737.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$521.10 |
| Max. Negotiated Rate |
$1,667.52 |
| Rate for Payer: Aetna Commercial |
$1,337.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,354.86
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cigna Commercial |
$1,441.71
|
| Rate for Payer: First Health Commercial |
$1,650.15
|
| Rate for Payer: Humana Commercial |
$1,476.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,424.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,281.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,528.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,302.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,389.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,511.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,198.53
|
| Rate for Payer: PHCS Commercial |
$1,667.52
|
| Rate for Payer: United Healthcare All Payer |
$1,528.56
|
|
|
SLEEVE UNIV C-TAPER +5
|
Facility
|
OP
|
$2,145.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$643.54 |
| Max. Negotiated Rate |
$2,059.32 |
| Rate for Payer: Aetna Commercial |
$1,651.74
|
| Rate for Payer: Anthem Medicaid |
$737.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,673.19
|
| Rate for Payer: Cash Price |
$1,072.56
|
| Rate for Payer: Cigna Commercial |
$1,780.45
|
| Rate for Payer: First Health Commercial |
$2,037.86
|
| Rate for Payer: Humana Commercial |
$1,823.35
|
| Rate for Payer: Humana KY Medicaid |
$737.71
|
| Rate for Payer: Kentucky WC Medicaid |
$745.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,759.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,583.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$643.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$752.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,887.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,608.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,716.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,866.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,480.13
|
| Rate for Payer: PHCS Commercial |
$2,059.32
|
| Rate for Payer: United Healthcare All Payer |
$1,887.71
|
|
|
SLEEVE UNIV C-TAPER +5
|
Facility
|
IP
|
$2,145.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$643.54 |
| Max. Negotiated Rate |
$2,059.32 |
| Rate for Payer: Aetna Commercial |
$1,651.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,673.19
|
| Rate for Payer: Cash Price |
$1,072.56
|
| Rate for Payer: Cigna Commercial |
$1,780.45
|
| Rate for Payer: First Health Commercial |
$2,037.86
|
| Rate for Payer: Humana Commercial |
$1,823.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,759.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,583.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$643.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,887.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,608.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,716.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,866.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,480.13
|
| Rate for Payer: PHCS Commercial |
$2,059.32
|
| Rate for Payer: United Healthcare All Payer |
$1,887.71
|
|
|
SLEEVE UNIVERSAL FEMORAL 46MM
|
Facility
|
OP
|
$18,615.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,584.62 |
| Max. Negotiated Rate |
$17,870.78 |
| Rate for Payer: Aetna Commercial |
$14,333.86
|
| Rate for Payer: Anthem Medicaid |
$6,401.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,520.01
|
| Rate for Payer: Cash Price |
$9,307.70
|
| Rate for Payer: Cigna Commercial |
$15,450.78
|
| Rate for Payer: First Health Commercial |
$17,684.63
|
| Rate for Payer: Humana Commercial |
$15,823.09
|
| Rate for Payer: Humana KY Medicaid |
$6,401.84
|
| Rate for Payer: Kentucky WC Medicaid |
$6,466.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,264.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,738.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,584.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,530.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,381.55
|
| Rate for Payer: Ohio Health Group HMO |
$13,961.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,892.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,195.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,844.63
|
| Rate for Payer: PHCS Commercial |
$17,870.78
|
| Rate for Payer: United Healthcare All Payer |
$16,381.55
|
|
|
SLEEVE UNIVERSAL FEMORAL 46MM
|
Facility
|
IP
|
$18,615.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,584.62 |
| Max. Negotiated Rate |
$17,870.78 |
| Rate for Payer: Aetna Commercial |
$14,333.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,520.01
|
| Rate for Payer: Cash Price |
$9,307.70
|
| Rate for Payer: Cigna Commercial |
$15,450.78
|
| Rate for Payer: First Health Commercial |
$17,684.63
|
| Rate for Payer: Humana Commercial |
$15,823.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,264.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,738.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,584.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,381.55
|
| Rate for Payer: Ohio Health Group HMO |
$13,961.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,892.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,195.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,844.63
|
| Rate for Payer: PHCS Commercial |
$17,870.78
|
| Rate for Payer: United Healthcare All Payer |
$16,381.55
|
|
|
SLEEVE UNIV FEM CEM 20MM
|
Facility
|
IP
|
$17,909.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,372.83 |
| Max. Negotiated Rate |
$17,193.06 |
| Rate for Payer: Aetna Commercial |
$13,790.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,969.36
|
| Rate for Payer: Cash Price |
$8,954.72
|
| Rate for Payer: Cigna Commercial |
$14,864.84
|
| Rate for Payer: First Health Commercial |
$17,013.97
|
| Rate for Payer: Humana Commercial |
$15,223.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,685.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,217.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,372.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,760.31
|
| Rate for Payer: Ohio Health Group HMO |
$13,432.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,327.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,581.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,357.51
|
| Rate for Payer: PHCS Commercial |
$17,193.06
|
| Rate for Payer: United Healthcare All Payer |
$15,760.31
|
|
|
SLEEVE UNIV FEM CEM 20MM
|
Facility
|
OP
|
$17,909.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,372.83 |
| Max. Negotiated Rate |
$17,193.06 |
| Rate for Payer: Aetna Commercial |
$13,790.27
|
| Rate for Payer: Anthem Medicaid |
$6,159.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,969.36
|
| Rate for Payer: Cash Price |
$8,954.72
|
| Rate for Payer: Cigna Commercial |
$14,864.84
|
| Rate for Payer: First Health Commercial |
$17,013.97
|
| Rate for Payer: Humana Commercial |
$15,223.02
|
| Rate for Payer: Humana KY Medicaid |
$6,159.06
|
| Rate for Payer: Kentucky WC Medicaid |
$6,221.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,685.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,217.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,372.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,282.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,760.31
|
| Rate for Payer: Ohio Health Group HMO |
$13,432.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,327.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,581.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,357.51
|
| Rate for Payer: PHCS Commercial |
$17,193.06
|
| Rate for Payer: United Healthcare All Payer |
$15,760.31
|
|
|
SLEEVE UNIV FEM DIS POR 31MM
|
Facility
|
IP
|
$21,646.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,493.88 |
| Max. Negotiated Rate |
$20,780.40 |
| Rate for Payer: Aetna Commercial |
$16,667.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,884.08
|
| Rate for Payer: Cash Price |
$10,823.12
|
| Rate for Payer: Cigna Commercial |
$17,966.39
|
| Rate for Payer: First Health Commercial |
$20,563.94
|
| Rate for Payer: Humana Commercial |
$18,399.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,749.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,974.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,493.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,048.70
|
| Rate for Payer: Ohio Health Group HMO |
$16,234.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,317.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,832.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,935.91
|
| Rate for Payer: PHCS Commercial |
$20,780.40
|
| Rate for Payer: United Healthcare All Payer |
$19,048.70
|
|
|
SLEEVE UNIV FEM DIS POR 31MM
|
Facility
|
OP
|
$21,646.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,493.88 |
| Max. Negotiated Rate |
$20,780.40 |
| Rate for Payer: Aetna Commercial |
$16,667.61
|
| Rate for Payer: Anthem Medicaid |
$7,444.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,884.08
|
| Rate for Payer: Cash Price |
$10,823.12
|
| Rate for Payer: Cigna Commercial |
$17,966.39
|
| Rate for Payer: First Health Commercial |
$20,563.94
|
| Rate for Payer: Humana Commercial |
$18,399.31
|
| Rate for Payer: Humana KY Medicaid |
$7,444.15
|
| Rate for Payer: Kentucky WC Medicaid |
$7,519.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,749.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,974.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,493.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,593.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,048.70
|
| Rate for Payer: Ohio Health Group HMO |
$16,234.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,317.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,832.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,935.91
|
| Rate for Payer: PHCS Commercial |
$20,780.40
|
| Rate for Payer: United Healthcare All Payer |
$19,048.70
|
|
|
SLEEVE UNIV FEM FP 31MM
|
Facility
|
IP
|
$29,044.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,713.22 |
| Max. Negotiated Rate |
$27,882.30 |
| Rate for Payer: Aetna Commercial |
$22,363.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,654.37
|
| Rate for Payer: Cash Price |
$14,522.03
|
| Rate for Payer: Cigna Commercial |
$24,106.57
|
| Rate for Payer: First Health Commercial |
$27,591.86
|
| Rate for Payer: Humana Commercial |
$24,687.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,816.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,434.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,713.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,558.77
|
| Rate for Payer: Ohio Health Group HMO |
$21,783.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,235.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,268.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,040.40
|
| Rate for Payer: PHCS Commercial |
$27,882.30
|
| Rate for Payer: United Healthcare All Payer |
$25,558.77
|
|
|
SLEEVE UNIV FEM FP 31MM
|
Facility
|
OP
|
$29,044.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,713.22 |
| Max. Negotiated Rate |
$27,882.30 |
| Rate for Payer: Aetna Commercial |
$22,363.93
|
| Rate for Payer: Anthem Medicaid |
$9,988.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,654.37
|
| Rate for Payer: Cash Price |
$14,522.03
|
| Rate for Payer: Cigna Commercial |
$24,106.57
|
| Rate for Payer: First Health Commercial |
$27,591.86
|
| Rate for Payer: Humana Commercial |
$24,687.45
|
| Rate for Payer: Humana KY Medicaid |
$9,988.25
|
| Rate for Payer: Kentucky WC Medicaid |
$10,089.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,816.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,434.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,713.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,188.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,558.77
|
| Rate for Payer: Ohio Health Group HMO |
$21,783.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,235.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,268.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,040.40
|
| Rate for Payer: PHCS Commercial |
$27,882.30
|
| Rate for Payer: United Healthcare All Payer |
$25,558.77
|
|
|
SLEEVE UNIV V40 TPR ADAPTER +0
|
Facility
|
IP
|
$2,145.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$643.54 |
| Max. Negotiated Rate |
$2,059.32 |
| Rate for Payer: Aetna Commercial |
$1,651.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,673.19
|
| Rate for Payer: Cash Price |
$1,072.56
|
| Rate for Payer: Cigna Commercial |
$1,780.45
|
| Rate for Payer: First Health Commercial |
$2,037.86
|
| Rate for Payer: Humana Commercial |
$1,823.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,759.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,583.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$643.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,887.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,608.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,716.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,866.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,480.13
|
| Rate for Payer: PHCS Commercial |
$2,059.32
|
| Rate for Payer: United Healthcare All Payer |
$1,887.71
|
|
|
SLEEVE UNIV V40 TPR ADAPTER +0
|
Facility
|
OP
|
$2,145.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$643.54 |
| Max. Negotiated Rate |
$2,059.32 |
| Rate for Payer: Aetna Commercial |
$1,651.74
|
| Rate for Payer: Anthem Medicaid |
$737.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,673.19
|
| Rate for Payer: Cash Price |
$1,072.56
|
| Rate for Payer: Cigna Commercial |
$1,780.45
|
| Rate for Payer: First Health Commercial |
$2,037.86
|
| Rate for Payer: Humana Commercial |
$1,823.35
|
| Rate for Payer: Humana KY Medicaid |
$737.71
|
| Rate for Payer: Kentucky WC Medicaid |
$745.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,759.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,583.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$643.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$752.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,887.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,608.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,716.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,866.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,480.13
|
| Rate for Payer: PHCS Commercial |
$2,059.32
|
| Rate for Payer: United Healthcare All Payer |
$1,887.71
|
|
|
SLEEVE UNIV V40 TPR ADAPTER +4
|
Facility
|
IP
|
$2,145.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$643.54 |
| Max. Negotiated Rate |
$2,059.32 |
| Rate for Payer: Aetna Commercial |
$1,651.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,673.19
|
| Rate for Payer: Cash Price |
$1,072.56
|
| Rate for Payer: Cigna Commercial |
$1,780.45
|
| Rate for Payer: First Health Commercial |
$2,037.86
|
| Rate for Payer: Humana Commercial |
$1,823.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,759.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,583.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$643.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,887.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,608.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,716.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,866.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,480.13
|
| Rate for Payer: PHCS Commercial |
$2,059.32
|
| Rate for Payer: United Healthcare All Payer |
$1,887.71
|
|
|
SLEEVE UNIV V40 TPR ADAPTER +4
|
Facility
|
OP
|
$2,145.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$643.54 |
| Max. Negotiated Rate |
$2,059.32 |
| Rate for Payer: Aetna Commercial |
$1,651.74
|
| Rate for Payer: Anthem Medicaid |
$737.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,673.19
|
| Rate for Payer: Cash Price |
$1,072.56
|
| Rate for Payer: Cigna Commercial |
$1,780.45
|
| Rate for Payer: First Health Commercial |
$2,037.86
|
| Rate for Payer: Humana Commercial |
$1,823.35
|
| Rate for Payer: Humana KY Medicaid |
$737.71
|
| Rate for Payer: Kentucky WC Medicaid |
$745.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,759.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,583.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$643.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$752.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,887.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,608.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,716.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,866.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,480.13
|
| Rate for Payer: PHCS Commercial |
$2,059.32
|
| Rate for Payer: United Healthcare All Payer |
$1,887.71
|
|
|
SLEEV UNIV V40 TPR ADPTER -2.5
|
Facility
|
IP
|
$2,145.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$643.54 |
| Max. Negotiated Rate |
$2,059.32 |
| Rate for Payer: Aetna Commercial |
$1,651.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,673.19
|
| Rate for Payer: Cash Price |
$1,072.56
|
| Rate for Payer: Cigna Commercial |
$1,780.45
|
| Rate for Payer: First Health Commercial |
$2,037.86
|
| Rate for Payer: Humana Commercial |
$1,823.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,759.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,583.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$643.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,887.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,608.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,716.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,866.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,480.13
|
| Rate for Payer: PHCS Commercial |
$2,059.32
|
| Rate for Payer: United Healthcare All Payer |
$1,887.71
|
|
|
SLEEV UNIV V40 TPR ADPTER -2.5
|
Facility
|
OP
|
$2,145.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$643.54 |
| Max. Negotiated Rate |
$2,059.32 |
| Rate for Payer: Aetna Commercial |
$1,651.74
|
| Rate for Payer: Anthem Medicaid |
$737.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,673.19
|
| Rate for Payer: Cash Price |
$1,072.56
|
| Rate for Payer: Cigna Commercial |
$1,780.45
|
| Rate for Payer: First Health Commercial |
$2,037.86
|
| Rate for Payer: Humana Commercial |
$1,823.35
|
| Rate for Payer: Humana KY Medicaid |
$737.71
|
| Rate for Payer: Kentucky WC Medicaid |
$745.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,759.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,583.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$643.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$752.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,887.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,608.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,716.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,866.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,480.13
|
| Rate for Payer: PHCS Commercial |
$2,059.32
|
| Rate for Payer: United Healthcare All Payer |
$1,887.71
|
|
|
SLENDER SHEATH 5FR
|
Facility
|
IP
|
$1,494.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$448.35 |
| Max. Negotiated Rate |
$1,434.72 |
| Rate for Payer: Aetna Commercial |
$1,150.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,165.71
|
| Rate for Payer: Cash Price |
$747.25
|
| Rate for Payer: Cigna Commercial |
$1,240.43
|
| Rate for Payer: First Health Commercial |
$1,419.78
|
| Rate for Payer: Humana Commercial |
$1,270.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,225.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,102.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$448.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,315.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,120.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,195.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,300.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,031.20
|
| Rate for Payer: PHCS Commercial |
$1,434.72
|
| Rate for Payer: United Healthcare All Payer |
$1,315.16
|
|
|
SLENDER SHEATH 5FR
|
Facility
|
OP
|
$1,494.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$448.35 |
| Max. Negotiated Rate |
$1,434.72 |
| Rate for Payer: Aetna Commercial |
$1,150.77
|
| Rate for Payer: Anthem Medicaid |
$513.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,165.71
|
| Rate for Payer: Cash Price |
$747.25
|
| Rate for Payer: Cigna Commercial |
$1,240.43
|
| Rate for Payer: First Health Commercial |
$1,419.78
|
| Rate for Payer: Humana Commercial |
$1,270.33
|
| Rate for Payer: Humana KY Medicaid |
$513.96
|
| Rate for Payer: Kentucky WC Medicaid |
$519.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,225.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,102.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$448.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$524.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,315.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,120.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,195.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,300.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,031.20
|
| Rate for Payer: PHCS Commercial |
$1,434.72
|
| Rate for Payer: United Healthcare All Payer |
$1,315.16
|
|
