|
TANDEM UNIPOLAR 41MM
|
Facility
|
OP
|
$3,981.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.60 |
| Max. Negotiated Rate |
$3,822.24 |
| Rate for Payer: Aetna Commercial |
$3,065.76
|
| Rate for Payer: Anthem Medicaid |
$1,369.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,105.57
|
| Rate for Payer: Cash Price |
$1,990.75
|
| Rate for Payer: Cigna Commercial |
$3,304.64
|
| Rate for Payer: First Health Commercial |
$3,782.42
|
| Rate for Payer: Humana Commercial |
$3,384.28
|
| Rate for Payer: Humana KY Medicaid |
$1,369.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,383.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,264.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,938.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,396.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,503.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,986.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,234.26
|
| Rate for Payer: PHCS Commercial |
$3,822.24
|
| Rate for Payer: United Healthcare All Payer |
$3,503.72
|
|
|
TANDEM UNIPOLAR 42MM
|
Facility
|
IP
|
$3,981.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.60 |
| Max. Negotiated Rate |
$3,822.24 |
| Rate for Payer: Aetna Commercial |
$3,065.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,105.57
|
| Rate for Payer: Cash Price |
$1,990.75
|
| Rate for Payer: Cigna Commercial |
$3,304.64
|
| Rate for Payer: First Health Commercial |
$3,782.42
|
| Rate for Payer: Humana Commercial |
$3,384.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,264.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,938.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,503.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,986.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,234.26
|
| Rate for Payer: PHCS Commercial |
$3,822.24
|
| Rate for Payer: United Healthcare All Payer |
$3,503.72
|
|
|
TANDEM UNIPOLAR 42MM
|
Facility
|
OP
|
$3,981.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.60 |
| Max. Negotiated Rate |
$3,822.24 |
| Rate for Payer: Aetna Commercial |
$3,065.76
|
| Rate for Payer: Anthem Medicaid |
$1,369.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,105.57
|
| Rate for Payer: Cash Price |
$1,990.75
|
| Rate for Payer: Cigna Commercial |
$3,304.64
|
| Rate for Payer: First Health Commercial |
$3,782.42
|
| Rate for Payer: Humana Commercial |
$3,384.28
|
| Rate for Payer: Humana KY Medicaid |
$1,369.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,383.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,264.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,938.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,396.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,503.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,986.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,234.26
|
| Rate for Payer: PHCS Commercial |
$3,822.24
|
| Rate for Payer: United Healthcare All Payer |
$3,503.72
|
|
|
TANDEM UNIPOLAR 43MM
|
Facility
|
OP
|
$3,981.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.60 |
| Max. Negotiated Rate |
$3,822.24 |
| Rate for Payer: Aetna Commercial |
$3,065.76
|
| Rate for Payer: Anthem Medicaid |
$1,369.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,105.57
|
| Rate for Payer: Cash Price |
$1,990.75
|
| Rate for Payer: Cigna Commercial |
$3,304.64
|
| Rate for Payer: First Health Commercial |
$3,782.42
|
| Rate for Payer: Humana Commercial |
$3,384.28
|
| Rate for Payer: Humana KY Medicaid |
$1,369.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,383.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,264.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,938.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,396.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,503.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,986.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,234.26
|
| Rate for Payer: PHCS Commercial |
$3,822.24
|
| Rate for Payer: United Healthcare All Payer |
$3,503.72
|
|
|
TANDEM UNIPOLAR 43MM
|
Facility
|
IP
|
$3,981.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.60 |
| Max. Negotiated Rate |
$3,822.24 |
| Rate for Payer: Aetna Commercial |
$3,065.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,105.57
|
| Rate for Payer: Cash Price |
$1,990.75
|
| Rate for Payer: Cigna Commercial |
$3,304.64
|
| Rate for Payer: First Health Commercial |
$3,782.42
|
| Rate for Payer: Humana Commercial |
$3,384.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,264.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,938.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,503.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,986.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,234.26
|
| Rate for Payer: PHCS Commercial |
$3,822.24
|
| Rate for Payer: United Healthcare All Payer |
$3,503.72
|
|
|
TANDEM UNIPOLAR 44MM
|
Facility
|
IP
|
$3,981.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.60 |
| Max. Negotiated Rate |
$3,822.24 |
| Rate for Payer: Aetna Commercial |
$3,065.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,105.57
|
| Rate for Payer: Cash Price |
$1,990.75
|
| Rate for Payer: Cigna Commercial |
$3,304.64
|
| Rate for Payer: First Health Commercial |
$3,782.42
|
| Rate for Payer: Humana Commercial |
$3,384.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,264.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,938.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,503.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,986.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,234.26
|
| Rate for Payer: PHCS Commercial |
$3,822.24
|
| Rate for Payer: United Healthcare All Payer |
$3,503.72
|
|
|
TANDEM UNIPOLAR 44MM
|
Facility
|
OP
|
$3,981.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.60 |
| Max. Negotiated Rate |
$3,822.24 |
| Rate for Payer: Aetna Commercial |
$3,065.76
|
| Rate for Payer: Anthem Medicaid |
$1,369.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,105.57
|
| Rate for Payer: Cash Price |
$1,990.75
|
| Rate for Payer: Cigna Commercial |
$3,304.64
|
| Rate for Payer: First Health Commercial |
$3,782.42
|
| Rate for Payer: Humana Commercial |
$3,384.28
|
| Rate for Payer: Humana KY Medicaid |
$1,369.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,383.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,264.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,938.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,396.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,503.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,986.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,234.26
|
| Rate for Payer: PHCS Commercial |
$3,822.24
|
| Rate for Payer: United Healthcare All Payer |
$3,503.72
|
|
|
TANDEM UNIPOLAR 45MM
|
Facility
|
IP
|
$3,981.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.60 |
| Max. Negotiated Rate |
$3,822.24 |
| Rate for Payer: Aetna Commercial |
$3,065.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,105.57
|
| Rate for Payer: Cash Price |
$1,990.75
|
| Rate for Payer: Cigna Commercial |
$3,304.64
|
| Rate for Payer: First Health Commercial |
$3,782.42
|
| Rate for Payer: Humana Commercial |
$3,384.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,264.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,938.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,503.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,986.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,234.26
|
| Rate for Payer: PHCS Commercial |
$3,822.24
|
| Rate for Payer: United Healthcare All Payer |
$3,503.72
|
|
|
TANDEM UNIPOLAR 45MM
|
Facility
|
OP
|
$3,981.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.60 |
| Max. Negotiated Rate |
$3,822.24 |
| Rate for Payer: Aetna Commercial |
$3,065.76
|
| Rate for Payer: Anthem Medicaid |
$1,369.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,105.57
|
| Rate for Payer: Cash Price |
$1,990.75
|
| Rate for Payer: Cigna Commercial |
$3,304.64
|
| Rate for Payer: First Health Commercial |
$3,782.42
|
| Rate for Payer: Humana Commercial |
$3,384.28
|
| Rate for Payer: Humana KY Medicaid |
$1,369.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,383.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,264.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,938.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,396.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,503.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,986.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,234.26
|
| Rate for Payer: PHCS Commercial |
$3,822.24
|
| Rate for Payer: United Healthcare All Payer |
$3,503.72
|
|
|
TANDEM UNIPOLAR 46MM
|
Facility
|
IP
|
$3,981.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.60 |
| Max. Negotiated Rate |
$3,822.24 |
| Rate for Payer: Aetna Commercial |
$3,065.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,105.57
|
| Rate for Payer: Cash Price |
$1,990.75
|
| Rate for Payer: Cigna Commercial |
$3,304.64
|
| Rate for Payer: First Health Commercial |
$3,782.42
|
| Rate for Payer: Humana Commercial |
$3,384.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,264.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,938.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,503.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,986.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,234.26
|
| Rate for Payer: PHCS Commercial |
$3,822.24
|
| Rate for Payer: United Healthcare All Payer |
$3,503.72
|
|
|
TANDEM UNIPOLAR 46MM
|
Facility
|
OP
|
$3,981.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.60 |
| Max. Negotiated Rate |
$3,822.24 |
| Rate for Payer: Aetna Commercial |
$3,065.76
|
| Rate for Payer: Anthem Medicaid |
$1,369.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,105.57
|
| Rate for Payer: Cash Price |
$1,990.75
|
| Rate for Payer: Cigna Commercial |
$3,304.64
|
| Rate for Payer: First Health Commercial |
$3,782.42
|
| Rate for Payer: Humana Commercial |
$3,384.28
|
| Rate for Payer: Humana KY Medicaid |
$1,369.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,383.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,264.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,938.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,396.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,503.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,986.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,234.26
|
| Rate for Payer: PHCS Commercial |
$3,822.24
|
| Rate for Payer: United Healthcare All Payer |
$3,503.72
|
|
|
TANDEM UNIPOLAR 47MM
|
Facility
|
IP
|
$3,981.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.60 |
| Max. Negotiated Rate |
$3,822.24 |
| Rate for Payer: Aetna Commercial |
$3,065.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,105.57
|
| Rate for Payer: Cash Price |
$1,990.75
|
| Rate for Payer: Cigna Commercial |
$3,304.64
|
| Rate for Payer: First Health Commercial |
$3,782.42
|
| Rate for Payer: Humana Commercial |
$3,384.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,264.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,938.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,503.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,986.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,234.26
|
| Rate for Payer: PHCS Commercial |
$3,822.24
|
| Rate for Payer: United Healthcare All Payer |
$3,503.72
|
|
|
TANDEM UNIPOLAR 47MM
|
Facility
|
OP
|
$3,981.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.60 |
| Max. Negotiated Rate |
$3,822.24 |
| Rate for Payer: Aetna Commercial |
$3,065.76
|
| Rate for Payer: Anthem Medicaid |
$1,369.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,105.57
|
| Rate for Payer: Cash Price |
$1,990.75
|
| Rate for Payer: Cigna Commercial |
$3,304.64
|
| Rate for Payer: First Health Commercial |
$3,782.42
|
| Rate for Payer: Humana Commercial |
$3,384.28
|
| Rate for Payer: Humana KY Medicaid |
$1,369.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,383.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,264.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,938.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,396.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,503.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,986.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,234.26
|
| Rate for Payer: PHCS Commercial |
$3,822.24
|
| Rate for Payer: United Healthcare All Payer |
$3,503.72
|
|
|
TANDEM UNIPOLAR 48MM
|
Facility
|
IP
|
$3,981.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.60 |
| Max. Negotiated Rate |
$3,822.24 |
| Rate for Payer: Aetna Commercial |
$3,065.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,105.57
|
| Rate for Payer: Cash Price |
$1,990.75
|
| Rate for Payer: Cigna Commercial |
$3,304.64
|
| Rate for Payer: First Health Commercial |
$3,782.42
|
| Rate for Payer: Humana Commercial |
$3,384.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,264.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,938.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,503.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,986.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,234.26
|
| Rate for Payer: PHCS Commercial |
$3,822.24
|
| Rate for Payer: United Healthcare All Payer |
$3,503.72
|
|
|
TANDEM UNIPOLAR 48MM
|
Facility
|
OP
|
$3,981.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.60 |
| Max. Negotiated Rate |
$3,822.24 |
| Rate for Payer: Aetna Commercial |
$3,065.76
|
| Rate for Payer: Anthem Medicaid |
$1,369.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,105.57
|
| Rate for Payer: Cash Price |
$1,990.75
|
| Rate for Payer: Cigna Commercial |
$3,304.64
|
| Rate for Payer: First Health Commercial |
$3,782.42
|
| Rate for Payer: Humana Commercial |
$3,384.28
|
| Rate for Payer: Humana KY Medicaid |
$1,369.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,383.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,264.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,938.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,396.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,503.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,986.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,234.26
|
| Rate for Payer: PHCS Commercial |
$3,822.24
|
| Rate for Payer: United Healthcare All Payer |
$3,503.72
|
|
|
TANDEM UNIPOLAR 49MM
|
Facility
|
IP
|
$3,981.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.60 |
| Max. Negotiated Rate |
$3,822.24 |
| Rate for Payer: Aetna Commercial |
$3,065.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,105.57
|
| Rate for Payer: Cash Price |
$1,990.75
|
| Rate for Payer: Cigna Commercial |
$3,304.64
|
| Rate for Payer: First Health Commercial |
$3,782.42
|
| Rate for Payer: Humana Commercial |
$3,384.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,264.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,938.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,503.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,986.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,234.26
|
| Rate for Payer: PHCS Commercial |
$3,822.24
|
| Rate for Payer: United Healthcare All Payer |
$3,503.72
|
|
|
TANDEM UNIPOLAR 49MM
|
Facility
|
OP
|
$3,981.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.60 |
| Max. Negotiated Rate |
$3,822.24 |
| Rate for Payer: Aetna Commercial |
$3,065.76
|
| Rate for Payer: Anthem Medicaid |
$1,369.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,105.57
|
| Rate for Payer: Cash Price |
$1,990.75
|
| Rate for Payer: Cigna Commercial |
$3,304.64
|
| Rate for Payer: First Health Commercial |
$3,782.42
|
| Rate for Payer: Humana Commercial |
$3,384.28
|
| Rate for Payer: Humana KY Medicaid |
$1,369.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,383.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,264.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,938.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,396.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,503.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,986.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,234.26
|
| Rate for Payer: PHCS Commercial |
$3,822.24
|
| Rate for Payer: United Healthcare All Payer |
$3,503.72
|
|
|
TANDEM UNIPOLAR 50MM
|
Facility
|
OP
|
$3,981.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.60 |
| Max. Negotiated Rate |
$3,822.24 |
| Rate for Payer: Aetna Commercial |
$3,065.76
|
| Rate for Payer: Anthem Medicaid |
$1,369.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,105.57
|
| Rate for Payer: Cash Price |
$1,990.75
|
| Rate for Payer: Cigna Commercial |
$3,304.64
|
| Rate for Payer: First Health Commercial |
$3,782.42
|
| Rate for Payer: Humana Commercial |
$3,384.28
|
| Rate for Payer: Humana KY Medicaid |
$1,369.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,383.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,264.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,938.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,396.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,503.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,986.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,234.26
|
| Rate for Payer: PHCS Commercial |
$3,822.24
|
| Rate for Payer: United Healthcare All Payer |
$3,503.72
|
|
|
TANDEM UNIPOLAR 50MM
|
Facility
|
IP
|
$3,981.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.60 |
| Max. Negotiated Rate |
$3,822.24 |
| Rate for Payer: Aetna Commercial |
$3,065.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,105.57
|
| Rate for Payer: Cash Price |
$1,990.75
|
| Rate for Payer: Cigna Commercial |
$3,304.64
|
| Rate for Payer: First Health Commercial |
$3,782.42
|
| Rate for Payer: Humana Commercial |
$3,384.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,264.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,938.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,503.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,986.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,234.26
|
| Rate for Payer: PHCS Commercial |
$3,822.24
|
| Rate for Payer: United Healthcare All Payer |
$3,503.72
|
|
|
TANDEM UNIPOLAR 51MM
|
Facility
|
IP
|
$3,981.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.60 |
| Max. Negotiated Rate |
$3,822.24 |
| Rate for Payer: Aetna Commercial |
$3,065.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,105.57
|
| Rate for Payer: Cash Price |
$1,990.75
|
| Rate for Payer: Cigna Commercial |
$3,304.64
|
| Rate for Payer: First Health Commercial |
$3,782.42
|
| Rate for Payer: Humana Commercial |
$3,384.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,264.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,938.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,503.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,986.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,234.26
|
| Rate for Payer: PHCS Commercial |
$3,822.24
|
| Rate for Payer: United Healthcare All Payer |
$3,503.72
|
|
|
TANDEM UNIPOLAR 51MM
|
Facility
|
OP
|
$3,981.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.60 |
| Max. Negotiated Rate |
$3,822.24 |
| Rate for Payer: Aetna Commercial |
$3,065.76
|
| Rate for Payer: Anthem Medicaid |
$1,369.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,105.57
|
| Rate for Payer: Cash Price |
$1,990.75
|
| Rate for Payer: Cigna Commercial |
$3,304.64
|
| Rate for Payer: First Health Commercial |
$3,782.42
|
| Rate for Payer: Humana Commercial |
$3,384.28
|
| Rate for Payer: Humana KY Medicaid |
$1,369.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,383.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,264.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,938.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,396.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,503.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,986.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,234.26
|
| Rate for Payer: PHCS Commercial |
$3,822.24
|
| Rate for Payer: United Healthcare All Payer |
$3,503.72
|
|
|
TANDEM UNIPOLAR 52MM
|
Facility
|
IP
|
$3,981.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.60 |
| Max. Negotiated Rate |
$3,822.24 |
| Rate for Payer: Aetna Commercial |
$3,065.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,105.57
|
| Rate for Payer: Cash Price |
$1,990.75
|
| Rate for Payer: Cigna Commercial |
$3,304.64
|
| Rate for Payer: First Health Commercial |
$3,782.42
|
| Rate for Payer: Humana Commercial |
$3,384.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,264.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,938.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,503.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,986.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,234.26
|
| Rate for Payer: PHCS Commercial |
$3,822.24
|
| Rate for Payer: United Healthcare All Payer |
$3,503.72
|
|
|
TANDEM UNIPOLAR 52MM
|
Facility
|
OP
|
$3,981.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.60 |
| Max. Negotiated Rate |
$3,822.24 |
| Rate for Payer: Aetna Commercial |
$3,065.76
|
| Rate for Payer: Anthem Medicaid |
$1,369.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,105.57
|
| Rate for Payer: Cash Price |
$1,990.75
|
| Rate for Payer: Cigna Commercial |
$3,304.64
|
| Rate for Payer: First Health Commercial |
$3,782.42
|
| Rate for Payer: Humana Commercial |
$3,384.28
|
| Rate for Payer: Humana KY Medicaid |
$1,369.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,383.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,264.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,938.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,396.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,503.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,986.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,234.26
|
| Rate for Payer: PHCS Commercial |
$3,822.24
|
| Rate for Payer: United Healthcare All Payer |
$3,503.72
|
|
|
TANDEM UNIPOLAR 53MM
|
Facility
|
IP
|
$3,981.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.60 |
| Max. Negotiated Rate |
$3,822.24 |
| Rate for Payer: Aetna Commercial |
$3,065.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,105.57
|
| Rate for Payer: Cash Price |
$1,990.75
|
| Rate for Payer: Cigna Commercial |
$3,304.64
|
| Rate for Payer: First Health Commercial |
$3,782.42
|
| Rate for Payer: Humana Commercial |
$3,384.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,264.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,938.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,503.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,986.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,234.26
|
| Rate for Payer: PHCS Commercial |
$3,822.24
|
| Rate for Payer: United Healthcare All Payer |
$3,503.72
|
|
|
TANDEM UNIPOLAR 53MM
|
Facility
|
OP
|
$3,981.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.60 |
| Max. Negotiated Rate |
$3,822.24 |
| Rate for Payer: Aetna Commercial |
$3,065.76
|
| Rate for Payer: Anthem Medicaid |
$1,369.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,105.57
|
| Rate for Payer: Cash Price |
$1,990.75
|
| Rate for Payer: Cigna Commercial |
$3,304.64
|
| Rate for Payer: First Health Commercial |
$3,782.42
|
| Rate for Payer: Humana Commercial |
$3,384.28
|
| Rate for Payer: Humana KY Medicaid |
$1,369.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,383.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,264.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,938.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,396.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,503.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,986.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,234.26
|
| Rate for Payer: PHCS Commercial |
$3,822.24
|
| Rate for Payer: United Healthcare All Payer |
$3,503.72
|
|
