|
TANDEM UNIPOLAR 41MM
|
Facility
|
OP
|
$3,908.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.62 |
| Max. Negotiated Rate |
$3,752.40 |
| Rate for Payer: Aetna Commercial |
$3,009.74
|
| Rate for Payer: Anthem Medicaid |
$1,344.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,048.82
|
| Rate for Payer: Cash Price |
$1,954.38
|
| Rate for Payer: Cigna Commercial |
$3,244.26
|
| Rate for Payer: First Health Commercial |
$3,713.31
|
| Rate for Payer: Humana Commercial |
$3,322.44
|
| Rate for Payer: Humana KY Medicaid |
$1,344.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,357.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,205.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,884.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,371.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,439.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,931.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,400.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,697.04
|
| Rate for Payer: PHCS Commercial |
$3,752.40
|
| Rate for Payer: United Healthcare All Payer |
$3,439.70
|
|
|
TANDEM UNIPOLAR 41MM
|
Facility
|
IP
|
$3,908.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.62 |
| Max. Negotiated Rate |
$3,752.40 |
| Rate for Payer: Aetna Commercial |
$3,009.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,048.82
|
| Rate for Payer: Cash Price |
$1,954.38
|
| Rate for Payer: Cigna Commercial |
$3,244.26
|
| Rate for Payer: First Health Commercial |
$3,713.31
|
| Rate for Payer: Humana Commercial |
$3,322.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,205.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,884.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,439.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,931.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,400.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,697.04
|
| Rate for Payer: PHCS Commercial |
$3,752.40
|
| Rate for Payer: United Healthcare All Payer |
$3,439.70
|
|
|
TANDEM UNIPOLAR 42MM
|
Facility
|
OP
|
$3,908.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.62 |
| Max. Negotiated Rate |
$3,752.40 |
| Rate for Payer: Aetna Commercial |
$3,009.74
|
| Rate for Payer: Anthem Medicaid |
$1,344.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,048.82
|
| Rate for Payer: Cash Price |
$1,954.38
|
| Rate for Payer: Cigna Commercial |
$3,244.26
|
| Rate for Payer: First Health Commercial |
$3,713.31
|
| Rate for Payer: Humana Commercial |
$3,322.44
|
| Rate for Payer: Humana KY Medicaid |
$1,344.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,357.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,205.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,884.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,371.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,439.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,931.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,400.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,697.04
|
| Rate for Payer: PHCS Commercial |
$3,752.40
|
| Rate for Payer: United Healthcare All Payer |
$3,439.70
|
|
|
TANDEM UNIPOLAR 42MM
|
Facility
|
IP
|
$3,908.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.62 |
| Max. Negotiated Rate |
$3,752.40 |
| Rate for Payer: Aetna Commercial |
$3,009.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,048.82
|
| Rate for Payer: Cash Price |
$1,954.38
|
| Rate for Payer: Cigna Commercial |
$3,244.26
|
| Rate for Payer: First Health Commercial |
$3,713.31
|
| Rate for Payer: Humana Commercial |
$3,322.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,205.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,884.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,439.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,931.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,400.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,697.04
|
| Rate for Payer: PHCS Commercial |
$3,752.40
|
| Rate for Payer: United Healthcare All Payer |
$3,439.70
|
|
|
TANDEM UNIPOLAR 43MM
|
Facility
|
OP
|
$3,908.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.62 |
| Max. Negotiated Rate |
$3,752.40 |
| Rate for Payer: Aetna Commercial |
$3,009.74
|
| Rate for Payer: Anthem Medicaid |
$1,344.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,048.82
|
| Rate for Payer: Cash Price |
$1,954.38
|
| Rate for Payer: Cigna Commercial |
$3,244.26
|
| Rate for Payer: First Health Commercial |
$3,713.31
|
| Rate for Payer: Humana Commercial |
$3,322.44
|
| Rate for Payer: Humana KY Medicaid |
$1,344.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,357.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,205.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,884.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,371.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,439.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,931.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,400.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,697.04
|
| Rate for Payer: PHCS Commercial |
$3,752.40
|
| Rate for Payer: United Healthcare All Payer |
$3,439.70
|
|
|
TANDEM UNIPOLAR 43MM
|
Facility
|
IP
|
$3,908.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.62 |
| Max. Negotiated Rate |
$3,752.40 |
| Rate for Payer: Aetna Commercial |
$3,009.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,048.82
|
| Rate for Payer: Cash Price |
$1,954.38
|
| Rate for Payer: Cigna Commercial |
$3,244.26
|
| Rate for Payer: First Health Commercial |
$3,713.31
|
| Rate for Payer: Humana Commercial |
$3,322.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,205.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,884.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,439.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,931.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,400.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,697.04
|
| Rate for Payer: PHCS Commercial |
$3,752.40
|
| Rate for Payer: United Healthcare All Payer |
$3,439.70
|
|
|
TANDEM UNIPOLAR 44MM
|
Facility
|
IP
|
$3,908.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.62 |
| Max. Negotiated Rate |
$3,752.40 |
| Rate for Payer: Aetna Commercial |
$3,009.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,048.82
|
| Rate for Payer: Cash Price |
$1,954.38
|
| Rate for Payer: Cigna Commercial |
$3,244.26
|
| Rate for Payer: First Health Commercial |
$3,713.31
|
| Rate for Payer: Humana Commercial |
$3,322.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,205.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,884.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,439.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,931.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,400.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,697.04
|
| Rate for Payer: PHCS Commercial |
$3,752.40
|
| Rate for Payer: United Healthcare All Payer |
$3,439.70
|
|
|
TANDEM UNIPOLAR 44MM
|
Facility
|
OP
|
$3,908.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.62 |
| Max. Negotiated Rate |
$3,752.40 |
| Rate for Payer: Aetna Commercial |
$3,009.74
|
| Rate for Payer: Anthem Medicaid |
$1,344.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,048.82
|
| Rate for Payer: Cash Price |
$1,954.38
|
| Rate for Payer: Cigna Commercial |
$3,244.26
|
| Rate for Payer: First Health Commercial |
$3,713.31
|
| Rate for Payer: Humana Commercial |
$3,322.44
|
| Rate for Payer: Humana KY Medicaid |
$1,344.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,357.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,205.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,884.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,371.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,439.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,931.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,400.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,697.04
|
| Rate for Payer: PHCS Commercial |
$3,752.40
|
| Rate for Payer: United Healthcare All Payer |
$3,439.70
|
|
|
TANDEM UNIPOLAR 45MM
|
Facility
|
OP
|
$3,908.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.62 |
| Max. Negotiated Rate |
$3,752.40 |
| Rate for Payer: Aetna Commercial |
$3,009.74
|
| Rate for Payer: Anthem Medicaid |
$1,344.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,048.82
|
| Rate for Payer: Cash Price |
$1,954.38
|
| Rate for Payer: Cigna Commercial |
$3,244.26
|
| Rate for Payer: First Health Commercial |
$3,713.31
|
| Rate for Payer: Humana Commercial |
$3,322.44
|
| Rate for Payer: Humana KY Medicaid |
$1,344.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,357.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,205.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,884.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,371.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,439.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,931.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,400.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,697.04
|
| Rate for Payer: PHCS Commercial |
$3,752.40
|
| Rate for Payer: United Healthcare All Payer |
$3,439.70
|
|
|
TANDEM UNIPOLAR 45MM
|
Facility
|
IP
|
$3,908.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.62 |
| Max. Negotiated Rate |
$3,752.40 |
| Rate for Payer: Aetna Commercial |
$3,009.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,048.82
|
| Rate for Payer: Cash Price |
$1,954.38
|
| Rate for Payer: Cigna Commercial |
$3,244.26
|
| Rate for Payer: First Health Commercial |
$3,713.31
|
| Rate for Payer: Humana Commercial |
$3,322.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,205.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,884.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,439.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,931.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,400.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,697.04
|
| Rate for Payer: PHCS Commercial |
$3,752.40
|
| Rate for Payer: United Healthcare All Payer |
$3,439.70
|
|
|
TANDEM UNIPOLAR 46MM
|
Facility
|
IP
|
$3,908.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.62 |
| Max. Negotiated Rate |
$3,752.40 |
| Rate for Payer: Aetna Commercial |
$3,009.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,048.82
|
| Rate for Payer: Cash Price |
$1,954.38
|
| Rate for Payer: Cigna Commercial |
$3,244.26
|
| Rate for Payer: First Health Commercial |
$3,713.31
|
| Rate for Payer: Humana Commercial |
$3,322.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,205.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,884.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,439.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,931.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,400.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,697.04
|
| Rate for Payer: PHCS Commercial |
$3,752.40
|
| Rate for Payer: United Healthcare All Payer |
$3,439.70
|
|
|
TANDEM UNIPOLAR 46MM
|
Facility
|
OP
|
$3,908.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.62 |
| Max. Negotiated Rate |
$3,752.40 |
| Rate for Payer: Aetna Commercial |
$3,009.74
|
| Rate for Payer: Anthem Medicaid |
$1,344.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,048.82
|
| Rate for Payer: Cash Price |
$1,954.38
|
| Rate for Payer: Cigna Commercial |
$3,244.26
|
| Rate for Payer: First Health Commercial |
$3,713.31
|
| Rate for Payer: Humana Commercial |
$3,322.44
|
| Rate for Payer: Humana KY Medicaid |
$1,344.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,357.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,205.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,884.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,371.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,439.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,931.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,400.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,697.04
|
| Rate for Payer: PHCS Commercial |
$3,752.40
|
| Rate for Payer: United Healthcare All Payer |
$3,439.70
|
|
|
TANDEM UNIPOLAR 47MM
|
Facility
|
OP
|
$3,908.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.62 |
| Max. Negotiated Rate |
$3,752.40 |
| Rate for Payer: Aetna Commercial |
$3,009.74
|
| Rate for Payer: Anthem Medicaid |
$1,344.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,048.82
|
| Rate for Payer: Cash Price |
$1,954.38
|
| Rate for Payer: Cigna Commercial |
$3,244.26
|
| Rate for Payer: First Health Commercial |
$3,713.31
|
| Rate for Payer: Humana Commercial |
$3,322.44
|
| Rate for Payer: Humana KY Medicaid |
$1,344.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,357.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,205.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,884.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,371.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,439.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,931.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,400.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,697.04
|
| Rate for Payer: PHCS Commercial |
$3,752.40
|
| Rate for Payer: United Healthcare All Payer |
$3,439.70
|
|
|
TANDEM UNIPOLAR 47MM
|
Facility
|
IP
|
$3,908.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.62 |
| Max. Negotiated Rate |
$3,752.40 |
| Rate for Payer: Aetna Commercial |
$3,009.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,048.82
|
| Rate for Payer: Cash Price |
$1,954.38
|
| Rate for Payer: Cigna Commercial |
$3,244.26
|
| Rate for Payer: First Health Commercial |
$3,713.31
|
| Rate for Payer: Humana Commercial |
$3,322.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,205.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,884.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,439.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,931.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,400.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,697.04
|
| Rate for Payer: PHCS Commercial |
$3,752.40
|
| Rate for Payer: United Healthcare All Payer |
$3,439.70
|
|
|
TANDEM UNIPOLAR 48MM
|
Facility
|
OP
|
$3,908.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.62 |
| Max. Negotiated Rate |
$3,752.40 |
| Rate for Payer: Aetna Commercial |
$3,009.74
|
| Rate for Payer: Anthem Medicaid |
$1,344.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,048.82
|
| Rate for Payer: Cash Price |
$1,954.38
|
| Rate for Payer: Cigna Commercial |
$3,244.26
|
| Rate for Payer: First Health Commercial |
$3,713.31
|
| Rate for Payer: Humana Commercial |
$3,322.44
|
| Rate for Payer: Humana KY Medicaid |
$1,344.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,357.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,205.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,884.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,371.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,439.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,931.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,400.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,697.04
|
| Rate for Payer: PHCS Commercial |
$3,752.40
|
| Rate for Payer: United Healthcare All Payer |
$3,439.70
|
|
|
TANDEM UNIPOLAR 48MM
|
Facility
|
IP
|
$3,908.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.62 |
| Max. Negotiated Rate |
$3,752.40 |
| Rate for Payer: Aetna Commercial |
$3,009.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,048.82
|
| Rate for Payer: Cash Price |
$1,954.38
|
| Rate for Payer: Cigna Commercial |
$3,244.26
|
| Rate for Payer: First Health Commercial |
$3,713.31
|
| Rate for Payer: Humana Commercial |
$3,322.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,205.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,884.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,439.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,931.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,400.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,697.04
|
| Rate for Payer: PHCS Commercial |
$3,752.40
|
| Rate for Payer: United Healthcare All Payer |
$3,439.70
|
|
|
TANDEM UNIPOLAR 49MM
|
Facility
|
IP
|
$3,908.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.62 |
| Max. Negotiated Rate |
$3,752.40 |
| Rate for Payer: Aetna Commercial |
$3,009.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,048.82
|
| Rate for Payer: Cash Price |
$1,954.38
|
| Rate for Payer: Cigna Commercial |
$3,244.26
|
| Rate for Payer: First Health Commercial |
$3,713.31
|
| Rate for Payer: Humana Commercial |
$3,322.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,205.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,884.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,439.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,931.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,400.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,697.04
|
| Rate for Payer: PHCS Commercial |
$3,752.40
|
| Rate for Payer: United Healthcare All Payer |
$3,439.70
|
|
|
TANDEM UNIPOLAR 49MM
|
Facility
|
OP
|
$3,908.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.62 |
| Max. Negotiated Rate |
$3,752.40 |
| Rate for Payer: Aetna Commercial |
$3,009.74
|
| Rate for Payer: Anthem Medicaid |
$1,344.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,048.82
|
| Rate for Payer: Cash Price |
$1,954.38
|
| Rate for Payer: Cigna Commercial |
$3,244.26
|
| Rate for Payer: First Health Commercial |
$3,713.31
|
| Rate for Payer: Humana Commercial |
$3,322.44
|
| Rate for Payer: Humana KY Medicaid |
$1,344.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,357.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,205.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,884.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,371.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,439.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,931.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,400.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,697.04
|
| Rate for Payer: PHCS Commercial |
$3,752.40
|
| Rate for Payer: United Healthcare All Payer |
$3,439.70
|
|
|
TANDEM UNIPOLAR 50MM
|
Facility
|
IP
|
$3,908.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.62 |
| Max. Negotiated Rate |
$3,752.40 |
| Rate for Payer: Aetna Commercial |
$3,009.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,048.82
|
| Rate for Payer: Cash Price |
$1,954.38
|
| Rate for Payer: Cigna Commercial |
$3,244.26
|
| Rate for Payer: First Health Commercial |
$3,713.31
|
| Rate for Payer: Humana Commercial |
$3,322.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,205.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,884.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,439.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,931.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,400.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,697.04
|
| Rate for Payer: PHCS Commercial |
$3,752.40
|
| Rate for Payer: United Healthcare All Payer |
$3,439.70
|
|
|
TANDEM UNIPOLAR 50MM
|
Facility
|
OP
|
$3,908.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.62 |
| Max. Negotiated Rate |
$3,752.40 |
| Rate for Payer: Aetna Commercial |
$3,009.74
|
| Rate for Payer: Anthem Medicaid |
$1,344.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,048.82
|
| Rate for Payer: Cash Price |
$1,954.38
|
| Rate for Payer: Cigna Commercial |
$3,244.26
|
| Rate for Payer: First Health Commercial |
$3,713.31
|
| Rate for Payer: Humana Commercial |
$3,322.44
|
| Rate for Payer: Humana KY Medicaid |
$1,344.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,357.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,205.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,884.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,371.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,439.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,931.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,400.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,697.04
|
| Rate for Payer: PHCS Commercial |
$3,752.40
|
| Rate for Payer: United Healthcare All Payer |
$3,439.70
|
|
|
TANDEM UNIPOLAR 51MM
|
Facility
|
IP
|
$3,908.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.62 |
| Max. Negotiated Rate |
$3,752.40 |
| Rate for Payer: Aetna Commercial |
$3,009.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,048.82
|
| Rate for Payer: Cash Price |
$1,954.38
|
| Rate for Payer: Cigna Commercial |
$3,244.26
|
| Rate for Payer: First Health Commercial |
$3,713.31
|
| Rate for Payer: Humana Commercial |
$3,322.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,205.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,884.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,439.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,931.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,400.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,697.04
|
| Rate for Payer: PHCS Commercial |
$3,752.40
|
| Rate for Payer: United Healthcare All Payer |
$3,439.70
|
|
|
TANDEM UNIPOLAR 51MM
|
Facility
|
OP
|
$3,908.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.62 |
| Max. Negotiated Rate |
$3,752.40 |
| Rate for Payer: Aetna Commercial |
$3,009.74
|
| Rate for Payer: Anthem Medicaid |
$1,344.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,048.82
|
| Rate for Payer: Cash Price |
$1,954.38
|
| Rate for Payer: Cigna Commercial |
$3,244.26
|
| Rate for Payer: First Health Commercial |
$3,713.31
|
| Rate for Payer: Humana Commercial |
$3,322.44
|
| Rate for Payer: Humana KY Medicaid |
$1,344.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,357.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,205.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,884.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,371.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,439.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,931.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,400.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,697.04
|
| Rate for Payer: PHCS Commercial |
$3,752.40
|
| Rate for Payer: United Healthcare All Payer |
$3,439.70
|
|
|
TANDEM UNIPOLAR 52MM
|
Facility
|
IP
|
$3,908.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.62 |
| Max. Negotiated Rate |
$3,752.40 |
| Rate for Payer: Aetna Commercial |
$3,009.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,048.82
|
| Rate for Payer: Cash Price |
$1,954.38
|
| Rate for Payer: Cigna Commercial |
$3,244.26
|
| Rate for Payer: First Health Commercial |
$3,713.31
|
| Rate for Payer: Humana Commercial |
$3,322.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,205.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,884.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,439.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,931.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,400.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,697.04
|
| Rate for Payer: PHCS Commercial |
$3,752.40
|
| Rate for Payer: United Healthcare All Payer |
$3,439.70
|
|
|
TANDEM UNIPOLAR 52MM
|
Facility
|
OP
|
$3,908.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.62 |
| Max. Negotiated Rate |
$3,752.40 |
| Rate for Payer: Aetna Commercial |
$3,009.74
|
| Rate for Payer: Anthem Medicaid |
$1,344.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,048.82
|
| Rate for Payer: Cash Price |
$1,954.38
|
| Rate for Payer: Cigna Commercial |
$3,244.26
|
| Rate for Payer: First Health Commercial |
$3,713.31
|
| Rate for Payer: Humana Commercial |
$3,322.44
|
| Rate for Payer: Humana KY Medicaid |
$1,344.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,357.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,205.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,884.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,371.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,439.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,931.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,400.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,697.04
|
| Rate for Payer: PHCS Commercial |
$3,752.40
|
| Rate for Payer: United Healthcare All Payer |
$3,439.70
|
|
|
TANDEM UNIPOLAR 53MM
|
Facility
|
IP
|
$3,908.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.62 |
| Max. Negotiated Rate |
$3,752.40 |
| Rate for Payer: Aetna Commercial |
$3,009.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,048.82
|
| Rate for Payer: Cash Price |
$1,954.38
|
| Rate for Payer: Cigna Commercial |
$3,244.26
|
| Rate for Payer: First Health Commercial |
$3,713.31
|
| Rate for Payer: Humana Commercial |
$3,322.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,205.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,884.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,439.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,931.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,400.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,697.04
|
| Rate for Payer: PHCS Commercial |
$3,752.40
|
| Rate for Payer: United Healthcare All Payer |
$3,439.70
|
|
