|
TITAN CHP 45 LNGTH 16 THRD
|
Facility
|
IP
|
$3,452.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$448.78 |
| Max. Negotiated Rate |
$3,314.04 |
| Rate for Payer: Aetna Commercial |
$2,658.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,692.65
|
| Rate for Payer: Cash Price |
$1,726.06
|
| Rate for Payer: Cigna Commercial |
$2,865.26
|
| Rate for Payer: First Health Commercial |
$3,279.51
|
| Rate for Payer: Humana Commercial |
$2,934.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,830.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,547.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,035.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,037.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,589.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$690.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,070.16
|
| Rate for Payer: PHCS Commercial |
$3,314.04
|
| Rate for Payer: United Healthcare All Payer |
$3,037.87
|
|
|
TITAN CHP 50 LNGTH 16 THRD
|
Facility
|
IP
|
$3,452.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$448.78 |
| Max. Negotiated Rate |
$3,314.04 |
| Rate for Payer: Aetna Commercial |
$2,658.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,692.65
|
| Rate for Payer: Cash Price |
$1,726.06
|
| Rate for Payer: Cigna Commercial |
$2,865.26
|
| Rate for Payer: First Health Commercial |
$3,279.51
|
| Rate for Payer: Humana Commercial |
$2,934.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,830.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,547.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,035.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,037.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,589.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$690.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,070.16
|
| Rate for Payer: PHCS Commercial |
$3,314.04
|
| Rate for Payer: United Healthcare All Payer |
$3,037.87
|
|
|
TITAN CHP 50 LNGTH 16 THRD
|
Facility
|
OP
|
$3,452.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$448.78 |
| Max. Negotiated Rate |
$3,314.04 |
| Rate for Payer: Aetna Commercial |
$2,658.13
|
| Rate for Payer: Anthem Medicaid |
$1,187.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,692.65
|
| Rate for Payer: Cash Price |
$1,726.06
|
| Rate for Payer: Cigna Commercial |
$2,865.26
|
| Rate for Payer: First Health Commercial |
$3,279.51
|
| Rate for Payer: Humana Commercial |
$2,934.30
|
| Rate for Payer: Humana KY Medicaid |
$1,187.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,199.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,830.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,547.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,035.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,211.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,037.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,589.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$690.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,070.16
|
| Rate for Payer: PHCS Commercial |
$3,314.04
|
| Rate for Payer: United Healthcare All Payer |
$3,037.87
|
|
|
TITAN CHP 55 LNGTH 16 THRD
|
Facility
|
OP
|
$3,452.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$448.78 |
| Max. Negotiated Rate |
$3,314.04 |
| Rate for Payer: Aetna Commercial |
$2,658.13
|
| Rate for Payer: Anthem Medicaid |
$1,187.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,692.65
|
| Rate for Payer: Cash Price |
$1,726.06
|
| Rate for Payer: Cigna Commercial |
$2,865.26
|
| Rate for Payer: First Health Commercial |
$3,279.51
|
| Rate for Payer: Humana Commercial |
$2,934.30
|
| Rate for Payer: Humana KY Medicaid |
$1,187.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,199.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,830.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,547.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,035.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,211.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,037.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,589.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$690.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,070.16
|
| Rate for Payer: PHCS Commercial |
$3,314.04
|
| Rate for Payer: United Healthcare All Payer |
$3,037.87
|
|
|
TITAN CHP 55 LNGTH 16 THRD
|
Facility
|
IP
|
$3,452.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$448.78 |
| Max. Negotiated Rate |
$3,314.04 |
| Rate for Payer: Aetna Commercial |
$2,658.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,692.65
|
| Rate for Payer: Cash Price |
$1,726.06
|
| Rate for Payer: Cigna Commercial |
$2,865.26
|
| Rate for Payer: First Health Commercial |
$3,279.51
|
| Rate for Payer: Humana Commercial |
$2,934.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,830.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,547.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,035.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,037.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,589.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$690.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,070.16
|
| Rate for Payer: PHCS Commercial |
$3,314.04
|
| Rate for Payer: United Healthcare All Payer |
$3,037.87
|
|
|
TITAN CHP 60 LNGTH 16 THRD
|
Facility
|
OP
|
$3,452.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$448.78 |
| Max. Negotiated Rate |
$3,314.04 |
| Rate for Payer: Aetna Commercial |
$2,658.13
|
| Rate for Payer: Anthem Medicaid |
$1,187.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,692.65
|
| Rate for Payer: Cash Price |
$1,726.06
|
| Rate for Payer: Cigna Commercial |
$2,865.26
|
| Rate for Payer: First Health Commercial |
$3,279.51
|
| Rate for Payer: Humana Commercial |
$2,934.30
|
| Rate for Payer: Humana KY Medicaid |
$1,187.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,199.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,830.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,547.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,035.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,211.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,037.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,589.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$690.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,070.16
|
| Rate for Payer: PHCS Commercial |
$3,314.04
|
| Rate for Payer: United Healthcare All Payer |
$3,037.87
|
|
|
TITAN CHP 60 LNGTH 16 THRD
|
Facility
|
IP
|
$3,452.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$448.78 |
| Max. Negotiated Rate |
$3,314.04 |
| Rate for Payer: Aetna Commercial |
$2,658.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,692.65
|
| Rate for Payer: Cash Price |
$1,726.06
|
| Rate for Payer: Cigna Commercial |
$2,865.26
|
| Rate for Payer: First Health Commercial |
$3,279.51
|
| Rate for Payer: Humana Commercial |
$2,934.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,830.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,547.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,035.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,037.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,589.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$690.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,070.16
|
| Rate for Payer: PHCS Commercial |
$3,314.04
|
| Rate for Payer: United Healthcare All Payer |
$3,037.87
|
|
|
TITAN CHP 65 LNGTH 16 THRD
|
Facility
|
OP
|
$3,452.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$448.78 |
| Max. Negotiated Rate |
$3,314.04 |
| Rate for Payer: Aetna Commercial |
$2,658.13
|
| Rate for Payer: Anthem Medicaid |
$1,187.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,692.65
|
| Rate for Payer: Cash Price |
$1,726.06
|
| Rate for Payer: Cigna Commercial |
$2,865.26
|
| Rate for Payer: First Health Commercial |
$3,279.51
|
| Rate for Payer: Humana Commercial |
$2,934.30
|
| Rate for Payer: Humana KY Medicaid |
$1,187.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,199.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,830.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,547.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,035.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,211.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,037.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,589.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$690.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,070.16
|
| Rate for Payer: PHCS Commercial |
$3,314.04
|
| Rate for Payer: United Healthcare All Payer |
$3,037.87
|
|
|
TITAN CHP 65 LNGTH 16 THRD
|
Facility
|
IP
|
$3,452.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$448.78 |
| Max. Negotiated Rate |
$3,314.04 |
| Rate for Payer: Aetna Commercial |
$2,658.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,692.65
|
| Rate for Payer: Cash Price |
$1,726.06
|
| Rate for Payer: Cigna Commercial |
$2,865.26
|
| Rate for Payer: First Health Commercial |
$3,279.51
|
| Rate for Payer: Humana Commercial |
$2,934.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,830.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,547.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,035.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,037.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,589.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$690.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,070.16
|
| Rate for Payer: PHCS Commercial |
$3,314.04
|
| Rate for Payer: United Healthcare All Payer |
$3,037.87
|
|
|
TITAN CHP 70 LNGTH 16 THRD
|
Facility
|
OP
|
$3,452.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$448.78 |
| Max. Negotiated Rate |
$3,314.04 |
| Rate for Payer: Aetna Commercial |
$2,658.13
|
| Rate for Payer: Anthem Medicaid |
$1,187.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,692.65
|
| Rate for Payer: Cash Price |
$1,726.06
|
| Rate for Payer: Cigna Commercial |
$2,865.26
|
| Rate for Payer: First Health Commercial |
$3,279.51
|
| Rate for Payer: Humana Commercial |
$2,934.30
|
| Rate for Payer: Humana KY Medicaid |
$1,187.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,199.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,830.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,547.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,035.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,211.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,037.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,589.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$690.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,070.16
|
| Rate for Payer: PHCS Commercial |
$3,314.04
|
| Rate for Payer: United Healthcare All Payer |
$3,037.87
|
|
|
TITAN CHP 70 LNGTH 16 THRD
|
Facility
|
IP
|
$3,452.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$448.78 |
| Max. Negotiated Rate |
$3,314.04 |
| Rate for Payer: Aetna Commercial |
$2,658.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,692.65
|
| Rate for Payer: Cash Price |
$1,726.06
|
| Rate for Payer: Cigna Commercial |
$2,865.26
|
| Rate for Payer: First Health Commercial |
$3,279.51
|
| Rate for Payer: Humana Commercial |
$2,934.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,830.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,547.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,035.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,037.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,589.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$690.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,070.16
|
| Rate for Payer: PHCS Commercial |
$3,314.04
|
| Rate for Payer: United Healthcare All Payer |
$3,037.87
|
|
|
TITAN CHP 75 LNGTH 16 THRD
|
Facility
|
OP
|
$3,452.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$448.78 |
| Max. Negotiated Rate |
$3,314.04 |
| Rate for Payer: Aetna Commercial |
$2,658.13
|
| Rate for Payer: Anthem Medicaid |
$1,187.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,692.65
|
| Rate for Payer: Cash Price |
$1,726.06
|
| Rate for Payer: Cigna Commercial |
$2,865.26
|
| Rate for Payer: First Health Commercial |
$3,279.51
|
| Rate for Payer: Humana Commercial |
$2,934.30
|
| Rate for Payer: Humana KY Medicaid |
$1,187.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,199.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,830.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,547.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,035.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,211.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,037.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,589.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$690.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,070.16
|
| Rate for Payer: PHCS Commercial |
$3,314.04
|
| Rate for Payer: United Healthcare All Payer |
$3,037.87
|
|
|
TITAN CHP 75 LNGTH 16 THRD
|
Facility
|
IP
|
$3,452.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$448.78 |
| Max. Negotiated Rate |
$3,314.04 |
| Rate for Payer: Aetna Commercial |
$2,658.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,692.65
|
| Rate for Payer: Cash Price |
$1,726.06
|
| Rate for Payer: Cigna Commercial |
$2,865.26
|
| Rate for Payer: First Health Commercial |
$3,279.51
|
| Rate for Payer: Humana Commercial |
$2,934.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,830.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,547.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,035.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,037.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,589.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$690.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,070.16
|
| Rate for Payer: PHCS Commercial |
$3,314.04
|
| Rate for Payer: United Healthcare All Payer |
$3,037.87
|
|
|
TITAN PENILE PROST ASSEMBLY KI
|
Facility
|
IP
|
$3,442.50
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.52 |
| Max. Negotiated Rate |
$3,304.80 |
| Rate for Payer: Aetna Commercial |
$2,650.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,685.15
|
| Rate for Payer: Cash Price |
$1,721.25
|
| Rate for Payer: Cigna Commercial |
$2,857.28
|
| Rate for Payer: First Health Commercial |
$3,270.38
|
| Rate for Payer: Humana Commercial |
$2,926.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,822.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,540.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,032.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,029.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,581.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$688.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$447.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,067.18
|
| Rate for Payer: PHCS Commercial |
$3,304.80
|
| Rate for Payer: United Healthcare All Payer |
$3,029.40
|
|
|
TITAN PENILE PROST ASSEMBLY KI
|
Facility
|
OP
|
$3,442.50
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.52 |
| Max. Negotiated Rate |
$3,304.80 |
| Rate for Payer: Aetna Commercial |
$2,650.72
|
| Rate for Payer: Anthem Medicaid |
$1,183.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,685.15
|
| Rate for Payer: Cash Price |
$1,721.25
|
| Rate for Payer: Cigna Commercial |
$2,857.28
|
| Rate for Payer: First Health Commercial |
$3,270.38
|
| Rate for Payer: Humana Commercial |
$2,926.12
|
| Rate for Payer: Humana KY Medicaid |
$1,183.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,195.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,822.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,540.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,032.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,207.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,029.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,581.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$688.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$447.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,067.18
|
| Rate for Payer: PHCS Commercial |
$3,304.80
|
| Rate for Payer: United Healthcare All Payer |
$3,029.40
|
|
|
TITAN PENILE PROSTHESES 14CM
|
Facility
|
OP
|
$22,046.25
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,866.01 |
| Max. Negotiated Rate |
$21,164.40 |
| Rate for Payer: Aetna Commercial |
$16,975.61
|
| Rate for Payer: Anthem Medicaid |
$7,581.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,196.08
|
| Rate for Payer: Cash Price |
$11,023.12
|
| Rate for Payer: Cigna Commercial |
$18,298.39
|
| Rate for Payer: First Health Commercial |
$20,943.94
|
| Rate for Payer: Humana Commercial |
$18,739.31
|
| Rate for Payer: Humana KY Medicaid |
$7,581.71
|
| Rate for Payer: Kentucky WC Medicaid |
$7,658.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,077.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,270.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,613.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,733.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,400.70
|
| Rate for Payer: Ohio Health Group HMO |
$16,534.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,409.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,866.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,834.34
|
| Rate for Payer: PHCS Commercial |
$21,164.40
|
| Rate for Payer: United Healthcare All Payer |
$19,400.70
|
|
|
TITAN PENILE PROSTHESES 14CM
|
Facility
|
IP
|
$22,046.25
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,866.01 |
| Max. Negotiated Rate |
$21,164.40 |
| Rate for Payer: Aetna Commercial |
$16,975.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,196.08
|
| Rate for Payer: Cash Price |
$11,023.12
|
| Rate for Payer: Cigna Commercial |
$18,298.39
|
| Rate for Payer: First Health Commercial |
$20,943.94
|
| Rate for Payer: Humana Commercial |
$18,739.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,077.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,270.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,613.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,400.70
|
| Rate for Payer: Ohio Health Group HMO |
$16,534.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,409.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,866.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,834.34
|
| Rate for Payer: PHCS Commercial |
$21,164.40
|
| Rate for Payer: United Healthcare All Payer |
$19,400.70
|
|
|
TITAN PENILE PROSTHESES 16CM
|
Facility
|
OP
|
$22,046.25
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,866.01 |
| Max. Negotiated Rate |
$21,164.40 |
| Rate for Payer: Aetna Commercial |
$16,975.61
|
| Rate for Payer: Anthem Medicaid |
$7,581.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,196.08
|
| Rate for Payer: Cash Price |
$11,023.12
|
| Rate for Payer: Cigna Commercial |
$18,298.39
|
| Rate for Payer: First Health Commercial |
$20,943.94
|
| Rate for Payer: Humana Commercial |
$18,739.31
|
| Rate for Payer: Humana KY Medicaid |
$7,581.71
|
| Rate for Payer: Kentucky WC Medicaid |
$7,658.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,077.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,270.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,613.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,733.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,400.70
|
| Rate for Payer: Ohio Health Group HMO |
$16,534.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,409.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,866.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,834.34
|
| Rate for Payer: PHCS Commercial |
$21,164.40
|
| Rate for Payer: United Healthcare All Payer |
$19,400.70
|
|
|
TITAN PENILE PROSTHESES 16CM
|
Facility
|
IP
|
$22,046.25
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,866.01 |
| Max. Negotiated Rate |
$21,164.40 |
| Rate for Payer: Aetna Commercial |
$16,975.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,196.08
|
| Rate for Payer: Cash Price |
$11,023.12
|
| Rate for Payer: Cigna Commercial |
$18,298.39
|
| Rate for Payer: First Health Commercial |
$20,943.94
|
| Rate for Payer: Humana Commercial |
$18,739.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,077.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,270.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,613.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,400.70
|
| Rate for Payer: Ohio Health Group HMO |
$16,534.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,409.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,866.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,834.34
|
| Rate for Payer: PHCS Commercial |
$21,164.40
|
| Rate for Payer: United Healthcare All Payer |
$19,400.70
|
|
|
TITAN PENILE PROSTHESES 18CM
|
Facility
|
OP
|
$22,046.25
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,866.01 |
| Max. Negotiated Rate |
$21,164.40 |
| Rate for Payer: Aetna Commercial |
$16,975.61
|
| Rate for Payer: Anthem Medicaid |
$7,581.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,196.08
|
| Rate for Payer: Cash Price |
$11,023.12
|
| Rate for Payer: Cigna Commercial |
$18,298.39
|
| Rate for Payer: First Health Commercial |
$20,943.94
|
| Rate for Payer: Humana Commercial |
$18,739.31
|
| Rate for Payer: Humana KY Medicaid |
$7,581.71
|
| Rate for Payer: Kentucky WC Medicaid |
$7,658.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,077.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,270.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,613.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,733.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,400.70
|
| Rate for Payer: Ohio Health Group HMO |
$16,534.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,409.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,866.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,834.34
|
| Rate for Payer: PHCS Commercial |
$21,164.40
|
| Rate for Payer: United Healthcare All Payer |
$19,400.70
|
|
|
TITAN PENILE PROSTHESES 18CM
|
Facility
|
IP
|
$22,046.25
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,866.01 |
| Max. Negotiated Rate |
$21,164.40 |
| Rate for Payer: Aetna Commercial |
$16,975.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,196.08
|
| Rate for Payer: Cash Price |
$11,023.12
|
| Rate for Payer: Cigna Commercial |
$18,298.39
|
| Rate for Payer: First Health Commercial |
$20,943.94
|
| Rate for Payer: Humana Commercial |
$18,739.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,077.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,270.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,613.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,400.70
|
| Rate for Payer: Ohio Health Group HMO |
$16,534.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,409.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,866.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,834.34
|
| Rate for Payer: PHCS Commercial |
$21,164.40
|
| Rate for Payer: United Healthcare All Payer |
$19,400.70
|
|
|
TITAN PENILE PROSTHESES 20CM
|
Facility
|
IP
|
$22,046.25
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,866.01 |
| Max. Negotiated Rate |
$21,164.40 |
| Rate for Payer: Aetna Commercial |
$16,975.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,196.08
|
| Rate for Payer: Cash Price |
$11,023.12
|
| Rate for Payer: Cigna Commercial |
$18,298.39
|
| Rate for Payer: First Health Commercial |
$20,943.94
|
| Rate for Payer: Humana Commercial |
$18,739.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,077.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,270.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,613.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,400.70
|
| Rate for Payer: Ohio Health Group HMO |
$16,534.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,409.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,866.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,834.34
|
| Rate for Payer: PHCS Commercial |
$21,164.40
|
| Rate for Payer: United Healthcare All Payer |
$19,400.70
|
|
|
TITAN PENILE PROSTHESES 20CM
|
Facility
|
OP
|
$22,046.25
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,866.01 |
| Max. Negotiated Rate |
$21,164.40 |
| Rate for Payer: Aetna Commercial |
$16,975.61
|
| Rate for Payer: Anthem Medicaid |
$7,581.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,196.08
|
| Rate for Payer: Cash Price |
$11,023.12
|
| Rate for Payer: Cigna Commercial |
$18,298.39
|
| Rate for Payer: First Health Commercial |
$20,943.94
|
| Rate for Payer: Humana Commercial |
$18,739.31
|
| Rate for Payer: Humana KY Medicaid |
$7,581.71
|
| Rate for Payer: Kentucky WC Medicaid |
$7,658.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,077.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,270.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,613.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,733.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,400.70
|
| Rate for Payer: Ohio Health Group HMO |
$16,534.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,409.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,866.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,834.34
|
| Rate for Payer: PHCS Commercial |
$21,164.40
|
| Rate for Payer: United Healthcare All Payer |
$19,400.70
|
|
|
TITAN PENILE PROSTHESES 22CM
|
Facility
|
OP
|
$22,046.25
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,866.01 |
| Max. Negotiated Rate |
$21,164.40 |
| Rate for Payer: Aetna Commercial |
$16,975.61
|
| Rate for Payer: Anthem Medicaid |
$7,581.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,196.08
|
| Rate for Payer: Cash Price |
$11,023.12
|
| Rate for Payer: Cigna Commercial |
$18,298.39
|
| Rate for Payer: First Health Commercial |
$20,943.94
|
| Rate for Payer: Humana Commercial |
$18,739.31
|
| Rate for Payer: Humana KY Medicaid |
$7,581.71
|
| Rate for Payer: Kentucky WC Medicaid |
$7,658.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,077.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,270.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,613.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,733.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,400.70
|
| Rate for Payer: Ohio Health Group HMO |
$16,534.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,409.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,866.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,834.34
|
| Rate for Payer: PHCS Commercial |
$21,164.40
|
| Rate for Payer: United Healthcare All Payer |
$19,400.70
|
|
|
TITAN PENILE PROSTHESES 22CM
|
Facility
|
IP
|
$22,046.25
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,866.01 |
| Max. Negotiated Rate |
$21,164.40 |
| Rate for Payer: Aetna Commercial |
$16,975.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,196.08
|
| Rate for Payer: Cash Price |
$11,023.12
|
| Rate for Payer: Cigna Commercial |
$18,298.39
|
| Rate for Payer: First Health Commercial |
$20,943.94
|
| Rate for Payer: Humana Commercial |
$18,739.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,077.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,270.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,613.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,400.70
|
| Rate for Payer: Ohio Health Group HMO |
$16,534.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,409.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,866.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,834.34
|
| Rate for Payer: PHCS Commercial |
$21,164.40
|
| Rate for Payer: United Healthcare All Payer |
$19,400.70
|
|
