|
TM REVERSE 40MM POLY LINER +3
|
Facility
|
OP
|
$7,916.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,374.97 |
| Max. Negotiated Rate |
$7,599.89 |
| Rate for Payer: Aetna Commercial |
$6,095.74
|
| Rate for Payer: Anthem Medicaid |
$2,722.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,174.91
|
| Rate for Payer: Cash Price |
$3,958.28
|
| Rate for Payer: Cigna Commercial |
$6,570.74
|
| Rate for Payer: First Health Commercial |
$7,520.72
|
| Rate for Payer: Humana Commercial |
$6,729.07
|
| Rate for Payer: Humana KY Medicaid |
$2,722.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,750.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,491.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,842.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,374.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,777.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,966.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,937.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,333.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,887.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,462.42
|
| Rate for Payer: PHCS Commercial |
$7,599.89
|
| Rate for Payer: United Healthcare All Payer |
$6,966.56
|
|
|
TM REVERSE 40MM POLY LINER +6
|
Facility
|
IP
|
$7,916.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,374.97 |
| Max. Negotiated Rate |
$7,599.89 |
| Rate for Payer: Aetna Commercial |
$6,095.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,174.91
|
| Rate for Payer: Cash Price |
$3,958.28
|
| Rate for Payer: Cigna Commercial |
$6,570.74
|
| Rate for Payer: First Health Commercial |
$7,520.72
|
| Rate for Payer: Humana Commercial |
$6,729.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,491.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,842.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,374.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,966.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,937.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,333.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,887.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,462.42
|
| Rate for Payer: PHCS Commercial |
$7,599.89
|
| Rate for Payer: United Healthcare All Payer |
$6,966.56
|
|
|
TM REVERSE 40MM POLY LINER +6
|
Facility
|
OP
|
$7,916.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,374.97 |
| Max. Negotiated Rate |
$7,599.89 |
| Rate for Payer: Aetna Commercial |
$6,095.74
|
| Rate for Payer: Anthem Medicaid |
$2,722.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,174.91
|
| Rate for Payer: Cash Price |
$3,958.28
|
| Rate for Payer: Cigna Commercial |
$6,570.74
|
| Rate for Payer: First Health Commercial |
$7,520.72
|
| Rate for Payer: Humana Commercial |
$6,729.07
|
| Rate for Payer: Humana KY Medicaid |
$2,722.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,750.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,491.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,842.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,374.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,777.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,966.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,937.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,333.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,887.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,462.42
|
| Rate for Payer: PHCS Commercial |
$7,599.89
|
| Rate for Payer: United Healthcare All Payer |
$6,966.56
|
|
|
TM REVERSE 40MM POLY LNR +0
|
Facility
|
IP
|
$8,385.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,515.78 |
| Max. Negotiated Rate |
$8,050.50 |
| Rate for Payer: Aetna Commercial |
$6,457.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,541.03
|
| Rate for Payer: Cash Price |
$4,192.97
|
| Rate for Payer: Cigna Commercial |
$6,960.33
|
| Rate for Payer: First Health Commercial |
$7,966.64
|
| Rate for Payer: Humana Commercial |
$7,128.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,876.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,188.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,515.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,379.63
|
| Rate for Payer: Ohio Health Group HMO |
$6,289.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,708.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,295.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,786.30
|
| Rate for Payer: PHCS Commercial |
$8,050.50
|
| Rate for Payer: United Healthcare All Payer |
$7,379.63
|
|
|
TM REVERSE 40MM POLY LNR +0
|
Facility
|
OP
|
$8,385.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,515.78 |
| Max. Negotiated Rate |
$8,050.50 |
| Rate for Payer: Aetna Commercial |
$6,457.17
|
| Rate for Payer: Anthem Medicaid |
$2,883.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,541.03
|
| Rate for Payer: Cash Price |
$4,192.97
|
| Rate for Payer: Cigna Commercial |
$6,960.33
|
| Rate for Payer: First Health Commercial |
$7,966.64
|
| Rate for Payer: Humana Commercial |
$7,128.05
|
| Rate for Payer: Humana KY Medicaid |
$2,883.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,913.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,876.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,188.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,515.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,941.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,379.63
|
| Rate for Payer: Ohio Health Group HMO |
$6,289.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,708.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,295.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,786.30
|
| Rate for Payer: PHCS Commercial |
$8,050.50
|
| Rate for Payer: United Healthcare All Payer |
$7,379.63
|
|
|
TM REVERSE 40MM POLY LNR +3
|
Facility
|
OP
|
$8,385.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,515.78 |
| Max. Negotiated Rate |
$8,050.50 |
| Rate for Payer: Aetna Commercial |
$6,457.17
|
| Rate for Payer: Anthem Medicaid |
$2,883.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,541.03
|
| Rate for Payer: Cash Price |
$4,192.97
|
| Rate for Payer: Cigna Commercial |
$6,960.33
|
| Rate for Payer: First Health Commercial |
$7,966.64
|
| Rate for Payer: Humana Commercial |
$7,128.05
|
| Rate for Payer: Humana KY Medicaid |
$2,883.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,913.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,876.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,188.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,515.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,941.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,379.63
|
| Rate for Payer: Ohio Health Group HMO |
$6,289.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,708.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,295.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,786.30
|
| Rate for Payer: PHCS Commercial |
$8,050.50
|
| Rate for Payer: United Healthcare All Payer |
$7,379.63
|
|
|
TM REVERSE 40MM POLY LNR +3
|
Facility
|
IP
|
$8,385.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,515.78 |
| Max. Negotiated Rate |
$8,050.50 |
| Rate for Payer: Aetna Commercial |
$6,457.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,541.03
|
| Rate for Payer: Cash Price |
$4,192.97
|
| Rate for Payer: Cigna Commercial |
$6,960.33
|
| Rate for Payer: First Health Commercial |
$7,966.64
|
| Rate for Payer: Humana Commercial |
$7,128.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,876.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,188.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,515.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,379.63
|
| Rate for Payer: Ohio Health Group HMO |
$6,289.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,708.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,295.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,786.30
|
| Rate for Payer: PHCS Commercial |
$8,050.50
|
| Rate for Payer: United Healthcare All Payer |
$7,379.63
|
|
|
TM REVERSE 40MM POLY LNR +6
|
Facility
|
OP
|
$8,385.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,515.78 |
| Max. Negotiated Rate |
$8,050.50 |
| Rate for Payer: Aetna Commercial |
$6,457.17
|
| Rate for Payer: Anthem Medicaid |
$2,883.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,541.03
|
| Rate for Payer: Cash Price |
$4,192.97
|
| Rate for Payer: Cigna Commercial |
$6,960.33
|
| Rate for Payer: First Health Commercial |
$7,966.64
|
| Rate for Payer: Humana Commercial |
$7,128.05
|
| Rate for Payer: Humana KY Medicaid |
$2,883.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,913.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,876.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,188.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,515.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,941.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,379.63
|
| Rate for Payer: Ohio Health Group HMO |
$6,289.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,708.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,295.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,786.30
|
| Rate for Payer: PHCS Commercial |
$8,050.50
|
| Rate for Payer: United Healthcare All Payer |
$7,379.63
|
|
|
TM REVERSE 40MM POLY LNR +6
|
Facility
|
IP
|
$8,385.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,515.78 |
| Max. Negotiated Rate |
$8,050.50 |
| Rate for Payer: Aetna Commercial |
$6,457.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,541.03
|
| Rate for Payer: Cash Price |
$4,192.97
|
| Rate for Payer: Cigna Commercial |
$6,960.33
|
| Rate for Payer: First Health Commercial |
$7,966.64
|
| Rate for Payer: Humana Commercial |
$7,128.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,876.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,188.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,515.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,379.63
|
| Rate for Payer: Ohio Health Group HMO |
$6,289.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,708.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,295.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,786.30
|
| Rate for Payer: PHCS Commercial |
$8,050.50
|
| Rate for Payer: United Healthcare All Payer |
$7,379.63
|
|
|
TM REVERSE BASE PLATE
|
Facility
|
IP
|
$13,317.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,995.39 |
| Max. Negotiated Rate |
$12,785.26 |
| Rate for Payer: Aetna Commercial |
$10,254.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,388.02
|
| Rate for Payer: Cash Price |
$6,658.99
|
| Rate for Payer: Cigna Commercial |
$11,053.92
|
| Rate for Payer: First Health Commercial |
$12,652.08
|
| Rate for Payer: Humana Commercial |
$11,320.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,920.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,828.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,995.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,719.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,988.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,654.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,586.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,189.41
|
| Rate for Payer: PHCS Commercial |
$12,785.26
|
| Rate for Payer: United Healthcare All Payer |
$11,719.82
|
|
|
TM REVERSE BASE PLATE
|
Facility
|
OP
|
$13,317.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,995.39 |
| Max. Negotiated Rate |
$12,785.26 |
| Rate for Payer: Aetna Commercial |
$10,254.84
|
| Rate for Payer: Anthem Medicaid |
$4,580.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,388.02
|
| Rate for Payer: Cash Price |
$6,658.99
|
| Rate for Payer: Cigna Commercial |
$11,053.92
|
| Rate for Payer: First Health Commercial |
$12,652.08
|
| Rate for Payer: Humana Commercial |
$11,320.28
|
| Rate for Payer: Humana KY Medicaid |
$4,580.05
|
| Rate for Payer: Kentucky WC Medicaid |
$4,626.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,920.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,828.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,995.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,671.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,719.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,988.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,654.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,586.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,189.41
|
| Rate for Payer: PHCS Commercial |
$12,785.26
|
| Rate for Payer: United Healthcare All Payer |
$11,719.82
|
|
|
TM REVERSE BASE PLATE 15MM
|
Facility
|
OP
|
$13,317.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,995.39 |
| Max. Negotiated Rate |
$12,785.26 |
| Rate for Payer: Aetna Commercial |
$10,254.84
|
| Rate for Payer: Anthem Medicaid |
$4,580.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,388.02
|
| Rate for Payer: Cash Price |
$6,658.99
|
| Rate for Payer: Cigna Commercial |
$11,053.92
|
| Rate for Payer: First Health Commercial |
$12,652.08
|
| Rate for Payer: Humana Commercial |
$11,320.28
|
| Rate for Payer: Humana KY Medicaid |
$4,580.05
|
| Rate for Payer: Kentucky WC Medicaid |
$4,626.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,920.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,828.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,995.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,671.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,719.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,988.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,654.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,586.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,189.41
|
| Rate for Payer: PHCS Commercial |
$12,785.26
|
| Rate for Payer: United Healthcare All Payer |
$11,719.82
|
|
|
TM REVERSE BASE PLATE 15MM
|
Facility
|
IP
|
$13,317.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,995.39 |
| Max. Negotiated Rate |
$12,785.26 |
| Rate for Payer: Aetna Commercial |
$10,254.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,388.02
|
| Rate for Payer: Cash Price |
$6,658.99
|
| Rate for Payer: Cigna Commercial |
$11,053.92
|
| Rate for Payer: First Health Commercial |
$12,652.08
|
| Rate for Payer: Humana Commercial |
$11,320.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,920.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,828.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,995.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,719.82
|
| Rate for Payer: Ohio Health Group HMO |
$9,988.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,654.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,586.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,189.41
|
| Rate for Payer: PHCS Commercial |
$12,785.26
|
| Rate for Payer: United Healthcare All Payer |
$11,719.82
|
|
|
TM REVERSE DUAL TAPER INSERT
|
Facility
|
IP
|
$5,366.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,609.80 |
| Max. Negotiated Rate |
$5,151.36 |
| Rate for Payer: Aetna Commercial |
$4,131.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,185.48
|
| Rate for Payer: Cash Price |
$2,683.00
|
| Rate for Payer: Cigna Commercial |
$4,453.78
|
| Rate for Payer: First Health Commercial |
$5,097.70
|
| Rate for Payer: Humana Commercial |
$4,561.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,400.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,960.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,609.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,722.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,024.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,292.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,668.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,702.54
|
| Rate for Payer: PHCS Commercial |
$5,151.36
|
| Rate for Payer: United Healthcare All Payer |
$4,722.08
|
|
|
TM REVERSE DUAL TAPER INSERT
|
Facility
|
OP
|
$5,366.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,609.80 |
| Max. Negotiated Rate |
$5,151.36 |
| Rate for Payer: Aetna Commercial |
$4,131.82
|
| Rate for Payer: Anthem Medicaid |
$1,845.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,185.48
|
| Rate for Payer: Cash Price |
$2,683.00
|
| Rate for Payer: Cigna Commercial |
$4,453.78
|
| Rate for Payer: First Health Commercial |
$5,097.70
|
| Rate for Payer: Humana Commercial |
$4,561.10
|
| Rate for Payer: Humana KY Medicaid |
$1,845.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,864.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,400.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,960.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,609.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,882.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,722.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,024.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,292.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,668.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,702.54
|
| Rate for Payer: PHCS Commercial |
$5,151.36
|
| Rate for Payer: United Healthcare All Payer |
$4,722.08
|
|
|
TM REVERSE DUAL TPR INSERT
|
Facility
|
IP
|
$5,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,570.20 |
| Max. Negotiated Rate |
$5,024.64 |
| Rate for Payer: Aetna Commercial |
$4,030.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,082.52
|
| Rate for Payer: Cash Price |
$2,617.00
|
| Rate for Payer: Cigna Commercial |
$4,344.22
|
| Rate for Payer: First Health Commercial |
$4,972.30
|
| Rate for Payer: Humana Commercial |
$4,448.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,291.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,862.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,570.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,605.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,925.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,187.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,553.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,611.46
|
| Rate for Payer: PHCS Commercial |
$5,024.64
|
| Rate for Payer: United Healthcare All Payer |
$4,605.92
|
|
|
TM REVERSE DUAL TPR INSERT
|
Facility
|
OP
|
$5,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,570.20 |
| Max. Negotiated Rate |
$5,024.64 |
| Rate for Payer: Aetna Commercial |
$4,030.18
|
| Rate for Payer: Anthem Medicaid |
$1,799.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,082.52
|
| Rate for Payer: Cash Price |
$2,617.00
|
| Rate for Payer: Cigna Commercial |
$4,344.22
|
| Rate for Payer: First Health Commercial |
$4,972.30
|
| Rate for Payer: Humana Commercial |
$4,448.90
|
| Rate for Payer: Humana KY Medicaid |
$1,799.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,818.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,291.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,862.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,570.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,836.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,605.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,925.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,187.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,553.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,611.46
|
| Rate for Payer: PHCS Commercial |
$5,024.64
|
| Rate for Payer: United Healthcare All Payer |
$4,605.92
|
|
|
TM REVERSE STEM 10MM*130MM
|
Facility
|
IP
|
$33,710.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,113.00 |
| Max. Negotiated Rate |
$32,361.60 |
| Rate for Payer: Aetna Commercial |
$25,956.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,293.80
|
| Rate for Payer: Cash Price |
$16,855.00
|
| Rate for Payer: Cigna Commercial |
$27,979.30
|
| Rate for Payer: First Health Commercial |
$32,024.50
|
| Rate for Payer: Humana Commercial |
$28,653.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,642.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,877.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,113.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,664.80
|
| Rate for Payer: Ohio Health Group HMO |
$25,282.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,968.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,327.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,259.90
|
| Rate for Payer: PHCS Commercial |
$32,361.60
|
| Rate for Payer: United Healthcare All Payer |
$29,664.80
|
|
|
TM REVERSE STEM 10MM*130MM
|
Facility
|
OP
|
$33,710.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,113.00 |
| Max. Negotiated Rate |
$32,361.60 |
| Rate for Payer: Aetna Commercial |
$25,956.70
|
| Rate for Payer: Anthem Medicaid |
$11,592.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,293.80
|
| Rate for Payer: Cash Price |
$16,855.00
|
| Rate for Payer: Cigna Commercial |
$27,979.30
|
| Rate for Payer: First Health Commercial |
$32,024.50
|
| Rate for Payer: Humana Commercial |
$28,653.50
|
| Rate for Payer: Humana KY Medicaid |
$11,592.87
|
| Rate for Payer: Kentucky WC Medicaid |
$11,710.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,642.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,877.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,113.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,825.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,664.80
|
| Rate for Payer: Ohio Health Group HMO |
$25,282.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,968.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,327.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,259.90
|
| Rate for Payer: PHCS Commercial |
$32,361.60
|
| Rate for Payer: United Healthcare All Payer |
$29,664.80
|
|
|
TM REVERSE STEM 10MM*170MM
|
Facility
|
OP
|
$33,710.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,113.00 |
| Max. Negotiated Rate |
$32,361.60 |
| Rate for Payer: Aetna Commercial |
$25,956.70
|
| Rate for Payer: Anthem Medicaid |
$11,592.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,293.80
|
| Rate for Payer: Cash Price |
$16,855.00
|
| Rate for Payer: Cigna Commercial |
$27,979.30
|
| Rate for Payer: First Health Commercial |
$32,024.50
|
| Rate for Payer: Humana Commercial |
$28,653.50
|
| Rate for Payer: Humana KY Medicaid |
$11,592.87
|
| Rate for Payer: Kentucky WC Medicaid |
$11,710.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,642.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,877.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,113.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,825.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,664.80
|
| Rate for Payer: Ohio Health Group HMO |
$25,282.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,968.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,327.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,259.90
|
| Rate for Payer: PHCS Commercial |
$32,361.60
|
| Rate for Payer: United Healthcare All Payer |
$29,664.80
|
|
|
TM REVERSE STEM 10MM*170MM
|
Facility
|
IP
|
$33,710.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,113.00 |
| Max. Negotiated Rate |
$32,361.60 |
| Rate for Payer: Aetna Commercial |
$25,956.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,293.80
|
| Rate for Payer: Cash Price |
$16,855.00
|
| Rate for Payer: Cigna Commercial |
$27,979.30
|
| Rate for Payer: First Health Commercial |
$32,024.50
|
| Rate for Payer: Humana Commercial |
$28,653.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,642.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,877.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,113.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,664.80
|
| Rate for Payer: Ohio Health Group HMO |
$25,282.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,968.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,327.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,259.90
|
| Rate for Payer: PHCS Commercial |
$32,361.60
|
| Rate for Payer: United Healthcare All Payer |
$29,664.80
|
|
|
TM REVERSE STEM 12MM*170MM
|
Facility
|
IP
|
$33,710.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,113.00 |
| Max. Negotiated Rate |
$32,361.60 |
| Rate for Payer: Aetna Commercial |
$25,956.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,293.80
|
| Rate for Payer: Cash Price |
$16,855.00
|
| Rate for Payer: Cigna Commercial |
$27,979.30
|
| Rate for Payer: First Health Commercial |
$32,024.50
|
| Rate for Payer: Humana Commercial |
$28,653.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,642.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,877.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,113.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,664.80
|
| Rate for Payer: Ohio Health Group HMO |
$25,282.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,968.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,327.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,259.90
|
| Rate for Payer: PHCS Commercial |
$32,361.60
|
| Rate for Payer: United Healthcare All Payer |
$29,664.80
|
|
|
TM REVERSE STEM 12MM*170MM
|
Facility
|
OP
|
$33,710.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,113.00 |
| Max. Negotiated Rate |
$32,361.60 |
| Rate for Payer: Aetna Commercial |
$25,956.70
|
| Rate for Payer: Anthem Medicaid |
$11,592.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,293.80
|
| Rate for Payer: Cash Price |
$16,855.00
|
| Rate for Payer: Cigna Commercial |
$27,979.30
|
| Rate for Payer: First Health Commercial |
$32,024.50
|
| Rate for Payer: Humana Commercial |
$28,653.50
|
| Rate for Payer: Humana KY Medicaid |
$11,592.87
|
| Rate for Payer: Kentucky WC Medicaid |
$11,710.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,642.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,877.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,113.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,825.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,664.80
|
| Rate for Payer: Ohio Health Group HMO |
$25,282.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,968.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,327.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,259.90
|
| Rate for Payer: PHCS Commercial |
$32,361.60
|
| Rate for Payer: United Healthcare All Payer |
$29,664.80
|
|
|
TM REVERSE STEM 14MM*130MM
|
Facility
|
IP
|
$33,710.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,113.00 |
| Max. Negotiated Rate |
$32,361.60 |
| Rate for Payer: Aetna Commercial |
$25,956.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,293.80
|
| Rate for Payer: Cash Price |
$16,855.00
|
| Rate for Payer: Cigna Commercial |
$27,979.30
|
| Rate for Payer: First Health Commercial |
$32,024.50
|
| Rate for Payer: Humana Commercial |
$28,653.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,642.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,877.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,113.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,664.80
|
| Rate for Payer: Ohio Health Group HMO |
$25,282.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,968.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,327.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,259.90
|
| Rate for Payer: PHCS Commercial |
$32,361.60
|
| Rate for Payer: United Healthcare All Payer |
$29,664.80
|
|
|
TM REVERSE STEM 14MM*130MM
|
Facility
|
OP
|
$33,710.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,113.00 |
| Max. Negotiated Rate |
$32,361.60 |
| Rate for Payer: Aetna Commercial |
$25,956.70
|
| Rate for Payer: Anthem Medicaid |
$11,592.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,293.80
|
| Rate for Payer: Cash Price |
$16,855.00
|
| Rate for Payer: Cigna Commercial |
$27,979.30
|
| Rate for Payer: First Health Commercial |
$32,024.50
|
| Rate for Payer: Humana Commercial |
$28,653.50
|
| Rate for Payer: Humana KY Medicaid |
$11,592.87
|
| Rate for Payer: Kentucky WC Medicaid |
$11,710.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,642.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,877.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,113.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,825.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,664.80
|
| Rate for Payer: Ohio Health Group HMO |
$25,282.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,968.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,327.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,259.90
|
| Rate for Payer: PHCS Commercial |
$32,361.60
|
| Rate for Payer: United Healthcare All Payer |
$29,664.80
|
|
