|
ULTIMA UNIPOLAR HEAD 44MM
|
Facility
|
OP
|
$3,617.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$470.28 |
| Max. Negotiated Rate |
$3,472.80 |
| Rate for Payer: Aetna Commercial |
$2,785.48
|
| Rate for Payer: Anthem Medicaid |
$1,244.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,821.65
|
| Rate for Payer: Cash Price |
$1,808.75
|
| Rate for Payer: Cigna Commercial |
$3,002.52
|
| Rate for Payer: First Health Commercial |
$3,436.62
|
| Rate for Payer: Humana Commercial |
$3,074.88
|
| Rate for Payer: Humana KY Medicaid |
$1,244.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,256.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,966.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,669.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,085.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,269.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,183.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,713.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$723.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,121.42
|
| Rate for Payer: PHCS Commercial |
$3,472.80
|
| Rate for Payer: United Healthcare All Payer |
$3,183.40
|
|
|
ULTIMA UNIPOLAR HEAD 45MM
|
Facility
|
OP
|
$3,617.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$470.28 |
| Max. Negotiated Rate |
$3,472.80 |
| Rate for Payer: Aetna Commercial |
$2,785.48
|
| Rate for Payer: Anthem Medicaid |
$1,244.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,821.65
|
| Rate for Payer: Cash Price |
$1,808.75
|
| Rate for Payer: Cigna Commercial |
$3,002.52
|
| Rate for Payer: First Health Commercial |
$3,436.62
|
| Rate for Payer: Humana Commercial |
$3,074.88
|
| Rate for Payer: Humana KY Medicaid |
$1,244.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,256.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,966.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,669.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,085.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,269.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,183.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,713.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$723.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,121.42
|
| Rate for Payer: PHCS Commercial |
$3,472.80
|
| Rate for Payer: United Healthcare All Payer |
$3,183.40
|
|
|
ULTIMA UNIPOLAR HEAD 45MM
|
Facility
|
IP
|
$3,617.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$470.28 |
| Max. Negotiated Rate |
$3,472.80 |
| Rate for Payer: Aetna Commercial |
$2,785.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,821.65
|
| Rate for Payer: Cash Price |
$1,808.75
|
| Rate for Payer: Cigna Commercial |
$3,002.52
|
| Rate for Payer: First Health Commercial |
$3,436.62
|
| Rate for Payer: Humana Commercial |
$3,074.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,966.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,669.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,085.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,183.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,713.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$723.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,121.42
|
| Rate for Payer: PHCS Commercial |
$3,472.80
|
| Rate for Payer: United Healthcare All Payer |
$3,183.40
|
|
|
ULTIMA UNIPOLAR HEAD 46MM
|
Facility
|
OP
|
$3,617.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$470.28 |
| Max. Negotiated Rate |
$3,472.80 |
| Rate for Payer: Aetna Commercial |
$2,785.48
|
| Rate for Payer: Anthem Medicaid |
$1,244.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,821.65
|
| Rate for Payer: Cash Price |
$1,808.75
|
| Rate for Payer: Cigna Commercial |
$3,002.52
|
| Rate for Payer: First Health Commercial |
$3,436.62
|
| Rate for Payer: Humana Commercial |
$3,074.88
|
| Rate for Payer: Humana KY Medicaid |
$1,244.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,256.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,966.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,669.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,085.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,269.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,183.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,713.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$723.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,121.42
|
| Rate for Payer: PHCS Commercial |
$3,472.80
|
| Rate for Payer: United Healthcare All Payer |
$3,183.40
|
|
|
ULTIMA UNIPOLAR HEAD 46MM
|
Facility
|
IP
|
$3,617.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$470.28 |
| Max. Negotiated Rate |
$3,472.80 |
| Rate for Payer: Aetna Commercial |
$2,785.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,821.65
|
| Rate for Payer: Cash Price |
$1,808.75
|
| Rate for Payer: Cigna Commercial |
$3,002.52
|
| Rate for Payer: First Health Commercial |
$3,436.62
|
| Rate for Payer: Humana Commercial |
$3,074.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,966.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,669.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,085.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,183.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,713.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$723.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,121.42
|
| Rate for Payer: PHCS Commercial |
$3,472.80
|
| Rate for Payer: United Healthcare All Payer |
$3,183.40
|
|
|
ULTIMA UNIPOLAR HEAD 47MM
|
Facility
|
IP
|
$3,617.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$470.28 |
| Max. Negotiated Rate |
$3,472.80 |
| Rate for Payer: Aetna Commercial |
$2,785.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,821.65
|
| Rate for Payer: Cash Price |
$1,808.75
|
| Rate for Payer: Cigna Commercial |
$3,002.52
|
| Rate for Payer: First Health Commercial |
$3,436.62
|
| Rate for Payer: Humana Commercial |
$3,074.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,966.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,669.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,085.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,183.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,713.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$723.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,121.42
|
| Rate for Payer: PHCS Commercial |
$3,472.80
|
| Rate for Payer: United Healthcare All Payer |
$3,183.40
|
|
|
ULTIMA UNIPOLAR HEAD 47MM
|
Facility
|
OP
|
$3,617.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$470.28 |
| Max. Negotiated Rate |
$3,472.80 |
| Rate for Payer: Aetna Commercial |
$2,785.48
|
| Rate for Payer: Anthem Medicaid |
$1,244.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,821.65
|
| Rate for Payer: Cash Price |
$1,808.75
|
| Rate for Payer: Cigna Commercial |
$3,002.52
|
| Rate for Payer: First Health Commercial |
$3,436.62
|
| Rate for Payer: Humana Commercial |
$3,074.88
|
| Rate for Payer: Humana KY Medicaid |
$1,244.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,256.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,966.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,669.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,085.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,269.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,183.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,713.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$723.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,121.42
|
| Rate for Payer: PHCS Commercial |
$3,472.80
|
| Rate for Payer: United Healthcare All Payer |
$3,183.40
|
|
|
ULTIMA UNIPOLAR HEAD 48MM
|
Facility
|
IP
|
$3,617.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$470.28 |
| Max. Negotiated Rate |
$3,472.80 |
| Rate for Payer: Aetna Commercial |
$2,785.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,821.65
|
| Rate for Payer: Cash Price |
$1,808.75
|
| Rate for Payer: Cigna Commercial |
$3,002.52
|
| Rate for Payer: First Health Commercial |
$3,436.62
|
| Rate for Payer: Humana Commercial |
$3,074.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,966.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,669.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,085.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,183.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,713.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$723.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,121.42
|
| Rate for Payer: PHCS Commercial |
$3,472.80
|
| Rate for Payer: United Healthcare All Payer |
$3,183.40
|
|
|
ULTIMA UNIPOLAR HEAD 48MM
|
Facility
|
OP
|
$3,617.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$470.28 |
| Max. Negotiated Rate |
$3,472.80 |
| Rate for Payer: Aetna Commercial |
$2,785.48
|
| Rate for Payer: Anthem Medicaid |
$1,244.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,821.65
|
| Rate for Payer: Cash Price |
$1,808.75
|
| Rate for Payer: Cigna Commercial |
$3,002.52
|
| Rate for Payer: First Health Commercial |
$3,436.62
|
| Rate for Payer: Humana Commercial |
$3,074.88
|
| Rate for Payer: Humana KY Medicaid |
$1,244.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,256.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,966.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,669.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,085.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,269.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,183.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,713.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$723.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,121.42
|
| Rate for Payer: PHCS Commercial |
$3,472.80
|
| Rate for Payer: United Healthcare All Payer |
$3,183.40
|
|
|
ULTIMA UNIPOLAR HEAD 49MM
|
Facility
|
IP
|
$3,617.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$470.28 |
| Max. Negotiated Rate |
$3,472.80 |
| Rate for Payer: Aetna Commercial |
$2,785.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,821.65
|
| Rate for Payer: Cash Price |
$1,808.75
|
| Rate for Payer: Cigna Commercial |
$3,002.52
|
| Rate for Payer: First Health Commercial |
$3,436.62
|
| Rate for Payer: Humana Commercial |
$3,074.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,966.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,669.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,085.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,183.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,713.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$723.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,121.42
|
| Rate for Payer: PHCS Commercial |
$3,472.80
|
| Rate for Payer: United Healthcare All Payer |
$3,183.40
|
|
|
ULTIMA UNIPOLAR HEAD 49MM
|
Facility
|
OP
|
$3,617.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$470.28 |
| Max. Negotiated Rate |
$3,472.80 |
| Rate for Payer: Aetna Commercial |
$2,785.48
|
| Rate for Payer: Anthem Medicaid |
$1,244.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,821.65
|
| Rate for Payer: Cash Price |
$1,808.75
|
| Rate for Payer: Cigna Commercial |
$3,002.52
|
| Rate for Payer: First Health Commercial |
$3,436.62
|
| Rate for Payer: Humana Commercial |
$3,074.88
|
| Rate for Payer: Humana KY Medicaid |
$1,244.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,256.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,966.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,669.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,085.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,269.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,183.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,713.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$723.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,121.42
|
| Rate for Payer: PHCS Commercial |
$3,472.80
|
| Rate for Payer: United Healthcare All Payer |
$3,183.40
|
|
|
ULTIMA UNIPOLAR HEAD 50MM
|
Facility
|
IP
|
$3,617.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$470.28 |
| Max. Negotiated Rate |
$3,472.80 |
| Rate for Payer: Aetna Commercial |
$2,785.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,821.65
|
| Rate for Payer: Cash Price |
$1,808.75
|
| Rate for Payer: Cigna Commercial |
$3,002.52
|
| Rate for Payer: First Health Commercial |
$3,436.62
|
| Rate for Payer: Humana Commercial |
$3,074.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,966.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,669.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,085.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,183.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,713.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$723.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,121.42
|
| Rate for Payer: PHCS Commercial |
$3,472.80
|
| Rate for Payer: United Healthcare All Payer |
$3,183.40
|
|
|
ULTIMA UNIPOLAR HEAD 50MM
|
Facility
|
OP
|
$3,617.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$470.28 |
| Max. Negotiated Rate |
$3,472.80 |
| Rate for Payer: Aetna Commercial |
$2,785.48
|
| Rate for Payer: Anthem Medicaid |
$1,244.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,821.65
|
| Rate for Payer: Cash Price |
$1,808.75
|
| Rate for Payer: Cigna Commercial |
$3,002.52
|
| Rate for Payer: First Health Commercial |
$3,436.62
|
| Rate for Payer: Humana Commercial |
$3,074.88
|
| Rate for Payer: Humana KY Medicaid |
$1,244.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,256.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,966.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,669.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,085.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,269.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,183.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,713.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$723.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,121.42
|
| Rate for Payer: PHCS Commercial |
$3,472.80
|
| Rate for Payer: United Healthcare All Payer |
$3,183.40
|
|
|
ULTIMA UNIPOLAR HEAD 51MM
|
Facility
|
OP
|
$3,617.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$470.28 |
| Max. Negotiated Rate |
$3,472.80 |
| Rate for Payer: Aetna Commercial |
$2,785.48
|
| Rate for Payer: Anthem Medicaid |
$1,244.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,821.65
|
| Rate for Payer: Cash Price |
$1,808.75
|
| Rate for Payer: Cigna Commercial |
$3,002.52
|
| Rate for Payer: First Health Commercial |
$3,436.62
|
| Rate for Payer: Humana Commercial |
$3,074.88
|
| Rate for Payer: Humana KY Medicaid |
$1,244.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,256.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,966.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,669.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,085.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,269.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,183.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,713.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$723.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,121.42
|
| Rate for Payer: PHCS Commercial |
$3,472.80
|
| Rate for Payer: United Healthcare All Payer |
$3,183.40
|
|
|
ULTIMA UNIPOLAR HEAD 51MM
|
Facility
|
IP
|
$3,617.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$470.28 |
| Max. Negotiated Rate |
$3,472.80 |
| Rate for Payer: Aetna Commercial |
$2,785.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,821.65
|
| Rate for Payer: Cash Price |
$1,808.75
|
| Rate for Payer: Cigna Commercial |
$3,002.52
|
| Rate for Payer: First Health Commercial |
$3,436.62
|
| Rate for Payer: Humana Commercial |
$3,074.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,966.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,669.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,085.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,183.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,713.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$723.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,121.42
|
| Rate for Payer: PHCS Commercial |
$3,472.80
|
| Rate for Payer: United Healthcare All Payer |
$3,183.40
|
|
|
ULTIMA UNIPOLAR HEAD 52MM
|
Facility
|
OP
|
$3,617.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$470.28 |
| Max. Negotiated Rate |
$3,472.80 |
| Rate for Payer: Aetna Commercial |
$2,785.48
|
| Rate for Payer: Anthem Medicaid |
$1,244.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,821.65
|
| Rate for Payer: Cash Price |
$1,808.75
|
| Rate for Payer: Cigna Commercial |
$3,002.52
|
| Rate for Payer: First Health Commercial |
$3,436.62
|
| Rate for Payer: Humana Commercial |
$3,074.88
|
| Rate for Payer: Humana KY Medicaid |
$1,244.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,256.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,966.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,669.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,085.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,269.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,183.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,713.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$723.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,121.42
|
| Rate for Payer: PHCS Commercial |
$3,472.80
|
| Rate for Payer: United Healthcare All Payer |
$3,183.40
|
|
|
ULTIMA UNIPOLAR HEAD 52MM
|
Facility
|
IP
|
$3,617.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$470.28 |
| Max. Negotiated Rate |
$3,472.80 |
| Rate for Payer: Aetna Commercial |
$2,785.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,821.65
|
| Rate for Payer: Cash Price |
$1,808.75
|
| Rate for Payer: Cigna Commercial |
$3,002.52
|
| Rate for Payer: First Health Commercial |
$3,436.62
|
| Rate for Payer: Humana Commercial |
$3,074.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,966.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,669.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,085.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,183.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,713.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$723.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,121.42
|
| Rate for Payer: PHCS Commercial |
$3,472.80
|
| Rate for Payer: United Healthcare All Payer |
$3,183.40
|
|
|
ULTIMA UNIPOLAR HEAD 53MM
|
Facility
|
OP
|
$3,617.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$470.28 |
| Max. Negotiated Rate |
$3,472.80 |
| Rate for Payer: Aetna Commercial |
$2,785.48
|
| Rate for Payer: Anthem Medicaid |
$1,244.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,821.65
|
| Rate for Payer: Cash Price |
$1,808.75
|
| Rate for Payer: Cigna Commercial |
$3,002.52
|
| Rate for Payer: First Health Commercial |
$3,436.62
|
| Rate for Payer: Humana Commercial |
$3,074.88
|
| Rate for Payer: Humana KY Medicaid |
$1,244.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,256.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,966.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,669.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,085.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,269.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,183.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,713.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$723.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,121.42
|
| Rate for Payer: PHCS Commercial |
$3,472.80
|
| Rate for Payer: United Healthcare All Payer |
$3,183.40
|
|
|
ULTIMA UNIPOLAR HEAD 53MM
|
Facility
|
IP
|
$3,617.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$470.28 |
| Max. Negotiated Rate |
$3,472.80 |
| Rate for Payer: Aetna Commercial |
$2,785.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,821.65
|
| Rate for Payer: Cash Price |
$1,808.75
|
| Rate for Payer: Cigna Commercial |
$3,002.52
|
| Rate for Payer: First Health Commercial |
$3,436.62
|
| Rate for Payer: Humana Commercial |
$3,074.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,966.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,669.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,085.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,183.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,713.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$723.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,121.42
|
| Rate for Payer: PHCS Commercial |
$3,472.80
|
| Rate for Payer: United Healthcare All Payer |
$3,183.40
|
|
|
ULTIMA UNIPOLAR HEAD 54MM
|
Facility
|
IP
|
$3,617.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$470.28 |
| Max. Negotiated Rate |
$3,472.80 |
| Rate for Payer: Aetna Commercial |
$2,785.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,821.65
|
| Rate for Payer: Cash Price |
$1,808.75
|
| Rate for Payer: Cigna Commercial |
$3,002.52
|
| Rate for Payer: First Health Commercial |
$3,436.62
|
| Rate for Payer: Humana Commercial |
$3,074.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,966.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,669.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,085.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,183.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,713.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$723.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,121.42
|
| Rate for Payer: PHCS Commercial |
$3,472.80
|
| Rate for Payer: United Healthcare All Payer |
$3,183.40
|
|
|
ULTIMA UNIPOLAR HEAD 54MM
|
Facility
|
OP
|
$3,617.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$470.28 |
| Max. Negotiated Rate |
$3,472.80 |
| Rate for Payer: Aetna Commercial |
$2,785.48
|
| Rate for Payer: Anthem Medicaid |
$1,244.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,821.65
|
| Rate for Payer: Cash Price |
$1,808.75
|
| Rate for Payer: Cigna Commercial |
$3,002.52
|
| Rate for Payer: First Health Commercial |
$3,436.62
|
| Rate for Payer: Humana Commercial |
$3,074.88
|
| Rate for Payer: Humana KY Medicaid |
$1,244.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,256.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,966.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,669.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,085.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,269.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,183.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,713.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$723.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,121.42
|
| Rate for Payer: PHCS Commercial |
$3,472.80
|
| Rate for Payer: United Healthcare All Payer |
$3,183.40
|
|
|
ULTIMA UNIPOLAR HEAD 55MM
|
Facility
|
OP
|
$3,617.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$470.28 |
| Max. Negotiated Rate |
$3,472.80 |
| Rate for Payer: Aetna Commercial |
$2,785.48
|
| Rate for Payer: Anthem Medicaid |
$1,244.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,821.65
|
| Rate for Payer: Cash Price |
$1,808.75
|
| Rate for Payer: Cigna Commercial |
$3,002.52
|
| Rate for Payer: First Health Commercial |
$3,436.62
|
| Rate for Payer: Humana Commercial |
$3,074.88
|
| Rate for Payer: Humana KY Medicaid |
$1,244.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,256.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,966.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,669.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,085.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,269.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,183.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,713.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$723.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,121.42
|
| Rate for Payer: PHCS Commercial |
$3,472.80
|
| Rate for Payer: United Healthcare All Payer |
$3,183.40
|
|
|
ULTIMA UNIPOLAR HEAD 55MM
|
Facility
|
IP
|
$3,617.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$470.28 |
| Max. Negotiated Rate |
$3,472.80 |
| Rate for Payer: Aetna Commercial |
$2,785.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,821.65
|
| Rate for Payer: Cash Price |
$1,808.75
|
| Rate for Payer: Cigna Commercial |
$3,002.52
|
| Rate for Payer: First Health Commercial |
$3,436.62
|
| Rate for Payer: Humana Commercial |
$3,074.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,966.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,669.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,085.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,183.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,713.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$723.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,121.42
|
| Rate for Payer: PHCS Commercial |
$3,472.80
|
| Rate for Payer: United Healthcare All Payer |
$3,183.40
|
|
|
ULTIMA UNIPOLAR HEAD 56MM
|
Facility
|
OP
|
$3,617.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$470.28 |
| Max. Negotiated Rate |
$3,472.80 |
| Rate for Payer: Aetna Commercial |
$2,785.48
|
| Rate for Payer: Anthem Medicaid |
$1,244.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,821.65
|
| Rate for Payer: Cash Price |
$1,808.75
|
| Rate for Payer: Cigna Commercial |
$3,002.52
|
| Rate for Payer: First Health Commercial |
$3,436.62
|
| Rate for Payer: Humana Commercial |
$3,074.88
|
| Rate for Payer: Humana KY Medicaid |
$1,244.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,256.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,966.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,669.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,085.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,269.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,183.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,713.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$723.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,121.42
|
| Rate for Payer: PHCS Commercial |
$3,472.80
|
| Rate for Payer: United Healthcare All Payer |
$3,183.40
|
|
|
ULTIMA UNIPOLAR HEAD 56MM
|
Facility
|
IP
|
$3,617.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$470.28 |
| Max. Negotiated Rate |
$3,472.80 |
| Rate for Payer: Aetna Commercial |
$2,785.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,821.65
|
| Rate for Payer: Cash Price |
$1,808.75
|
| Rate for Payer: Cigna Commercial |
$3,002.52
|
| Rate for Payer: First Health Commercial |
$3,436.62
|
| Rate for Payer: Humana Commercial |
$3,074.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,966.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,669.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,085.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,183.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,713.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$723.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,121.42
|
| Rate for Payer: PHCS Commercial |
$3,472.80
|
| Rate for Payer: United Healthcare All Payer |
$3,183.40
|
|
