|
UNI EIUS TIB XLARGE 10MM RM/LL
|
Facility
|
OP
|
$8,117.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.25 |
| Max. Negotiated Rate |
$7,792.63 |
| Rate for Payer: Aetna Commercial |
$6,250.34
|
| Rate for Payer: Anthem Medicaid |
$2,791.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,331.51
|
| Rate for Payer: Cash Price |
$4,058.66
|
| Rate for Payer: Cigna Commercial |
$6,737.38
|
| Rate for Payer: First Health Commercial |
$7,711.45
|
| Rate for Payer: Humana Commercial |
$6,899.72
|
| Rate for Payer: Humana KY Medicaid |
$2,791.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,819.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,656.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,990.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,435.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,847.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,143.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,087.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,623.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,055.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,516.37
|
| Rate for Payer: PHCS Commercial |
$7,792.63
|
| Rate for Payer: United Healthcare All Payer |
$7,143.24
|
|
|
UNI EIUS TIB XLARGE 10MM RM/LL
|
Facility
|
IP
|
$8,117.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.25 |
| Max. Negotiated Rate |
$7,792.63 |
| Rate for Payer: Aetna Commercial |
$6,250.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,331.51
|
| Rate for Payer: Cash Price |
$4,058.66
|
| Rate for Payer: Cigna Commercial |
$6,737.38
|
| Rate for Payer: First Health Commercial |
$7,711.45
|
| Rate for Payer: Humana Commercial |
$6,899.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,656.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,990.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,435.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,143.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,087.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,623.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,055.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,516.37
|
| Rate for Payer: PHCS Commercial |
$7,792.63
|
| Rate for Payer: United Healthcare All Payer |
$7,143.24
|
|
|
UNI EIUS TIB XLARGE 12MM LM/RL
|
Facility
|
OP
|
$8,117.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.25 |
| Max. Negotiated Rate |
$7,792.63 |
| Rate for Payer: Aetna Commercial |
$6,250.34
|
| Rate for Payer: Anthem Medicaid |
$2,791.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,331.51
|
| Rate for Payer: Cash Price |
$4,058.66
|
| Rate for Payer: Cigna Commercial |
$6,737.38
|
| Rate for Payer: First Health Commercial |
$7,711.45
|
| Rate for Payer: Humana Commercial |
$6,899.72
|
| Rate for Payer: Humana KY Medicaid |
$2,791.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,819.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,656.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,990.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,435.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,847.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,143.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,087.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,623.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,055.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,516.37
|
| Rate for Payer: PHCS Commercial |
$7,792.63
|
| Rate for Payer: United Healthcare All Payer |
$7,143.24
|
|
|
UNI EIUS TIB XLARGE 12MM LM/RL
|
Facility
|
IP
|
$8,117.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.25 |
| Max. Negotiated Rate |
$7,792.63 |
| Rate for Payer: Aetna Commercial |
$6,250.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,331.51
|
| Rate for Payer: Cash Price |
$4,058.66
|
| Rate for Payer: Cigna Commercial |
$6,737.38
|
| Rate for Payer: First Health Commercial |
$7,711.45
|
| Rate for Payer: Humana Commercial |
$6,899.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,656.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,990.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,435.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,143.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,087.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,623.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,055.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,516.37
|
| Rate for Payer: PHCS Commercial |
$7,792.63
|
| Rate for Payer: United Healthcare All Payer |
$7,143.24
|
|
|
UNI EIUS TIB XLARGE 12MM RM/LL
|
Facility
|
IP
|
$8,117.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.25 |
| Max. Negotiated Rate |
$7,792.63 |
| Rate for Payer: Aetna Commercial |
$6,250.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,331.51
|
| Rate for Payer: Cash Price |
$4,058.66
|
| Rate for Payer: Cigna Commercial |
$6,737.38
|
| Rate for Payer: First Health Commercial |
$7,711.45
|
| Rate for Payer: Humana Commercial |
$6,899.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,656.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,990.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,435.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,143.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,087.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,623.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,055.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,516.37
|
| Rate for Payer: PHCS Commercial |
$7,792.63
|
| Rate for Payer: United Healthcare All Payer |
$7,143.24
|
|
|
UNI EIUS TIB XLARGE 12MM RM/LL
|
Facility
|
OP
|
$8,117.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.25 |
| Max. Negotiated Rate |
$7,792.63 |
| Rate for Payer: Aetna Commercial |
$6,250.34
|
| Rate for Payer: Anthem Medicaid |
$2,791.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,331.51
|
| Rate for Payer: Cash Price |
$4,058.66
|
| Rate for Payer: Cigna Commercial |
$6,737.38
|
| Rate for Payer: First Health Commercial |
$7,711.45
|
| Rate for Payer: Humana Commercial |
$6,899.72
|
| Rate for Payer: Humana KY Medicaid |
$2,791.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,819.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,656.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,990.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,435.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,847.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,143.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,087.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,623.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,055.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,516.37
|
| Rate for Payer: PHCS Commercial |
$7,792.63
|
| Rate for Payer: United Healthcare All Payer |
$7,143.24
|
|
|
UNI EIUS TIB XLARGE 8MM LM/RL
|
Facility
|
OP
|
$8,117.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.25 |
| Max. Negotiated Rate |
$7,792.63 |
| Rate for Payer: Aetna Commercial |
$6,250.34
|
| Rate for Payer: Anthem Medicaid |
$2,791.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,331.51
|
| Rate for Payer: Cash Price |
$4,058.66
|
| Rate for Payer: Cigna Commercial |
$6,737.38
|
| Rate for Payer: First Health Commercial |
$7,711.45
|
| Rate for Payer: Humana Commercial |
$6,899.72
|
| Rate for Payer: Humana KY Medicaid |
$2,791.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,819.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,656.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,990.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,435.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,847.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,143.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,087.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,623.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,055.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,516.37
|
| Rate for Payer: PHCS Commercial |
$7,792.63
|
| Rate for Payer: United Healthcare All Payer |
$7,143.24
|
|
|
UNI EIUS TIB XLARGE 8MM LM/RL
|
Facility
|
IP
|
$8,117.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.25 |
| Max. Negotiated Rate |
$7,792.63 |
| Rate for Payer: Aetna Commercial |
$6,250.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,331.51
|
| Rate for Payer: Cash Price |
$4,058.66
|
| Rate for Payer: Cigna Commercial |
$6,737.38
|
| Rate for Payer: First Health Commercial |
$7,711.45
|
| Rate for Payer: Humana Commercial |
$6,899.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,656.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,990.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,435.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,143.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,087.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,623.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,055.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,516.37
|
| Rate for Payer: PHCS Commercial |
$7,792.63
|
| Rate for Payer: United Healthcare All Payer |
$7,143.24
|
|
|
UNI EIUS TIB XLARGE 8MM RM/LL
|
Facility
|
IP
|
$8,117.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.25 |
| Max. Negotiated Rate |
$7,792.63 |
| Rate for Payer: Aetna Commercial |
$6,250.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,331.51
|
| Rate for Payer: Cash Price |
$4,058.66
|
| Rate for Payer: Cigna Commercial |
$6,737.38
|
| Rate for Payer: First Health Commercial |
$7,711.45
|
| Rate for Payer: Humana Commercial |
$6,899.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,656.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,990.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,435.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,143.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,087.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,623.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,055.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,516.37
|
| Rate for Payer: PHCS Commercial |
$7,792.63
|
| Rate for Payer: United Healthcare All Payer |
$7,143.24
|
|
|
UNI EIUS TIB XLARGE 8MM RM/LL
|
Facility
|
OP
|
$8,117.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.25 |
| Max. Negotiated Rate |
$7,792.63 |
| Rate for Payer: Aetna Commercial |
$6,250.34
|
| Rate for Payer: Anthem Medicaid |
$2,791.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,331.51
|
| Rate for Payer: Cash Price |
$4,058.66
|
| Rate for Payer: Cigna Commercial |
$6,737.38
|
| Rate for Payer: First Health Commercial |
$7,711.45
|
| Rate for Payer: Humana Commercial |
$6,899.72
|
| Rate for Payer: Humana KY Medicaid |
$2,791.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,819.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,656.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,990.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,435.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,847.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,143.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,087.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,623.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,055.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,516.37
|
| Rate for Payer: PHCS Commercial |
$7,792.63
|
| Rate for Payer: United Healthcare All Payer |
$7,143.24
|
|
|
UNI EIUS TIB XLARGE 9MM LM/RL
|
Facility
|
IP
|
$8,117.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.25 |
| Max. Negotiated Rate |
$7,792.63 |
| Rate for Payer: Aetna Commercial |
$6,250.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,331.51
|
| Rate for Payer: Cash Price |
$4,058.66
|
| Rate for Payer: Cigna Commercial |
$6,737.38
|
| Rate for Payer: First Health Commercial |
$7,711.45
|
| Rate for Payer: Humana Commercial |
$6,899.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,656.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,990.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,435.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,143.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,087.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,623.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,055.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,516.37
|
| Rate for Payer: PHCS Commercial |
$7,792.63
|
| Rate for Payer: United Healthcare All Payer |
$7,143.24
|
|
|
UNI EIUS TIB XLARGE 9MM LM/RL
|
Facility
|
OP
|
$8,117.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.25 |
| Max. Negotiated Rate |
$7,792.63 |
| Rate for Payer: Aetna Commercial |
$6,250.34
|
| Rate for Payer: Anthem Medicaid |
$2,791.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,331.51
|
| Rate for Payer: Cash Price |
$4,058.66
|
| Rate for Payer: Cigna Commercial |
$6,737.38
|
| Rate for Payer: First Health Commercial |
$7,711.45
|
| Rate for Payer: Humana Commercial |
$6,899.72
|
| Rate for Payer: Humana KY Medicaid |
$2,791.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,819.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,656.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,990.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,435.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,847.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,143.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,087.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,623.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,055.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,516.37
|
| Rate for Payer: PHCS Commercial |
$7,792.63
|
| Rate for Payer: United Healthcare All Payer |
$7,143.24
|
|
|
UNI EIUS TIB XLARGE 9MM RM/LL
|
Facility
|
OP
|
$8,117.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.25 |
| Max. Negotiated Rate |
$7,792.63 |
| Rate for Payer: Aetna Commercial |
$6,250.34
|
| Rate for Payer: Anthem Medicaid |
$2,791.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,331.51
|
| Rate for Payer: Cash Price |
$4,058.66
|
| Rate for Payer: Cigna Commercial |
$6,737.38
|
| Rate for Payer: First Health Commercial |
$7,711.45
|
| Rate for Payer: Humana Commercial |
$6,899.72
|
| Rate for Payer: Humana KY Medicaid |
$2,791.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,819.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,656.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,990.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,435.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,847.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,143.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,087.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,623.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,055.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,516.37
|
| Rate for Payer: PHCS Commercial |
$7,792.63
|
| Rate for Payer: United Healthcare All Payer |
$7,143.24
|
|
|
UNI EIUS TIB XLARGE 9MM RM/LL
|
Facility
|
IP
|
$8,117.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.25 |
| Max. Negotiated Rate |
$7,792.63 |
| Rate for Payer: Aetna Commercial |
$6,250.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,331.51
|
| Rate for Payer: Cash Price |
$4,058.66
|
| Rate for Payer: Cigna Commercial |
$6,737.38
|
| Rate for Payer: First Health Commercial |
$7,711.45
|
| Rate for Payer: Humana Commercial |
$6,899.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,656.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,990.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,435.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,143.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,087.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,623.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,055.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,516.37
|
| Rate for Payer: PHCS Commercial |
$7,792.63
|
| Rate for Payer: United Healthcare All Payer |
$7,143.24
|
|
|
UNI EIUS TIB XSMALL 10MM LM/RL
|
Facility
|
IP
|
$8,015.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.97 |
| Max. Negotiated Rate |
$7,694.52 |
| Rate for Payer: Aetna Commercial |
$6,171.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,251.79
|
| Rate for Payer: Cash Price |
$4,007.56
|
| Rate for Payer: Cigna Commercial |
$6,652.55
|
| Rate for Payer: First Health Commercial |
$7,614.36
|
| Rate for Payer: Humana Commercial |
$6,812.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,572.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,915.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,404.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,053.31
|
| Rate for Payer: Ohio Health Group HMO |
$6,011.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,603.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,041.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,484.69
|
| Rate for Payer: PHCS Commercial |
$7,694.52
|
| Rate for Payer: United Healthcare All Payer |
$7,053.31
|
|
|
UNI EIUS TIB XSMALL 10MM LM/RL
|
Facility
|
OP
|
$8,015.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.97 |
| Max. Negotiated Rate |
$7,694.52 |
| Rate for Payer: Aetna Commercial |
$6,171.64
|
| Rate for Payer: Anthem Medicaid |
$2,756.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,251.79
|
| Rate for Payer: Cash Price |
$4,007.56
|
| Rate for Payer: Cigna Commercial |
$6,652.55
|
| Rate for Payer: First Health Commercial |
$7,614.36
|
| Rate for Payer: Humana Commercial |
$6,812.85
|
| Rate for Payer: Humana KY Medicaid |
$2,756.40
|
| Rate for Payer: Kentucky WC Medicaid |
$2,784.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,572.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,915.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,404.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,811.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,053.31
|
| Rate for Payer: Ohio Health Group HMO |
$6,011.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,603.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,041.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,484.69
|
| Rate for Payer: PHCS Commercial |
$7,694.52
|
| Rate for Payer: United Healthcare All Payer |
$7,053.31
|
|
|
UNI EIUS TIB XSMALL 10MM RM/LL
|
Facility
|
IP
|
$8,015.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.97 |
| Max. Negotiated Rate |
$7,694.52 |
| Rate for Payer: Aetna Commercial |
$6,171.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,251.79
|
| Rate for Payer: Cash Price |
$4,007.56
|
| Rate for Payer: Cigna Commercial |
$6,652.55
|
| Rate for Payer: First Health Commercial |
$7,614.36
|
| Rate for Payer: Humana Commercial |
$6,812.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,572.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,915.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,404.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,053.31
|
| Rate for Payer: Ohio Health Group HMO |
$6,011.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,603.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,041.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,484.69
|
| Rate for Payer: PHCS Commercial |
$7,694.52
|
| Rate for Payer: United Healthcare All Payer |
$7,053.31
|
|
|
UNI EIUS TIB XSMALL 10MM RM/LL
|
Facility
|
OP
|
$8,015.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.97 |
| Max. Negotiated Rate |
$7,694.52 |
| Rate for Payer: Aetna Commercial |
$6,171.64
|
| Rate for Payer: Anthem Medicaid |
$2,756.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,251.79
|
| Rate for Payer: Cash Price |
$4,007.56
|
| Rate for Payer: Cigna Commercial |
$6,652.55
|
| Rate for Payer: First Health Commercial |
$7,614.36
|
| Rate for Payer: Humana Commercial |
$6,812.85
|
| Rate for Payer: Humana KY Medicaid |
$2,756.40
|
| Rate for Payer: Kentucky WC Medicaid |
$2,784.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,572.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,915.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,404.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,811.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,053.31
|
| Rate for Payer: Ohio Health Group HMO |
$6,011.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,603.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,041.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,484.69
|
| Rate for Payer: PHCS Commercial |
$7,694.52
|
| Rate for Payer: United Healthcare All Payer |
$7,053.31
|
|
|
UNI EIUS TIB XSMALL 12MM LM/RL
|
Facility
|
OP
|
$8,117.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.25 |
| Max. Negotiated Rate |
$7,792.63 |
| Rate for Payer: Aetna Commercial |
$6,250.34
|
| Rate for Payer: Anthem Medicaid |
$2,791.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,331.51
|
| Rate for Payer: Cash Price |
$4,058.66
|
| Rate for Payer: Cigna Commercial |
$6,737.38
|
| Rate for Payer: First Health Commercial |
$7,711.45
|
| Rate for Payer: Humana Commercial |
$6,899.72
|
| Rate for Payer: Humana KY Medicaid |
$2,791.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,819.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,656.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,990.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,435.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,847.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,143.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,087.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,623.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,055.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,516.37
|
| Rate for Payer: PHCS Commercial |
$7,792.63
|
| Rate for Payer: United Healthcare All Payer |
$7,143.24
|
|
|
UNI EIUS TIB XSMALL 12MM LM/RL
|
Facility
|
IP
|
$8,117.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.25 |
| Max. Negotiated Rate |
$7,792.63 |
| Rate for Payer: Aetna Commercial |
$6,250.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,331.51
|
| Rate for Payer: Cash Price |
$4,058.66
|
| Rate for Payer: Cigna Commercial |
$6,737.38
|
| Rate for Payer: First Health Commercial |
$7,711.45
|
| Rate for Payer: Humana Commercial |
$6,899.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,656.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,990.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,435.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,143.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,087.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,623.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,055.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,516.37
|
| Rate for Payer: PHCS Commercial |
$7,792.63
|
| Rate for Payer: United Healthcare All Payer |
$7,143.24
|
|
|
UNI EIUS TIB XSMALL 12MM RM/LL
|
Facility
|
IP
|
$8,117.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.25 |
| Max. Negotiated Rate |
$7,792.63 |
| Rate for Payer: Aetna Commercial |
$6,250.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,331.51
|
| Rate for Payer: Cash Price |
$4,058.66
|
| Rate for Payer: Cigna Commercial |
$6,737.38
|
| Rate for Payer: First Health Commercial |
$7,711.45
|
| Rate for Payer: Humana Commercial |
$6,899.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,656.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,990.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,435.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,143.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,087.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,623.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,055.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,516.37
|
| Rate for Payer: PHCS Commercial |
$7,792.63
|
| Rate for Payer: United Healthcare All Payer |
$7,143.24
|
|
|
UNI EIUS TIB XSMALL 12MM RM/LL
|
Facility
|
OP
|
$8,117.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.25 |
| Max. Negotiated Rate |
$7,792.63 |
| Rate for Payer: Aetna Commercial |
$6,250.34
|
| Rate for Payer: Anthem Medicaid |
$2,791.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,331.51
|
| Rate for Payer: Cash Price |
$4,058.66
|
| Rate for Payer: Cigna Commercial |
$6,737.38
|
| Rate for Payer: First Health Commercial |
$7,711.45
|
| Rate for Payer: Humana Commercial |
$6,899.72
|
| Rate for Payer: Humana KY Medicaid |
$2,791.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,819.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,656.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,990.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,435.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,847.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,143.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,087.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,623.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,055.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,516.37
|
| Rate for Payer: PHCS Commercial |
$7,792.63
|
| Rate for Payer: United Healthcare All Payer |
$7,143.24
|
|
|
UNI EIUS TIB XSMALL 8MM LM/RL
|
Facility
|
OP
|
$8,015.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.97 |
| Max. Negotiated Rate |
$7,694.52 |
| Rate for Payer: Aetna Commercial |
$6,171.64
|
| Rate for Payer: Anthem Medicaid |
$2,756.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,251.79
|
| Rate for Payer: Cash Price |
$4,007.56
|
| Rate for Payer: Cigna Commercial |
$6,652.55
|
| Rate for Payer: First Health Commercial |
$7,614.36
|
| Rate for Payer: Humana Commercial |
$6,812.85
|
| Rate for Payer: Humana KY Medicaid |
$2,756.40
|
| Rate for Payer: Kentucky WC Medicaid |
$2,784.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,572.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,915.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,404.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,811.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,053.31
|
| Rate for Payer: Ohio Health Group HMO |
$6,011.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,603.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,041.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,484.69
|
| Rate for Payer: PHCS Commercial |
$7,694.52
|
| Rate for Payer: United Healthcare All Payer |
$7,053.31
|
|
|
UNI EIUS TIB XSMALL 8MM LM/RL
|
Facility
|
IP
|
$8,015.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.97 |
| Max. Negotiated Rate |
$7,694.52 |
| Rate for Payer: Aetna Commercial |
$6,171.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,251.79
|
| Rate for Payer: Cash Price |
$4,007.56
|
| Rate for Payer: Cigna Commercial |
$6,652.55
|
| Rate for Payer: First Health Commercial |
$7,614.36
|
| Rate for Payer: Humana Commercial |
$6,812.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,572.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,915.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,404.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,053.31
|
| Rate for Payer: Ohio Health Group HMO |
$6,011.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,603.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,041.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,484.69
|
| Rate for Payer: PHCS Commercial |
$7,694.52
|
| Rate for Payer: United Healthcare All Payer |
$7,053.31
|
|
|
UNI EIUS TIB XSMALL 8MM RM/LL
|
Facility
|
OP
|
$8,015.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.97 |
| Max. Negotiated Rate |
$7,694.52 |
| Rate for Payer: Aetna Commercial |
$6,171.64
|
| Rate for Payer: Anthem Medicaid |
$2,756.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,251.79
|
| Rate for Payer: Cash Price |
$4,007.56
|
| Rate for Payer: Cigna Commercial |
$6,652.55
|
| Rate for Payer: First Health Commercial |
$7,614.36
|
| Rate for Payer: Humana Commercial |
$6,812.85
|
| Rate for Payer: Humana KY Medicaid |
$2,756.40
|
| Rate for Payer: Kentucky WC Medicaid |
$2,784.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,572.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,915.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,404.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,811.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,053.31
|
| Rate for Payer: Ohio Health Group HMO |
$6,011.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,603.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,041.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,484.69
|
| Rate for Payer: PHCS Commercial |
$7,694.52
|
| Rate for Payer: United Healthcare All Payer |
$7,053.31
|
|
