|
UNITRAX ENDO HEAD 43MM
|
Facility
|
OP
|
$6,705.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$871.72 |
| Max. Negotiated Rate |
$6,437.28 |
| Rate for Payer: Aetna Commercial |
$5,163.24
|
| Rate for Payer: Anthem Medicaid |
$2,306.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.29
|
| Rate for Payer: Cash Price |
$3,352.75
|
| Rate for Payer: Cigna Commercial |
$5,565.56
|
| Rate for Payer: First Health Commercial |
$6,370.22
|
| Rate for Payer: Humana Commercial |
$5,699.68
|
| Rate for Payer: Humana KY Medicaid |
$2,306.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,329.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,352.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,341.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$871.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,078.70
|
| Rate for Payer: PHCS Commercial |
$6,437.28
|
| Rate for Payer: United Healthcare All Payer |
$5,900.84
|
|
|
UNITRAX ENDO HEAD 43MM
|
Facility
|
IP
|
$6,705.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$871.72 |
| Max. Negotiated Rate |
$6,437.28 |
| Rate for Payer: Aetna Commercial |
$5,163.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.29
|
| Rate for Payer: Cash Price |
$3,352.75
|
| Rate for Payer: Cigna Commercial |
$5,565.56
|
| Rate for Payer: First Health Commercial |
$6,370.22
|
| Rate for Payer: Humana Commercial |
$5,699.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,341.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$871.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,078.70
|
| Rate for Payer: PHCS Commercial |
$6,437.28
|
| Rate for Payer: United Healthcare All Payer |
$5,900.84
|
|
|
UNITRAX ENDO HEAD 44MM
|
Facility
|
OP
|
$6,705.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$871.72 |
| Max. Negotiated Rate |
$6,437.28 |
| Rate for Payer: Aetna Commercial |
$5,163.24
|
| Rate for Payer: Anthem Medicaid |
$2,306.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.29
|
| Rate for Payer: Cash Price |
$3,352.75
|
| Rate for Payer: Cigna Commercial |
$5,565.56
|
| Rate for Payer: First Health Commercial |
$6,370.22
|
| Rate for Payer: Humana Commercial |
$5,699.68
|
| Rate for Payer: Humana KY Medicaid |
$2,306.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,329.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,352.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,341.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$871.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,078.70
|
| Rate for Payer: PHCS Commercial |
$6,437.28
|
| Rate for Payer: United Healthcare All Payer |
$5,900.84
|
|
|
UNITRAX ENDO HEAD 44MM
|
Facility
|
IP
|
$6,705.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$871.72 |
| Max. Negotiated Rate |
$6,437.28 |
| Rate for Payer: Aetna Commercial |
$5,163.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.29
|
| Rate for Payer: Cash Price |
$3,352.75
|
| Rate for Payer: Cigna Commercial |
$5,565.56
|
| Rate for Payer: First Health Commercial |
$6,370.22
|
| Rate for Payer: Humana Commercial |
$5,699.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,341.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$871.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,078.70
|
| Rate for Payer: PHCS Commercial |
$6,437.28
|
| Rate for Payer: United Healthcare All Payer |
$5,900.84
|
|
|
UNITRAX ENDO HEAD 45MM
|
Facility
|
OP
|
$6,705.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$871.72 |
| Max. Negotiated Rate |
$6,437.28 |
| Rate for Payer: Aetna Commercial |
$5,163.24
|
| Rate for Payer: Anthem Medicaid |
$2,306.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.29
|
| Rate for Payer: Cash Price |
$3,352.75
|
| Rate for Payer: Cigna Commercial |
$5,565.56
|
| Rate for Payer: First Health Commercial |
$6,370.22
|
| Rate for Payer: Humana Commercial |
$5,699.68
|
| Rate for Payer: Humana KY Medicaid |
$2,306.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,329.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,352.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,341.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$871.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,078.70
|
| Rate for Payer: PHCS Commercial |
$6,437.28
|
| Rate for Payer: United Healthcare All Payer |
$5,900.84
|
|
|
UNITRAX ENDO HEAD 45MM
|
Facility
|
IP
|
$6,705.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$871.72 |
| Max. Negotiated Rate |
$6,437.28 |
| Rate for Payer: Aetna Commercial |
$5,163.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.29
|
| Rate for Payer: Cash Price |
$3,352.75
|
| Rate for Payer: Cigna Commercial |
$5,565.56
|
| Rate for Payer: First Health Commercial |
$6,370.22
|
| Rate for Payer: Humana Commercial |
$5,699.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,341.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$871.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,078.70
|
| Rate for Payer: PHCS Commercial |
$6,437.28
|
| Rate for Payer: United Healthcare All Payer |
$5,900.84
|
|
|
UNITRAX ENDO HEAD 46MM
|
Facility
|
OP
|
$6,705.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$871.72 |
| Max. Negotiated Rate |
$6,437.28 |
| Rate for Payer: Aetna Commercial |
$5,163.24
|
| Rate for Payer: Anthem Medicaid |
$2,306.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.29
|
| Rate for Payer: Cash Price |
$3,352.75
|
| Rate for Payer: Cigna Commercial |
$5,565.56
|
| Rate for Payer: First Health Commercial |
$6,370.22
|
| Rate for Payer: Humana Commercial |
$5,699.68
|
| Rate for Payer: Humana KY Medicaid |
$2,306.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,329.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,352.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,341.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$871.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,078.70
|
| Rate for Payer: PHCS Commercial |
$6,437.28
|
| Rate for Payer: United Healthcare All Payer |
$5,900.84
|
|
|
UNITRAX ENDO HEAD 46MM
|
Facility
|
IP
|
$6,705.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$871.72 |
| Max. Negotiated Rate |
$6,437.28 |
| Rate for Payer: Aetna Commercial |
$5,163.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.29
|
| Rate for Payer: Cash Price |
$3,352.75
|
| Rate for Payer: Cigna Commercial |
$5,565.56
|
| Rate for Payer: First Health Commercial |
$6,370.22
|
| Rate for Payer: Humana Commercial |
$5,699.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,341.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$871.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,078.70
|
| Rate for Payer: PHCS Commercial |
$6,437.28
|
| Rate for Payer: United Healthcare All Payer |
$5,900.84
|
|
|
UNITRAX ENDO HEAD 47MM
|
Facility
|
OP
|
$6,705.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$871.72 |
| Max. Negotiated Rate |
$6,437.28 |
| Rate for Payer: Aetna Commercial |
$5,163.24
|
| Rate for Payer: Anthem Medicaid |
$2,306.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.29
|
| Rate for Payer: Cash Price |
$3,352.75
|
| Rate for Payer: Cigna Commercial |
$5,565.56
|
| Rate for Payer: First Health Commercial |
$6,370.22
|
| Rate for Payer: Humana Commercial |
$5,699.68
|
| Rate for Payer: Humana KY Medicaid |
$2,306.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,329.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,352.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,341.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$871.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,078.70
|
| Rate for Payer: PHCS Commercial |
$6,437.28
|
| Rate for Payer: United Healthcare All Payer |
$5,900.84
|
|
|
UNITRAX ENDO HEAD 47MM
|
Facility
|
IP
|
$6,705.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$871.72 |
| Max. Negotiated Rate |
$6,437.28 |
| Rate for Payer: Aetna Commercial |
$5,163.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.29
|
| Rate for Payer: Cash Price |
$3,352.75
|
| Rate for Payer: Cigna Commercial |
$5,565.56
|
| Rate for Payer: First Health Commercial |
$6,370.22
|
| Rate for Payer: Humana Commercial |
$5,699.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,341.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$871.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,078.70
|
| Rate for Payer: PHCS Commercial |
$6,437.28
|
| Rate for Payer: United Healthcare All Payer |
$5,900.84
|
|
|
UNITRAX ENDO HEAD 48MM
|
Facility
|
IP
|
$6,705.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$871.72 |
| Max. Negotiated Rate |
$6,437.28 |
| Rate for Payer: Aetna Commercial |
$5,163.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.29
|
| Rate for Payer: Cash Price |
$3,352.75
|
| Rate for Payer: Cigna Commercial |
$5,565.56
|
| Rate for Payer: First Health Commercial |
$6,370.22
|
| Rate for Payer: Humana Commercial |
$5,699.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,341.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$871.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,078.70
|
| Rate for Payer: PHCS Commercial |
$6,437.28
|
| Rate for Payer: United Healthcare All Payer |
$5,900.84
|
|
|
UNITRAX ENDO HEAD 48MM
|
Facility
|
OP
|
$6,705.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$871.72 |
| Max. Negotiated Rate |
$6,437.28 |
| Rate for Payer: Aetna Commercial |
$5,163.24
|
| Rate for Payer: Anthem Medicaid |
$2,306.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.29
|
| Rate for Payer: Cash Price |
$3,352.75
|
| Rate for Payer: Cigna Commercial |
$5,565.56
|
| Rate for Payer: First Health Commercial |
$6,370.22
|
| Rate for Payer: Humana Commercial |
$5,699.68
|
| Rate for Payer: Humana KY Medicaid |
$2,306.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,329.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,352.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,341.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$871.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,078.70
|
| Rate for Payer: PHCS Commercial |
$6,437.28
|
| Rate for Payer: United Healthcare All Payer |
$5,900.84
|
|
|
UNITRAX ENDO HEAD 49MM
|
Facility
|
IP
|
$6,705.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$871.72 |
| Max. Negotiated Rate |
$6,437.28 |
| Rate for Payer: Aetna Commercial |
$5,163.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.29
|
| Rate for Payer: Cash Price |
$3,352.75
|
| Rate for Payer: Cigna Commercial |
$5,565.56
|
| Rate for Payer: First Health Commercial |
$6,370.22
|
| Rate for Payer: Humana Commercial |
$5,699.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,341.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$871.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,078.70
|
| Rate for Payer: PHCS Commercial |
$6,437.28
|
| Rate for Payer: United Healthcare All Payer |
$5,900.84
|
|
|
UNITRAX ENDO HEAD 49MM
|
Facility
|
OP
|
$6,705.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$871.72 |
| Max. Negotiated Rate |
$6,437.28 |
| Rate for Payer: Aetna Commercial |
$5,163.24
|
| Rate for Payer: Anthem Medicaid |
$2,306.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.29
|
| Rate for Payer: Cash Price |
$3,352.75
|
| Rate for Payer: Cigna Commercial |
$5,565.56
|
| Rate for Payer: First Health Commercial |
$6,370.22
|
| Rate for Payer: Humana Commercial |
$5,699.68
|
| Rate for Payer: Humana KY Medicaid |
$2,306.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,329.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,352.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,341.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$871.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,078.70
|
| Rate for Payer: PHCS Commercial |
$6,437.28
|
| Rate for Payer: United Healthcare All Payer |
$5,900.84
|
|
|
UNITRAX ENDO HEAD 50MM
|
Facility
|
OP
|
$6,705.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$871.72 |
| Max. Negotiated Rate |
$6,437.28 |
| Rate for Payer: Aetna Commercial |
$5,163.24
|
| Rate for Payer: Anthem Medicaid |
$2,306.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.29
|
| Rate for Payer: Cash Price |
$3,352.75
|
| Rate for Payer: Cigna Commercial |
$5,565.56
|
| Rate for Payer: First Health Commercial |
$6,370.22
|
| Rate for Payer: Humana Commercial |
$5,699.68
|
| Rate for Payer: Humana KY Medicaid |
$2,306.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,329.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,352.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,341.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$871.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,078.70
|
| Rate for Payer: PHCS Commercial |
$6,437.28
|
| Rate for Payer: United Healthcare All Payer |
$5,900.84
|
|
|
UNITRAX ENDO HEAD 50MM
|
Facility
|
IP
|
$6,705.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$871.72 |
| Max. Negotiated Rate |
$6,437.28 |
| Rate for Payer: Aetna Commercial |
$5,163.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.29
|
| Rate for Payer: Cash Price |
$3,352.75
|
| Rate for Payer: Cigna Commercial |
$5,565.56
|
| Rate for Payer: First Health Commercial |
$6,370.22
|
| Rate for Payer: Humana Commercial |
$5,699.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,341.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$871.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,078.70
|
| Rate for Payer: PHCS Commercial |
$6,437.28
|
| Rate for Payer: United Healthcare All Payer |
$5,900.84
|
|
|
UNITRAX ENDO HEAD 51MM
|
Facility
|
OP
|
$6,705.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$871.72 |
| Max. Negotiated Rate |
$6,437.28 |
| Rate for Payer: Aetna Commercial |
$5,163.24
|
| Rate for Payer: Anthem Medicaid |
$2,306.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.29
|
| Rate for Payer: Cash Price |
$3,352.75
|
| Rate for Payer: Cigna Commercial |
$5,565.56
|
| Rate for Payer: First Health Commercial |
$6,370.22
|
| Rate for Payer: Humana Commercial |
$5,699.68
|
| Rate for Payer: Humana KY Medicaid |
$2,306.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,329.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,352.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,341.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$871.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,078.70
|
| Rate for Payer: PHCS Commercial |
$6,437.28
|
| Rate for Payer: United Healthcare All Payer |
$5,900.84
|
|
|
UNITRAX ENDO HEAD 51MM
|
Facility
|
IP
|
$6,705.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$871.72 |
| Max. Negotiated Rate |
$6,437.28 |
| Rate for Payer: Aetna Commercial |
$5,163.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.29
|
| Rate for Payer: Cash Price |
$3,352.75
|
| Rate for Payer: Cigna Commercial |
$5,565.56
|
| Rate for Payer: First Health Commercial |
$6,370.22
|
| Rate for Payer: Humana Commercial |
$5,699.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,341.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$871.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,078.70
|
| Rate for Payer: PHCS Commercial |
$6,437.28
|
| Rate for Payer: United Healthcare All Payer |
$5,900.84
|
|
|
UNITRAX ENDO HEAD 52MM
|
Facility
|
IP
|
$6,705.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$871.72 |
| Max. Negotiated Rate |
$6,437.28 |
| Rate for Payer: Aetna Commercial |
$5,163.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.29
|
| Rate for Payer: Cash Price |
$3,352.75
|
| Rate for Payer: Cigna Commercial |
$5,565.56
|
| Rate for Payer: First Health Commercial |
$6,370.22
|
| Rate for Payer: Humana Commercial |
$5,699.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,341.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$871.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,078.70
|
| Rate for Payer: PHCS Commercial |
$6,437.28
|
| Rate for Payer: United Healthcare All Payer |
$5,900.84
|
|
|
UNITRAX ENDO HEAD 52MM
|
Facility
|
OP
|
$6,705.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$871.72 |
| Max. Negotiated Rate |
$6,437.28 |
| Rate for Payer: Aetna Commercial |
$5,163.24
|
| Rate for Payer: Anthem Medicaid |
$2,306.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.29
|
| Rate for Payer: Cash Price |
$3,352.75
|
| Rate for Payer: Cigna Commercial |
$5,565.56
|
| Rate for Payer: First Health Commercial |
$6,370.22
|
| Rate for Payer: Humana Commercial |
$5,699.68
|
| Rate for Payer: Humana KY Medicaid |
$2,306.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,329.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,352.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,341.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$871.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,078.70
|
| Rate for Payer: PHCS Commercial |
$6,437.28
|
| Rate for Payer: United Healthcare All Payer |
$5,900.84
|
|
|
UNITRAX ENDO HEAD 53MM
|
Facility
|
OP
|
$6,705.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$871.72 |
| Max. Negotiated Rate |
$6,437.28 |
| Rate for Payer: Aetna Commercial |
$5,163.24
|
| Rate for Payer: Anthem Medicaid |
$2,306.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.29
|
| Rate for Payer: Cash Price |
$3,352.75
|
| Rate for Payer: Cigna Commercial |
$5,565.56
|
| Rate for Payer: First Health Commercial |
$6,370.22
|
| Rate for Payer: Humana Commercial |
$5,699.68
|
| Rate for Payer: Humana KY Medicaid |
$2,306.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,329.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,352.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,341.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$871.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,078.70
|
| Rate for Payer: PHCS Commercial |
$6,437.28
|
| Rate for Payer: United Healthcare All Payer |
$5,900.84
|
|
|
UNITRAX ENDO HEAD 53MM
|
Facility
|
IP
|
$6,705.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$871.72 |
| Max. Negotiated Rate |
$6,437.28 |
| Rate for Payer: Aetna Commercial |
$5,163.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.29
|
| Rate for Payer: Cash Price |
$3,352.75
|
| Rate for Payer: Cigna Commercial |
$5,565.56
|
| Rate for Payer: First Health Commercial |
$6,370.22
|
| Rate for Payer: Humana Commercial |
$5,699.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,341.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$871.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,078.70
|
| Rate for Payer: PHCS Commercial |
$6,437.28
|
| Rate for Payer: United Healthcare All Payer |
$5,900.84
|
|
|
UNITRAX ENDO HEAD 54MM
|
Facility
|
OP
|
$6,705.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$871.72 |
| Max. Negotiated Rate |
$6,437.28 |
| Rate for Payer: Aetna Commercial |
$5,163.24
|
| Rate for Payer: Anthem Medicaid |
$2,306.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.29
|
| Rate for Payer: Cash Price |
$3,352.75
|
| Rate for Payer: Cigna Commercial |
$5,565.56
|
| Rate for Payer: First Health Commercial |
$6,370.22
|
| Rate for Payer: Humana Commercial |
$5,699.68
|
| Rate for Payer: Humana KY Medicaid |
$2,306.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,329.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,352.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,341.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$871.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,078.70
|
| Rate for Payer: PHCS Commercial |
$6,437.28
|
| Rate for Payer: United Healthcare All Payer |
$5,900.84
|
|
|
UNITRAX ENDO HEAD 54MM
|
Facility
|
IP
|
$6,705.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$871.72 |
| Max. Negotiated Rate |
$6,437.28 |
| Rate for Payer: Aetna Commercial |
$5,163.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.29
|
| Rate for Payer: Cash Price |
$3,352.75
|
| Rate for Payer: Cigna Commercial |
$5,565.56
|
| Rate for Payer: First Health Commercial |
$6,370.22
|
| Rate for Payer: Humana Commercial |
$5,699.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,341.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$871.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,078.70
|
| Rate for Payer: PHCS Commercial |
$6,437.28
|
| Rate for Payer: United Healthcare All Payer |
$5,900.84
|
|
|
UNITRAX ENDO HEAD 55MM
|
Facility
|
IP
|
$6,705.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$871.72 |
| Max. Negotiated Rate |
$6,437.28 |
| Rate for Payer: Aetna Commercial |
$5,163.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.29
|
| Rate for Payer: Cash Price |
$3,352.75
|
| Rate for Payer: Cigna Commercial |
$5,565.56
|
| Rate for Payer: First Health Commercial |
$6,370.22
|
| Rate for Payer: Humana Commercial |
$5,699.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,341.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$871.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,078.70
|
| Rate for Payer: PHCS Commercial |
$6,437.28
|
| Rate for Payer: United Healthcare All Payer |
$5,900.84
|
|
