|
UNIVERSAL HEAD 26MM ID 51MM OD
|
Facility
|
IP
|
$6,593.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.10 |
| Max. Negotiated Rate |
$6,329.36 |
| Rate for Payer: Aetna Commercial |
$5,076.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,142.60
|
| Rate for Payer: Cash Price |
$3,296.54
|
| Rate for Payer: Cigna Commercial |
$5,472.26
|
| Rate for Payer: First Health Commercial |
$6,263.43
|
| Rate for Payer: Humana Commercial |
$5,604.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,406.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,865.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,977.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,801.91
|
| Rate for Payer: Ohio Health Group HMO |
$4,944.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,318.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$857.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,043.85
|
| Rate for Payer: PHCS Commercial |
$6,329.36
|
| Rate for Payer: United Healthcare All Payer |
$5,801.91
|
|
|
UNIVERSAL HEAD 26MM ID 51MM OD
|
Facility
|
OP
|
$6,593.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.10 |
| Max. Negotiated Rate |
$6,329.36 |
| Rate for Payer: Aetna Commercial |
$5,076.67
|
| Rate for Payer: Anthem Medicaid |
$2,267.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,142.60
|
| Rate for Payer: Cash Price |
$3,296.54
|
| Rate for Payer: Cigna Commercial |
$5,472.26
|
| Rate for Payer: First Health Commercial |
$6,263.43
|
| Rate for Payer: Humana Commercial |
$5,604.12
|
| Rate for Payer: Humana KY Medicaid |
$2,267.36
|
| Rate for Payer: Kentucky WC Medicaid |
$2,290.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,406.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,865.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,977.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,312.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,801.91
|
| Rate for Payer: Ohio Health Group HMO |
$4,944.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,318.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$857.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,043.85
|
| Rate for Payer: PHCS Commercial |
$6,329.36
|
| Rate for Payer: United Healthcare All Payer |
$5,801.91
|
|
|
UNIVERSAL HEAD 26MM ID 52MM OD
|
Facility
|
OP
|
$6,593.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.10 |
| Max. Negotiated Rate |
$6,329.36 |
| Rate for Payer: Aetna Commercial |
$5,076.67
|
| Rate for Payer: Anthem Medicaid |
$2,267.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,142.60
|
| Rate for Payer: Cash Price |
$3,296.54
|
| Rate for Payer: Cigna Commercial |
$5,472.26
|
| Rate for Payer: First Health Commercial |
$6,263.43
|
| Rate for Payer: Humana Commercial |
$5,604.12
|
| Rate for Payer: Humana KY Medicaid |
$2,267.36
|
| Rate for Payer: Kentucky WC Medicaid |
$2,290.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,406.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,865.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,977.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,312.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,801.91
|
| Rate for Payer: Ohio Health Group HMO |
$4,944.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,318.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$857.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,043.85
|
| Rate for Payer: PHCS Commercial |
$6,329.36
|
| Rate for Payer: United Healthcare All Payer |
$5,801.91
|
|
|
UNIVERSAL HEAD 26MM ID 52MM OD
|
Facility
|
IP
|
$6,593.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.10 |
| Max. Negotiated Rate |
$6,329.36 |
| Rate for Payer: Aetna Commercial |
$5,076.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,142.60
|
| Rate for Payer: Cash Price |
$3,296.54
|
| Rate for Payer: Cigna Commercial |
$5,472.26
|
| Rate for Payer: First Health Commercial |
$6,263.43
|
| Rate for Payer: Humana Commercial |
$5,604.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,406.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,865.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,977.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,801.91
|
| Rate for Payer: Ohio Health Group HMO |
$4,944.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,318.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$857.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,043.85
|
| Rate for Payer: PHCS Commercial |
$6,329.36
|
| Rate for Payer: United Healthcare All Payer |
$5,801.91
|
|
|
UNIVERSAL HEAD 26MM ID 53MM OD
|
Facility
|
OP
|
$6,706.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$871.90 |
| Max. Negotiated Rate |
$6,438.68 |
| Rate for Payer: Aetna Commercial |
$5,164.36
|
| Rate for Payer: Anthem Medicaid |
$2,306.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,231.43
|
| Rate for Payer: Cash Price |
$3,353.48
|
| Rate for Payer: Cigna Commercial |
$5,566.78
|
| Rate for Payer: First Health Commercial |
$6,371.61
|
| Rate for Payer: Humana Commercial |
$5,700.92
|
| Rate for Payer: Humana KY Medicaid |
$2,306.52
|
| Rate for Payer: Kentucky WC Medicaid |
$2,330.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,499.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,949.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,012.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,352.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,902.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,030.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,341.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$871.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,079.16
|
| Rate for Payer: PHCS Commercial |
$6,438.68
|
| Rate for Payer: United Healthcare All Payer |
$5,902.12
|
|
|
UNIVERSAL HEAD 26MM ID 53MM OD
|
Facility
|
IP
|
$6,706.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$871.90 |
| Max. Negotiated Rate |
$6,438.68 |
| Rate for Payer: Aetna Commercial |
$5,164.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,231.43
|
| Rate for Payer: Cash Price |
$3,353.48
|
| Rate for Payer: Cigna Commercial |
$5,566.78
|
| Rate for Payer: First Health Commercial |
$6,371.61
|
| Rate for Payer: Humana Commercial |
$5,700.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,499.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,949.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,012.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,902.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,030.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,341.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$871.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,079.16
|
| Rate for Payer: PHCS Commercial |
$6,438.68
|
| Rate for Payer: United Healthcare All Payer |
$5,902.12
|
|
|
UNIVERSAL HEAD 26MM ID 54MM OD
|
Facility
|
OP
|
$6,593.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.10 |
| Max. Negotiated Rate |
$6,329.36 |
| Rate for Payer: Aetna Commercial |
$5,076.67
|
| Rate for Payer: Anthem Medicaid |
$2,267.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,142.60
|
| Rate for Payer: Cash Price |
$3,296.54
|
| Rate for Payer: Cigna Commercial |
$5,472.26
|
| Rate for Payer: First Health Commercial |
$6,263.43
|
| Rate for Payer: Humana Commercial |
$5,604.12
|
| Rate for Payer: Humana KY Medicaid |
$2,267.36
|
| Rate for Payer: Kentucky WC Medicaid |
$2,290.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,406.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,865.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,977.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,312.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,801.91
|
| Rate for Payer: Ohio Health Group HMO |
$4,944.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,318.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$857.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,043.85
|
| Rate for Payer: PHCS Commercial |
$6,329.36
|
| Rate for Payer: United Healthcare All Payer |
$5,801.91
|
|
|
UNIVERSAL HEAD 26MM ID 54MM OD
|
Facility
|
IP
|
$6,593.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.10 |
| Max. Negotiated Rate |
$6,329.36 |
| Rate for Payer: Aetna Commercial |
$5,076.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,142.60
|
| Rate for Payer: Cash Price |
$3,296.54
|
| Rate for Payer: Cigna Commercial |
$5,472.26
|
| Rate for Payer: First Health Commercial |
$6,263.43
|
| Rate for Payer: Humana Commercial |
$5,604.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,406.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,865.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,977.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,801.91
|
| Rate for Payer: Ohio Health Group HMO |
$4,944.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,318.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$857.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,043.85
|
| Rate for Payer: PHCS Commercial |
$6,329.36
|
| Rate for Payer: United Healthcare All Payer |
$5,801.91
|
|
|
UNIVERSAL HEAD 26MM ID 55MM OD
|
Facility
|
OP
|
$6,593.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.10 |
| Max. Negotiated Rate |
$6,329.36 |
| Rate for Payer: Aetna Commercial |
$5,076.67
|
| Rate for Payer: Anthem Medicaid |
$2,267.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,142.60
|
| Rate for Payer: Cash Price |
$3,296.54
|
| Rate for Payer: Cigna Commercial |
$5,472.26
|
| Rate for Payer: First Health Commercial |
$6,263.43
|
| Rate for Payer: Humana Commercial |
$5,604.12
|
| Rate for Payer: Humana KY Medicaid |
$2,267.36
|
| Rate for Payer: Kentucky WC Medicaid |
$2,290.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,406.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,865.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,977.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,312.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,801.91
|
| Rate for Payer: Ohio Health Group HMO |
$4,944.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,318.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$857.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,043.85
|
| Rate for Payer: PHCS Commercial |
$6,329.36
|
| Rate for Payer: United Healthcare All Payer |
$5,801.91
|
|
|
UNIVERSAL HEAD 26MM ID 55MM OD
|
Facility
|
IP
|
$6,593.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.10 |
| Max. Negotiated Rate |
$6,329.36 |
| Rate for Payer: Aetna Commercial |
$5,076.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,142.60
|
| Rate for Payer: Cash Price |
$3,296.54
|
| Rate for Payer: Cigna Commercial |
$5,472.26
|
| Rate for Payer: First Health Commercial |
$6,263.43
|
| Rate for Payer: Humana Commercial |
$5,604.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,406.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,865.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,977.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,801.91
|
| Rate for Payer: Ohio Health Group HMO |
$4,944.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,318.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$857.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,043.85
|
| Rate for Payer: PHCS Commercial |
$6,329.36
|
| Rate for Payer: United Healthcare All Payer |
$5,801.91
|
|
|
UNIVERSAL HEAD 26MM ID 56MM OD
|
Facility
|
IP
|
$6,467.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$840.78 |
| Max. Negotiated Rate |
$6,208.82 |
| Rate for Payer: Aetna Commercial |
$4,979.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,044.67
|
| Rate for Payer: Cash Price |
$3,233.76
|
| Rate for Payer: Cigna Commercial |
$5,368.04
|
| Rate for Payer: First Health Commercial |
$6,144.14
|
| Rate for Payer: Humana Commercial |
$5,497.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,303.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,773.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,940.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,691.42
|
| Rate for Payer: Ohio Health Group HMO |
$4,850.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,293.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$840.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,004.93
|
| Rate for Payer: PHCS Commercial |
$6,208.82
|
| Rate for Payer: United Healthcare All Payer |
$5,691.42
|
|
|
UNIVERSAL HEAD 26MM ID 56MM OD
|
Facility
|
OP
|
$6,467.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$840.78 |
| Max. Negotiated Rate |
$6,208.82 |
| Rate for Payer: Aetna Commercial |
$4,979.99
|
| Rate for Payer: Anthem Medicaid |
$2,224.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,044.67
|
| Rate for Payer: Cash Price |
$3,233.76
|
| Rate for Payer: Cigna Commercial |
$5,368.04
|
| Rate for Payer: First Health Commercial |
$6,144.14
|
| Rate for Payer: Humana Commercial |
$5,497.39
|
| Rate for Payer: Humana KY Medicaid |
$2,224.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,246.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,303.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,773.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,940.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,268.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,691.42
|
| Rate for Payer: Ohio Health Group HMO |
$4,850.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,293.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$840.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,004.93
|
| Rate for Payer: PHCS Commercial |
$6,208.82
|
| Rate for Payer: United Healthcare All Payer |
$5,691.42
|
|
|
UNIVERSAL HEAD 26MM ID 58MM OD
|
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
|
|
|
UNIVERSAL HEAD 26MM ID 58MM OD
|
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
|
|
|
UNIVERSAL HEAD 26MM ID 61MM OD
|
Facility
|
IP
|
$6,706.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$871.90 |
| Max. Negotiated Rate |
$6,438.68 |
| Rate for Payer: Aetna Commercial |
$5,164.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,231.43
|
| Rate for Payer: Cash Price |
$3,353.48
|
| Rate for Payer: Cigna Commercial |
$5,566.78
|
| Rate for Payer: First Health Commercial |
$6,371.61
|
| Rate for Payer: Humana Commercial |
$5,700.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,499.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,949.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,012.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,902.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,030.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,341.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$871.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,079.16
|
| Rate for Payer: PHCS Commercial |
$6,438.68
|
| Rate for Payer: United Healthcare All Payer |
$5,902.12
|
|
|
UNIVERSAL HEAD 26MM ID 61MM OD
|
Facility
|
OP
|
$6,706.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$871.90 |
| Max. Negotiated Rate |
$6,438.68 |
| Rate for Payer: Aetna Commercial |
$5,164.36
|
| Rate for Payer: Anthem Medicaid |
$2,306.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,231.43
|
| Rate for Payer: Cash Price |
$3,353.48
|
| Rate for Payer: Cigna Commercial |
$5,566.78
|
| Rate for Payer: First Health Commercial |
$6,371.61
|
| Rate for Payer: Humana Commercial |
$5,700.92
|
| Rate for Payer: Humana KY Medicaid |
$2,306.52
|
| Rate for Payer: Kentucky WC Medicaid |
$2,330.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,499.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,949.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,012.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,352.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,902.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,030.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,341.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$871.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,079.16
|
| Rate for Payer: PHCS Commercial |
$6,438.68
|
| Rate for Payer: United Healthcare All Payer |
$5,902.12
|
|
|
UNIVERSAL HEAD 28MM ID 44MM OD
|
Facility
|
IP
|
$5,009.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$651.27 |
| Max. Negotiated Rate |
$4,809.41 |
| Rate for Payer: Aetna Commercial |
$3,857.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,907.64
|
| Rate for Payer: Cash Price |
$2,504.90
|
| Rate for Payer: Cigna Commercial |
$4,158.13
|
| Rate for Payer: First Health Commercial |
$4,759.31
|
| Rate for Payer: Humana Commercial |
$4,258.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,108.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,697.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,408.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,757.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,001.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$651.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,553.04
|
| Rate for Payer: PHCS Commercial |
$4,809.41
|
| Rate for Payer: United Healthcare All Payer |
$4,408.62
|
|
|
UNIVERSAL HEAD 28MM ID 44MM OD
|
Facility
|
OP
|
$5,009.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$651.27 |
| Max. Negotiated Rate |
$4,809.41 |
| Rate for Payer: Aetna Commercial |
$3,857.55
|
| Rate for Payer: Anthem Medicaid |
$1,722.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,907.64
|
| Rate for Payer: Cash Price |
$2,504.90
|
| Rate for Payer: Cigna Commercial |
$4,158.13
|
| Rate for Payer: First Health Commercial |
$4,759.31
|
| Rate for Payer: Humana Commercial |
$4,258.33
|
| Rate for Payer: Humana KY Medicaid |
$1,722.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,740.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,108.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,697.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,757.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,408.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,757.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,001.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$651.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,553.04
|
| Rate for Payer: PHCS Commercial |
$4,809.41
|
| Rate for Payer: United Healthcare All Payer |
$4,408.62
|
|
|
UNIVERSAL HEAD 28MM ID 45MM OD
|
Facility
|
IP
|
$5,009.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$651.27 |
| Max. Negotiated Rate |
$4,809.41 |
| Rate for Payer: Aetna Commercial |
$3,857.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,907.64
|
| Rate for Payer: Cash Price |
$2,504.90
|
| Rate for Payer: Cigna Commercial |
$4,158.13
|
| Rate for Payer: First Health Commercial |
$4,759.31
|
| Rate for Payer: Humana Commercial |
$4,258.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,108.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,697.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,408.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,757.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,001.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$651.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,553.04
|
| Rate for Payer: PHCS Commercial |
$4,809.41
|
| Rate for Payer: United Healthcare All Payer |
$4,408.62
|
|
|
UNIVERSAL HEAD 28MM ID 45MM OD
|
Facility
|
OP
|
$5,009.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$651.27 |
| Max. Negotiated Rate |
$4,809.41 |
| Rate for Payer: Aetna Commercial |
$3,857.55
|
| Rate for Payer: Anthem Medicaid |
$1,722.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,907.64
|
| Rate for Payer: Cash Price |
$2,504.90
|
| Rate for Payer: Cigna Commercial |
$4,158.13
|
| Rate for Payer: First Health Commercial |
$4,759.31
|
| Rate for Payer: Humana Commercial |
$4,258.33
|
| Rate for Payer: Humana KY Medicaid |
$1,722.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,740.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,108.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,697.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,757.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,408.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,757.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,001.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$651.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,553.04
|
| Rate for Payer: PHCS Commercial |
$4,809.41
|
| Rate for Payer: United Healthcare All Payer |
$4,408.62
|
|
|
UNIVERSAL HEAD 28MM ID 46MM OD
|
Facility
|
IP
|
$5,009.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$651.27 |
| Max. Negotiated Rate |
$4,809.41 |
| Rate for Payer: Aetna Commercial |
$3,857.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,907.64
|
| Rate for Payer: Cash Price |
$2,504.90
|
| Rate for Payer: Cigna Commercial |
$4,158.13
|
| Rate for Payer: First Health Commercial |
$4,759.31
|
| Rate for Payer: Humana Commercial |
$4,258.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,108.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,697.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,408.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,757.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,001.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$651.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,553.04
|
| Rate for Payer: PHCS Commercial |
$4,809.41
|
| Rate for Payer: United Healthcare All Payer |
$4,408.62
|
|
|
UNIVERSAL HEAD 28MM ID 46MM OD
|
Facility
|
OP
|
$5,009.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$651.27 |
| Max. Negotiated Rate |
$4,809.41 |
| Rate for Payer: Aetna Commercial |
$3,857.55
|
| Rate for Payer: Anthem Medicaid |
$1,722.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,907.64
|
| Rate for Payer: Cash Price |
$2,504.90
|
| Rate for Payer: Cigna Commercial |
$4,158.13
|
| Rate for Payer: First Health Commercial |
$4,759.31
|
| Rate for Payer: Humana Commercial |
$4,258.33
|
| Rate for Payer: Humana KY Medicaid |
$1,722.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,740.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,108.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,697.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,757.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,408.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,757.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,001.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$651.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,553.04
|
| Rate for Payer: PHCS Commercial |
$4,809.41
|
| Rate for Payer: United Healthcare All Payer |
$4,408.62
|
|
|
UNIVERSAL HEAD 28MM ID 47MM OD
|
Facility
|
IP
|
$5,009.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$651.27 |
| Max. Negotiated Rate |
$4,809.41 |
| Rate for Payer: Aetna Commercial |
$3,857.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,907.64
|
| Rate for Payer: Cash Price |
$2,504.90
|
| Rate for Payer: Cigna Commercial |
$4,158.13
|
| Rate for Payer: First Health Commercial |
$4,759.31
|
| Rate for Payer: Humana Commercial |
$4,258.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,108.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,697.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,408.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,757.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,001.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$651.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,553.04
|
| Rate for Payer: PHCS Commercial |
$4,809.41
|
| Rate for Payer: United Healthcare All Payer |
$4,408.62
|
|
|
UNIVERSAL HEAD 28MM ID 47MM OD
|
Facility
|
OP
|
$5,009.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$651.27 |
| Max. Negotiated Rate |
$4,809.41 |
| Rate for Payer: Aetna Commercial |
$3,857.55
|
| Rate for Payer: Anthem Medicaid |
$1,722.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,907.64
|
| Rate for Payer: Cash Price |
$2,504.90
|
| Rate for Payer: Cigna Commercial |
$4,158.13
|
| Rate for Payer: First Health Commercial |
$4,759.31
|
| Rate for Payer: Humana Commercial |
$4,258.33
|
| Rate for Payer: Humana KY Medicaid |
$1,722.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,740.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,108.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,697.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,757.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,408.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,757.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,001.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$651.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,553.04
|
| Rate for Payer: PHCS Commercial |
$4,809.41
|
| Rate for Payer: United Healthcare All Payer |
$4,408.62
|
|
|
UNIVERSAL HEAD 28MM ID 48MM OD
|
Facility
|
OP
|
$5,009.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$651.27 |
| Max. Negotiated Rate |
$4,809.41 |
| Rate for Payer: Aetna Commercial |
$3,857.55
|
| Rate for Payer: Anthem Medicaid |
$1,722.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,907.64
|
| Rate for Payer: Cash Price |
$2,504.90
|
| Rate for Payer: Cigna Commercial |
$4,158.13
|
| Rate for Payer: First Health Commercial |
$4,759.31
|
| Rate for Payer: Humana Commercial |
$4,258.33
|
| Rate for Payer: Humana KY Medicaid |
$1,722.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,740.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,108.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,697.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,757.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,408.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,757.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,001.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$651.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,553.04
|
| Rate for Payer: PHCS Commercial |
$4,809.41
|
| Rate for Payer: United Healthcare All Payer |
$4,408.62
|
|
