|
UNIVERSAL HEAD 28MM ID 48MM 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 49MM 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 49MM 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 50MM 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 50MM 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 51MM 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 51MM 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 52MM OD
|
Facility
|
OP
|
$5,038.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$654.96 |
| Max. Negotiated Rate |
$4,836.66 |
| Rate for Payer: Aetna Commercial |
$3,879.41
|
| Rate for Payer: Anthem Medicaid |
$1,732.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,929.79
|
| Rate for Payer: Cash Price |
$2,519.09
|
| Rate for Payer: Cigna Commercial |
$4,181.70
|
| Rate for Payer: First Health Commercial |
$4,786.28
|
| Rate for Payer: Humana Commercial |
$4,282.46
|
| Rate for Payer: Humana KY Medicaid |
$1,732.63
|
| Rate for Payer: Kentucky WC Medicaid |
$1,750.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,131.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,718.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,511.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,767.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,433.61
|
| Rate for Payer: Ohio Health Group HMO |
$3,778.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,007.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$654.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,561.84
|
| Rate for Payer: PHCS Commercial |
$4,836.66
|
| Rate for Payer: United Healthcare All Payer |
$4,433.61
|
|
|
UNIVERSAL HEAD 28MM ID 52MM OD
|
Facility
|
IP
|
$5,038.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$654.96 |
| Max. Negotiated Rate |
$4,836.66 |
| Rate for Payer: Aetna Commercial |
$3,879.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,929.79
|
| Rate for Payer: Cash Price |
$2,519.09
|
| Rate for Payer: Cigna Commercial |
$4,181.70
|
| Rate for Payer: First Health Commercial |
$4,786.28
|
| Rate for Payer: Humana Commercial |
$4,282.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,131.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,718.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,511.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,433.61
|
| Rate for Payer: Ohio Health Group HMO |
$3,778.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,007.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$654.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,561.84
|
| Rate for Payer: PHCS Commercial |
$4,836.66
|
| Rate for Payer: United Healthcare All Payer |
$4,433.61
|
|
|
UNIVERSAL HEAD 28MM ID 53MM 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 53MM 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 54MM OD
|
Facility
|
OP
|
$5,038.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$654.96 |
| Max. Negotiated Rate |
$4,836.66 |
| Rate for Payer: Aetna Commercial |
$3,879.41
|
| Rate for Payer: Anthem Medicaid |
$1,732.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,929.79
|
| Rate for Payer: Cash Price |
$2,519.09
|
| Rate for Payer: Cigna Commercial |
$4,181.70
|
| Rate for Payer: First Health Commercial |
$4,786.28
|
| Rate for Payer: Humana Commercial |
$4,282.46
|
| Rate for Payer: Humana KY Medicaid |
$1,732.63
|
| Rate for Payer: Kentucky WC Medicaid |
$1,750.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,131.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,718.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,511.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,767.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,433.61
|
| Rate for Payer: Ohio Health Group HMO |
$3,778.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,007.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$654.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,561.84
|
| Rate for Payer: PHCS Commercial |
$4,836.66
|
| Rate for Payer: United Healthcare All Payer |
$4,433.61
|
|
|
UNIVERSAL HEAD 28MM ID 54MM OD
|
Facility
|
IP
|
$5,038.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$654.96 |
| Max. Negotiated Rate |
$4,836.66 |
| Rate for Payer: Aetna Commercial |
$3,879.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,929.79
|
| Rate for Payer: Cash Price |
$2,519.09
|
| Rate for Payer: Cigna Commercial |
$4,181.70
|
| Rate for Payer: First Health Commercial |
$4,786.28
|
| Rate for Payer: Humana Commercial |
$4,282.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,131.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,718.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,511.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,433.61
|
| Rate for Payer: Ohio Health Group HMO |
$3,778.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,007.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$654.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,561.84
|
| Rate for Payer: PHCS Commercial |
$4,836.66
|
| Rate for Payer: United Healthcare All Payer |
$4,433.61
|
|
|
UNIVERSAL HEAD 28MM ID 55MM OD
|
Facility
|
OP
|
$5,038.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$654.96 |
| Max. Negotiated Rate |
$4,836.66 |
| Rate for Payer: Aetna Commercial |
$3,879.41
|
| Rate for Payer: Anthem Medicaid |
$1,732.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,929.79
|
| Rate for Payer: Cash Price |
$2,519.09
|
| Rate for Payer: Cigna Commercial |
$4,181.70
|
| Rate for Payer: First Health Commercial |
$4,786.28
|
| Rate for Payer: Humana Commercial |
$4,282.46
|
| Rate for Payer: Humana KY Medicaid |
$1,732.63
|
| Rate for Payer: Kentucky WC Medicaid |
$1,750.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,131.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,718.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,511.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,767.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,433.61
|
| Rate for Payer: Ohio Health Group HMO |
$3,778.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,007.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$654.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,561.84
|
| Rate for Payer: PHCS Commercial |
$4,836.66
|
| Rate for Payer: United Healthcare All Payer |
$4,433.61
|
|
|
UNIVERSAL HEAD 28MM ID 55MM OD
|
Facility
|
IP
|
$5,038.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$654.96 |
| Max. Negotiated Rate |
$4,836.66 |
| Rate for Payer: Aetna Commercial |
$3,879.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,929.79
|
| Rate for Payer: Cash Price |
$2,519.09
|
| Rate for Payer: Cigna Commercial |
$4,181.70
|
| Rate for Payer: First Health Commercial |
$4,786.28
|
| Rate for Payer: Humana Commercial |
$4,282.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,131.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,718.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,511.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,433.61
|
| Rate for Payer: Ohio Health Group HMO |
$3,778.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,007.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$654.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,561.84
|
| Rate for Payer: PHCS Commercial |
$4,836.66
|
| Rate for Payer: United Healthcare All Payer |
$4,433.61
|
|
|
UNIVERSAL HEAD 28MM ID 56MM OD
|
Facility
|
IP
|
$5,038.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$654.96 |
| Max. Negotiated Rate |
$4,836.66 |
| Rate for Payer: Aetna Commercial |
$3,879.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,929.79
|
| Rate for Payer: Cash Price |
$2,519.09
|
| Rate for Payer: Cigna Commercial |
$4,181.70
|
| Rate for Payer: First Health Commercial |
$4,786.28
|
| Rate for Payer: Humana Commercial |
$4,282.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,131.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,718.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,511.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,433.61
|
| Rate for Payer: Ohio Health Group HMO |
$3,778.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,007.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$654.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,561.84
|
| Rate for Payer: PHCS Commercial |
$4,836.66
|
| Rate for Payer: United Healthcare All Payer |
$4,433.61
|
|
|
UNIVERSAL HEAD 28MM ID 56MM OD
|
Facility
|
OP
|
$5,038.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$654.96 |
| Max. Negotiated Rate |
$4,836.66 |
| Rate for Payer: Aetna Commercial |
$3,879.41
|
| Rate for Payer: Anthem Medicaid |
$1,732.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,929.79
|
| Rate for Payer: Cash Price |
$2,519.09
|
| Rate for Payer: Cigna Commercial |
$4,181.70
|
| Rate for Payer: First Health Commercial |
$4,786.28
|
| Rate for Payer: Humana Commercial |
$4,282.46
|
| Rate for Payer: Humana KY Medicaid |
$1,732.63
|
| Rate for Payer: Kentucky WC Medicaid |
$1,750.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,131.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,718.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,511.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,767.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,433.61
|
| Rate for Payer: Ohio Health Group HMO |
$3,778.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,007.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$654.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,561.84
|
| Rate for Payer: PHCS Commercial |
$4,836.66
|
| Rate for Payer: United Healthcare All Payer |
$4,433.61
|
|
|
UNIVERSAL HEAD 28MM 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 28MM 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 28MM ID 61MM 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 28MM ID 61MM 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 STEM 115*10MM FLUTED
|
Facility
|
OP
|
$12,405.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.76 |
| Max. Negotiated Rate |
$11,909.61 |
| Rate for Payer: Aetna Commercial |
$9,552.50
|
| Rate for Payer: Anthem Medicaid |
$4,266.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,676.56
|
| Rate for Payer: Cash Price |
$6,202.92
|
| Rate for Payer: Cigna Commercial |
$10,296.85
|
| Rate for Payer: First Health Commercial |
$11,785.55
|
| Rate for Payer: Humana Commercial |
$10,544.96
|
| Rate for Payer: Humana KY Medicaid |
$4,266.37
|
| Rate for Payer: Kentucky WC Medicaid |
$4,309.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,172.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,155.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,721.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,351.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,917.14
|
| Rate for Payer: Ohio Health Group HMO |
$9,304.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,481.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,612.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,845.81
|
| Rate for Payer: PHCS Commercial |
$11,909.61
|
| Rate for Payer: United Healthcare All Payer |
$10,917.14
|
|
|
UNIVERSAL STEM 115*10MM FLUTED
|
Facility
|
IP
|
$12,405.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.76 |
| Max. Negotiated Rate |
$11,909.61 |
| Rate for Payer: Aetna Commercial |
$9,552.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,676.56
|
| Rate for Payer: Cash Price |
$6,202.92
|
| Rate for Payer: Cigna Commercial |
$10,296.85
|
| Rate for Payer: First Health Commercial |
$11,785.55
|
| Rate for Payer: Humana Commercial |
$10,544.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,172.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,155.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,721.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,917.14
|
| Rate for Payer: Ohio Health Group HMO |
$9,304.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,481.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,612.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,845.81
|
| Rate for Payer: PHCS Commercial |
$11,909.61
|
| Rate for Payer: United Healthcare All Payer |
$10,917.14
|
|
|
UNIVERSAL STEM 115*12MM FLUTED
|
Facility
|
OP
|
$12,405.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.76 |
| Max. Negotiated Rate |
$11,909.61 |
| Rate for Payer: Aetna Commercial |
$9,552.50
|
| Rate for Payer: Anthem Medicaid |
$4,266.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,676.56
|
| Rate for Payer: Cash Price |
$6,202.92
|
| Rate for Payer: Cigna Commercial |
$10,296.85
|
| Rate for Payer: First Health Commercial |
$11,785.55
|
| Rate for Payer: Humana Commercial |
$10,544.96
|
| Rate for Payer: Humana KY Medicaid |
$4,266.37
|
| Rate for Payer: Kentucky WC Medicaid |
$4,309.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,172.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,155.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,721.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,351.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,917.14
|
| Rate for Payer: Ohio Health Group HMO |
$9,304.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,481.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,612.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,845.81
|
| Rate for Payer: PHCS Commercial |
$11,909.61
|
| Rate for Payer: United Healthcare All Payer |
$10,917.14
|
|
|
UNIVERSAL STEM 115*12MM FLUTED
|
Facility
|
IP
|
$12,405.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.76 |
| Max. Negotiated Rate |
$11,909.61 |
| Rate for Payer: Aetna Commercial |
$9,552.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,676.56
|
| Rate for Payer: Cash Price |
$6,202.92
|
| Rate for Payer: Cigna Commercial |
$10,296.85
|
| Rate for Payer: First Health Commercial |
$11,785.55
|
| Rate for Payer: Humana Commercial |
$10,544.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,172.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,155.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,721.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,917.14
|
| Rate for Payer: Ohio Health Group HMO |
$9,304.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,481.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,612.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,845.81
|
| Rate for Payer: PHCS Commercial |
$11,909.61
|
| Rate for Payer: United Healthcare All Payer |
$10,917.14
|
|
