|
BIOLOXDELTAHEADSH+0 12/14 40MM
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
BIOLOXDELTAHEADSH+0 12/14 40MM
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
BIOLOX DELTAHEDLG+8 12/14 40MM
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
BIOLOX DELTAHEDLG+8 12/14 40MM
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
BIOLOX TAPER SLEEVE 1*-3 NECK
|
Facility
|
IP
|
$2,075.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$622.56 |
| Max. Negotiated Rate |
$1,992.19 |
| Rate for Payer: Aetna Commercial |
$1,597.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,618.66
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cigna Commercial |
$1,722.42
|
| Rate for Payer: First Health Commercial |
$1,971.44
|
| Rate for Payer: Humana Commercial |
$1,763.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,701.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,531.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$622.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,826.18
|
| Rate for Payer: Ohio Health Group HMO |
$1,556.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,660.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,805.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,431.89
|
| Rate for Payer: PHCS Commercial |
$1,992.19
|
| Rate for Payer: United Healthcare All Payer |
$1,826.18
|
|
|
BIOLOX TAPER SLEEVE 1*-3 NECK
|
Facility
|
OP
|
$2,075.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$622.56 |
| Max. Negotiated Rate |
$1,992.19 |
| Rate for Payer: Aetna Commercial |
$1,597.90
|
| Rate for Payer: Anthem Medicaid |
$713.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,618.66
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cigna Commercial |
$1,722.42
|
| Rate for Payer: First Health Commercial |
$1,971.44
|
| Rate for Payer: Humana Commercial |
$1,763.92
|
| Rate for Payer: Humana KY Medicaid |
$713.66
|
| Rate for Payer: Kentucky WC Medicaid |
$720.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,701.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,531.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$622.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$727.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,826.18
|
| Rate for Payer: Ohio Health Group HMO |
$1,556.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,660.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,805.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,431.89
|
| Rate for Payer: PHCS Commercial |
$1,992.19
|
| Rate for Payer: United Healthcare All Payer |
$1,826.18
|
|
|
BIO-MOD 40*15MM EAS HD
|
Facility
|
IP
|
$10,048.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,014.45 |
| Max. Negotiated Rate |
$9,646.22 |
| Rate for Payer: Aetna Commercial |
$7,737.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,837.56
|
| Rate for Payer: Cash Price |
$5,024.08
|
| Rate for Payer: Cigna Commercial |
$8,339.96
|
| Rate for Payer: First Health Commercial |
$9,545.74
|
| Rate for Payer: Humana Commercial |
$8,540.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,239.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,415.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,014.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,842.37
|
| Rate for Payer: Ohio Health Group HMO |
$7,536.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,038.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,741.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,933.22
|
| Rate for Payer: PHCS Commercial |
$9,646.22
|
| Rate for Payer: United Healthcare All Payer |
$8,842.37
|
|
|
BIO-MOD 40*15MM EAS HD
|
Facility
|
OP
|
$10,048.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,014.45 |
| Max. Negotiated Rate |
$9,646.22 |
| Rate for Payer: Aetna Commercial |
$7,737.08
|
| Rate for Payer: Anthem Medicaid |
$3,455.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,837.56
|
| Rate for Payer: Cash Price |
$5,024.08
|
| Rate for Payer: Cigna Commercial |
$8,339.96
|
| Rate for Payer: First Health Commercial |
$9,545.74
|
| Rate for Payer: Humana Commercial |
$8,540.93
|
| Rate for Payer: Humana KY Medicaid |
$3,455.56
|
| Rate for Payer: Kentucky WC Medicaid |
$3,490.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,239.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,415.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,014.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,524.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,842.37
|
| Rate for Payer: Ohio Health Group HMO |
$7,536.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,038.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,741.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,933.22
|
| Rate for Payer: PHCS Commercial |
$9,646.22
|
| Rate for Payer: United Healthcare All Payer |
$8,842.37
|
|
|
BIO-MOD 40*20MM EAS HD
|
Facility
|
OP
|
$10,048.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,014.45 |
| Max. Negotiated Rate |
$9,646.22 |
| Rate for Payer: Aetna Commercial |
$7,737.08
|
| Rate for Payer: Anthem Medicaid |
$3,455.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,837.56
|
| Rate for Payer: Cash Price |
$5,024.08
|
| Rate for Payer: Cigna Commercial |
$8,339.96
|
| Rate for Payer: First Health Commercial |
$9,545.74
|
| Rate for Payer: Humana Commercial |
$8,540.93
|
| Rate for Payer: Humana KY Medicaid |
$3,455.56
|
| Rate for Payer: Kentucky WC Medicaid |
$3,490.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,239.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,415.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,014.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,524.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,842.37
|
| Rate for Payer: Ohio Health Group HMO |
$7,536.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,038.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,741.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,933.22
|
| Rate for Payer: PHCS Commercial |
$9,646.22
|
| Rate for Payer: United Healthcare All Payer |
$8,842.37
|
|
|
BIO-MOD 40*20MM EAS HD
|
Facility
|
IP
|
$10,048.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,014.45 |
| Max. Negotiated Rate |
$9,646.22 |
| Rate for Payer: Aetna Commercial |
$7,737.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,837.56
|
| Rate for Payer: Cash Price |
$5,024.08
|
| Rate for Payer: Cigna Commercial |
$8,339.96
|
| Rate for Payer: First Health Commercial |
$9,545.74
|
| Rate for Payer: Humana Commercial |
$8,540.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,239.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,415.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,014.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,842.37
|
| Rate for Payer: Ohio Health Group HMO |
$7,536.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,038.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,741.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,933.22
|
| Rate for Payer: PHCS Commercial |
$9,646.22
|
| Rate for Payer: United Healthcare All Payer |
$8,842.37
|
|
|
BIO-MOD 44*17MM EAS HD
|
Facility
|
OP
|
$10,048.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,014.45 |
| Max. Negotiated Rate |
$9,646.22 |
| Rate for Payer: Aetna Commercial |
$7,737.08
|
| Rate for Payer: Anthem Medicaid |
$3,455.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,837.56
|
| Rate for Payer: Cash Price |
$5,024.08
|
| Rate for Payer: Cigna Commercial |
$8,339.96
|
| Rate for Payer: First Health Commercial |
$9,545.74
|
| Rate for Payer: Humana Commercial |
$8,540.93
|
| Rate for Payer: Humana KY Medicaid |
$3,455.56
|
| Rate for Payer: Kentucky WC Medicaid |
$3,490.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,239.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,415.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,014.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,524.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,842.37
|
| Rate for Payer: Ohio Health Group HMO |
$7,536.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,038.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,741.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,933.22
|
| Rate for Payer: PHCS Commercial |
$9,646.22
|
| Rate for Payer: United Healthcare All Payer |
$8,842.37
|
|
|
BIO-MOD 44*17MM EAS HD
|
Facility
|
IP
|
$10,048.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,014.45 |
| Max. Negotiated Rate |
$9,646.22 |
| Rate for Payer: Aetna Commercial |
$7,737.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,837.56
|
| Rate for Payer: Cash Price |
$5,024.08
|
| Rate for Payer: Cigna Commercial |
$8,339.96
|
| Rate for Payer: First Health Commercial |
$9,545.74
|
| Rate for Payer: Humana Commercial |
$8,540.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,239.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,415.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,014.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,842.37
|
| Rate for Payer: Ohio Health Group HMO |
$7,536.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,038.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,741.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,933.22
|
| Rate for Payer: PHCS Commercial |
$9,646.22
|
| Rate for Payer: United Healthcare All Payer |
$8,842.37
|
|
|
BIO-MOD 44*22MM EAS HD
|
Facility
|
IP
|
$10,048.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,014.45 |
| Max. Negotiated Rate |
$9,646.22 |
| Rate for Payer: Aetna Commercial |
$7,737.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,837.56
|
| Rate for Payer: Cash Price |
$5,024.08
|
| Rate for Payer: Cigna Commercial |
$8,339.96
|
| Rate for Payer: First Health Commercial |
$9,545.74
|
| Rate for Payer: Humana Commercial |
$8,540.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,239.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,415.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,014.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,842.37
|
| Rate for Payer: Ohio Health Group HMO |
$7,536.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,038.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,741.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,933.22
|
| Rate for Payer: PHCS Commercial |
$9,646.22
|
| Rate for Payer: United Healthcare All Payer |
$8,842.37
|
|
|
BIO-MOD 44*22MM EAS HD
|
Facility
|
OP
|
$10,048.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,014.45 |
| Max. Negotiated Rate |
$9,646.22 |
| Rate for Payer: Aetna Commercial |
$7,737.08
|
| Rate for Payer: Anthem Medicaid |
$3,455.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,837.56
|
| Rate for Payer: Cash Price |
$5,024.08
|
| Rate for Payer: Cigna Commercial |
$8,339.96
|
| Rate for Payer: First Health Commercial |
$9,545.74
|
| Rate for Payer: Humana Commercial |
$8,540.93
|
| Rate for Payer: Humana KY Medicaid |
$3,455.56
|
| Rate for Payer: Kentucky WC Medicaid |
$3,490.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,239.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,415.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,014.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,524.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,842.37
|
| Rate for Payer: Ohio Health Group HMO |
$7,536.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,038.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,741.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,933.22
|
| Rate for Payer: PHCS Commercial |
$9,646.22
|
| Rate for Payer: United Healthcare All Payer |
$8,842.37
|
|
|
BIO-MOD 44*27MM EAS HD
|
Facility
|
IP
|
$10,048.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,014.45 |
| Max. Negotiated Rate |
$9,646.22 |
| Rate for Payer: Aetna Commercial |
$7,737.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,837.56
|
| Rate for Payer: Cash Price |
$5,024.08
|
| Rate for Payer: Cigna Commercial |
$8,339.96
|
| Rate for Payer: First Health Commercial |
$9,545.74
|
| Rate for Payer: Humana Commercial |
$8,540.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,239.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,415.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,014.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,842.37
|
| Rate for Payer: Ohio Health Group HMO |
$7,536.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,038.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,741.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,933.22
|
| Rate for Payer: PHCS Commercial |
$9,646.22
|
| Rate for Payer: United Healthcare All Payer |
$8,842.37
|
|
|
BIO-MOD 44*27MM EAS HD
|
Facility
|
OP
|
$10,048.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,014.45 |
| Max. Negotiated Rate |
$9,646.22 |
| Rate for Payer: Aetna Commercial |
$7,737.08
|
| Rate for Payer: Anthem Medicaid |
$3,455.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,837.56
|
| Rate for Payer: Cash Price |
$5,024.08
|
| Rate for Payer: Cigna Commercial |
$8,339.96
|
| Rate for Payer: First Health Commercial |
$9,545.74
|
| Rate for Payer: Humana Commercial |
$8,540.93
|
| Rate for Payer: Humana KY Medicaid |
$3,455.56
|
| Rate for Payer: Kentucky WC Medicaid |
$3,490.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,239.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,415.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,014.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,524.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,842.37
|
| Rate for Payer: Ohio Health Group HMO |
$7,536.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,038.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,741.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,933.22
|
| Rate for Payer: PHCS Commercial |
$9,646.22
|
| Rate for Payer: United Healthcare All Payer |
$8,842.37
|
|
|
BIO-MOD 48*19MM EAS HD
|
Facility
|
OP
|
$10,048.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,014.45 |
| Max. Negotiated Rate |
$9,646.22 |
| Rate for Payer: Aetna Commercial |
$7,737.08
|
| Rate for Payer: Anthem Medicaid |
$3,455.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,837.56
|
| Rate for Payer: Cash Price |
$5,024.08
|
| Rate for Payer: Cigna Commercial |
$8,339.96
|
| Rate for Payer: First Health Commercial |
$9,545.74
|
| Rate for Payer: Humana Commercial |
$8,540.93
|
| Rate for Payer: Humana KY Medicaid |
$3,455.56
|
| Rate for Payer: Kentucky WC Medicaid |
$3,490.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,239.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,415.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,014.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,524.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,842.37
|
| Rate for Payer: Ohio Health Group HMO |
$7,536.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,038.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,741.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,933.22
|
| Rate for Payer: PHCS Commercial |
$9,646.22
|
| Rate for Payer: United Healthcare All Payer |
$8,842.37
|
|
|
BIO-MOD 48*19MM EAS HD
|
Facility
|
IP
|
$10,048.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,014.45 |
| Max. Negotiated Rate |
$9,646.22 |
| Rate for Payer: Aetna Commercial |
$7,737.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,837.56
|
| Rate for Payer: Cash Price |
$5,024.08
|
| Rate for Payer: Cigna Commercial |
$8,339.96
|
| Rate for Payer: First Health Commercial |
$9,545.74
|
| Rate for Payer: Humana Commercial |
$8,540.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,239.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,415.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,014.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,842.37
|
| Rate for Payer: Ohio Health Group HMO |
$7,536.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,038.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,741.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,933.22
|
| Rate for Payer: PHCS Commercial |
$9,646.22
|
| Rate for Payer: United Healthcare All Payer |
$8,842.37
|
|
|
BIO-MOD 48*24MM EAS HD
|
Facility
|
IP
|
$10,048.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,014.45 |
| Max. Negotiated Rate |
$9,646.22 |
| Rate for Payer: Aetna Commercial |
$7,737.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,837.56
|
| Rate for Payer: Cash Price |
$5,024.08
|
| Rate for Payer: Cigna Commercial |
$8,339.96
|
| Rate for Payer: First Health Commercial |
$9,545.74
|
| Rate for Payer: Humana Commercial |
$8,540.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,239.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,415.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,014.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,842.37
|
| Rate for Payer: Ohio Health Group HMO |
$7,536.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,038.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,741.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,933.22
|
| Rate for Payer: PHCS Commercial |
$9,646.22
|
| Rate for Payer: United Healthcare All Payer |
$8,842.37
|
|
|
BIO-MOD 48*24MM EAS HD
|
Facility
|
OP
|
$10,048.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,014.45 |
| Max. Negotiated Rate |
$9,646.22 |
| Rate for Payer: Aetna Commercial |
$7,737.08
|
| Rate for Payer: Anthem Medicaid |
$3,455.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,837.56
|
| Rate for Payer: Cash Price |
$5,024.08
|
| Rate for Payer: Cigna Commercial |
$8,339.96
|
| Rate for Payer: First Health Commercial |
$9,545.74
|
| Rate for Payer: Humana Commercial |
$8,540.93
|
| Rate for Payer: Humana KY Medicaid |
$3,455.56
|
| Rate for Payer: Kentucky WC Medicaid |
$3,490.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,239.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,415.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,014.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,524.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,842.37
|
| Rate for Payer: Ohio Health Group HMO |
$7,536.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,038.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,741.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,933.22
|
| Rate for Payer: PHCS Commercial |
$9,646.22
|
| Rate for Payer: United Healthcare All Payer |
$8,842.37
|
|
|
BIO-MOD 54*22MM EAS HD
|
Facility
|
OP
|
$10,048.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,014.45 |
| Max. Negotiated Rate |
$9,646.22 |
| Rate for Payer: Aetna Commercial |
$7,737.08
|
| Rate for Payer: Anthem Medicaid |
$3,455.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,837.56
|
| Rate for Payer: Cash Price |
$5,024.08
|
| Rate for Payer: Cigna Commercial |
$8,339.96
|
| Rate for Payer: First Health Commercial |
$9,545.74
|
| Rate for Payer: Humana Commercial |
$8,540.93
|
| Rate for Payer: Humana KY Medicaid |
$3,455.56
|
| Rate for Payer: Kentucky WC Medicaid |
$3,490.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,239.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,415.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,014.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,524.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,842.37
|
| Rate for Payer: Ohio Health Group HMO |
$7,536.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,038.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,741.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,933.22
|
| Rate for Payer: PHCS Commercial |
$9,646.22
|
| Rate for Payer: United Healthcare All Payer |
$8,842.37
|
|
|
BIO-MOD 54*22MM EAS HD
|
Facility
|
IP
|
$10,048.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,014.45 |
| Max. Negotiated Rate |
$9,646.22 |
| Rate for Payer: Aetna Commercial |
$7,737.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,837.56
|
| Rate for Payer: Cash Price |
$5,024.08
|
| Rate for Payer: Cigna Commercial |
$8,339.96
|
| Rate for Payer: First Health Commercial |
$9,545.74
|
| Rate for Payer: Humana Commercial |
$8,540.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,239.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,415.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,014.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,842.37
|
| Rate for Payer: Ohio Health Group HMO |
$7,536.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,038.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,741.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,933.22
|
| Rate for Payer: PHCS Commercial |
$9,646.22
|
| Rate for Payer: United Healthcare All Payer |
$8,842.37
|
|
|
BIO-MOD 54*24MM EAS HD
|
Facility
|
IP
|
$10,048.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,014.45 |
| Max. Negotiated Rate |
$9,646.22 |
| Rate for Payer: Aetna Commercial |
$7,737.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,837.56
|
| Rate for Payer: Cash Price |
$5,024.08
|
| Rate for Payer: Cigna Commercial |
$8,339.96
|
| Rate for Payer: First Health Commercial |
$9,545.74
|
| Rate for Payer: Humana Commercial |
$8,540.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,239.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,415.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,014.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,842.37
|
| Rate for Payer: Ohio Health Group HMO |
$7,536.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,038.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,741.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,933.22
|
| Rate for Payer: PHCS Commercial |
$9,646.22
|
| Rate for Payer: United Healthcare All Payer |
$8,842.37
|
|
|
BIO-MOD 54*24MM EAS HD
|
Facility
|
OP
|
$10,048.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,014.45 |
| Max. Negotiated Rate |
$9,646.22 |
| Rate for Payer: Aetna Commercial |
$7,737.08
|
| Rate for Payer: Anthem Medicaid |
$3,455.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,837.56
|
| Rate for Payer: Cash Price |
$5,024.08
|
| Rate for Payer: Cigna Commercial |
$8,339.96
|
| Rate for Payer: First Health Commercial |
$9,545.74
|
| Rate for Payer: Humana Commercial |
$8,540.93
|
| Rate for Payer: Humana KY Medicaid |
$3,455.56
|
| Rate for Payer: Kentucky WC Medicaid |
$3,490.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,239.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,415.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,014.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,524.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,842.37
|
| Rate for Payer: Ohio Health Group HMO |
$7,536.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,038.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,741.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,933.22
|
| Rate for Payer: PHCS Commercial |
$9,646.22
|
| Rate for Payer: United Healthcare All Payer |
$8,842.37
|
|
|
BIO-MOD GLEN KEEL ALLPLY LG 4M
|
Facility
|
OP
|
$8,350.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,505.27 |
| Max. Negotiated Rate |
$8,016.86 |
| Rate for Payer: Aetna Commercial |
$6,430.19
|
| Rate for Payer: Anthem Medicaid |
$2,871.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,513.70
|
| Rate for Payer: Cash Price |
$4,175.45
|
| Rate for Payer: Cigna Commercial |
$6,931.25
|
| Rate for Payer: First Health Commercial |
$7,933.35
|
| Rate for Payer: Humana Commercial |
$7,098.27
|
| Rate for Payer: Humana KY Medicaid |
$2,871.87
|
| Rate for Payer: Kentucky WC Medicaid |
$2,901.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,847.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,162.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,505.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,929.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,348.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,263.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,680.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,265.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,762.12
|
| Rate for Payer: PHCS Commercial |
$8,016.86
|
| Rate for Payer: United Healthcare All Payer |
$7,348.79
|
|
