|
ULTIMA ACETABULAR ROOF RING 62
|
Facility
|
IP
|
$8,590.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,577.21 |
| Max. Negotiated Rate |
$8,247.07 |
| Rate for Payer: Aetna Commercial |
$6,614.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,700.75
|
| Rate for Payer: Cash Price |
$4,295.35
|
| Rate for Payer: Cigna Commercial |
$7,130.28
|
| Rate for Payer: First Health Commercial |
$8,161.16
|
| Rate for Payer: Humana Commercial |
$7,302.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,044.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,339.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,577.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,559.82
|
| Rate for Payer: Ohio Health Group HMO |
$6,443.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,872.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,473.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,927.58
|
| Rate for Payer: PHCS Commercial |
$8,247.07
|
| Rate for Payer: United Healthcare All Payer |
$7,559.82
|
|
|
ULTIMA UNIPOLAR ADAP SLEEV 0MM
|
Facility
|
IP
|
$2,948.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$884.41 |
| Max. Negotiated Rate |
$2,830.12 |
| Rate for Payer: Aetna Commercial |
$2,269.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,299.47
|
| Rate for Payer: Cash Price |
$1,474.02
|
| Rate for Payer: Cigna Commercial |
$2,446.87
|
| Rate for Payer: First Health Commercial |
$2,800.64
|
| Rate for Payer: Humana Commercial |
$2,505.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,417.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,175.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$884.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,594.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,211.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,358.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,564.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,034.15
|
| Rate for Payer: PHCS Commercial |
$2,830.12
|
| Rate for Payer: United Healthcare All Payer |
$2,594.28
|
|
|
ULTIMA UNIPOLAR ADAP SLEEV 0MM
|
Facility
|
OP
|
$2,948.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$884.41 |
| Max. Negotiated Rate |
$2,830.12 |
| Rate for Payer: Aetna Commercial |
$2,269.99
|
| Rate for Payer: Anthem Medicaid |
$1,013.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,299.47
|
| Rate for Payer: Cash Price |
$1,474.02
|
| Rate for Payer: Cigna Commercial |
$2,446.87
|
| Rate for Payer: First Health Commercial |
$2,800.64
|
| Rate for Payer: Humana Commercial |
$2,505.83
|
| Rate for Payer: Humana KY Medicaid |
$1,013.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,024.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,417.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,175.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$884.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,034.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,594.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,211.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,358.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,564.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,034.15
|
| Rate for Payer: PHCS Commercial |
$2,830.12
|
| Rate for Payer: United Healthcare All Payer |
$2,594.28
|
|
|
ULTIMA UNIPOLAR ADAP SLEEV 6MM
|
Facility
|
IP
|
$2,948.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$884.41 |
| Max. Negotiated Rate |
$2,830.12 |
| Rate for Payer: Aetna Commercial |
$2,269.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,299.47
|
| Rate for Payer: Cash Price |
$1,474.02
|
| Rate for Payer: Cigna Commercial |
$2,446.87
|
| Rate for Payer: First Health Commercial |
$2,800.64
|
| Rate for Payer: Humana Commercial |
$2,505.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,417.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,175.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$884.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,594.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,211.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,358.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,564.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,034.15
|
| Rate for Payer: PHCS Commercial |
$2,830.12
|
| Rate for Payer: United Healthcare All Payer |
$2,594.28
|
|
|
ULTIMA UNIPOLAR ADAP SLEEV 6MM
|
Facility
|
OP
|
$2,948.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$884.41 |
| Max. Negotiated Rate |
$2,830.12 |
| Rate for Payer: Aetna Commercial |
$2,269.99
|
| Rate for Payer: Anthem Medicaid |
$1,013.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,299.47
|
| Rate for Payer: Cash Price |
$1,474.02
|
| Rate for Payer: Cigna Commercial |
$2,446.87
|
| Rate for Payer: First Health Commercial |
$2,800.64
|
| Rate for Payer: Humana Commercial |
$2,505.83
|
| Rate for Payer: Humana KY Medicaid |
$1,013.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,024.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,417.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,175.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$884.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,034.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,594.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,211.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,358.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,564.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,034.15
|
| Rate for Payer: PHCS Commercial |
$2,830.12
|
| Rate for Payer: United Healthcare All Payer |
$2,594.28
|
|
|
ULTIMA UNIPOLAR HEAD 38MM
|
Facility
|
IP
|
$3,518.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.62 |
| Max. Negotiated Rate |
$3,378.00 |
| Rate for Payer: Aetna Commercial |
$2,709.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,744.62
|
| Rate for Payer: Cash Price |
$1,759.38
|
| Rate for Payer: Cigna Commercial |
$2,920.56
|
| Rate for Payer: First Health Commercial |
$3,342.81
|
| Rate for Payer: Humana Commercial |
$2,990.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,885.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,596.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,055.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,096.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,639.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,815.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,061.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,427.94
|
| Rate for Payer: PHCS Commercial |
$3,378.00
|
| Rate for Payer: United Healthcare All Payer |
$3,096.50
|
|
|
ULTIMA UNIPOLAR HEAD 38MM
|
Facility
|
OP
|
$3,518.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.62 |
| Max. Negotiated Rate |
$3,378.00 |
| Rate for Payer: Aetna Commercial |
$2,709.44
|
| Rate for Payer: Anthem Medicaid |
$1,210.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,744.62
|
| Rate for Payer: Cash Price |
$1,759.38
|
| Rate for Payer: Cigna Commercial |
$2,920.56
|
| Rate for Payer: First Health Commercial |
$3,342.81
|
| Rate for Payer: Humana Commercial |
$2,990.94
|
| Rate for Payer: Humana KY Medicaid |
$1,210.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,222.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,885.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,596.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,055.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,234.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,096.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,639.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,815.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,061.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,427.94
|
| Rate for Payer: PHCS Commercial |
$3,378.00
|
| Rate for Payer: United Healthcare All Payer |
$3,096.50
|
|
|
ULTIMA UNIPOLAR HEAD 39MM
|
Facility
|
OP
|
$3,518.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.62 |
| Max. Negotiated Rate |
$3,378.00 |
| Rate for Payer: Aetna Commercial |
$2,709.44
|
| Rate for Payer: Anthem Medicaid |
$1,210.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,744.62
|
| Rate for Payer: Cash Price |
$1,759.38
|
| Rate for Payer: Cigna Commercial |
$2,920.56
|
| Rate for Payer: First Health Commercial |
$3,342.81
|
| Rate for Payer: Humana Commercial |
$2,990.94
|
| Rate for Payer: Humana KY Medicaid |
$1,210.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,222.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,885.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,596.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,055.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,234.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,096.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,639.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,815.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,061.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,427.94
|
| Rate for Payer: PHCS Commercial |
$3,378.00
|
| Rate for Payer: United Healthcare All Payer |
$3,096.50
|
|
|
ULTIMA UNIPOLAR HEAD 39MM
|
Facility
|
IP
|
$3,518.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.62 |
| Max. Negotiated Rate |
$3,378.00 |
| Rate for Payer: Aetna Commercial |
$2,709.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,744.62
|
| Rate for Payer: Cash Price |
$1,759.38
|
| Rate for Payer: Cigna Commercial |
$2,920.56
|
| Rate for Payer: First Health Commercial |
$3,342.81
|
| Rate for Payer: Humana Commercial |
$2,990.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,885.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,596.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,055.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,096.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,639.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,815.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,061.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,427.94
|
| Rate for Payer: PHCS Commercial |
$3,378.00
|
| Rate for Payer: United Healthcare All Payer |
$3,096.50
|
|
|
ULTIMA UNIPOLAR HEAD 40MM
|
Facility
|
IP
|
$3,518.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.62 |
| Max. Negotiated Rate |
$3,378.00 |
| Rate for Payer: Aetna Commercial |
$2,709.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,744.62
|
| Rate for Payer: Cash Price |
$1,759.38
|
| Rate for Payer: Cigna Commercial |
$2,920.56
|
| Rate for Payer: First Health Commercial |
$3,342.81
|
| Rate for Payer: Humana Commercial |
$2,990.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,885.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,596.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,055.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,096.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,639.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,815.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,061.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,427.94
|
| Rate for Payer: PHCS Commercial |
$3,378.00
|
| Rate for Payer: United Healthcare All Payer |
$3,096.50
|
|
|
ULTIMA UNIPOLAR HEAD 40MM
|
Facility
|
OP
|
$3,518.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.62 |
| Max. Negotiated Rate |
$3,378.00 |
| Rate for Payer: Aetna Commercial |
$2,709.44
|
| Rate for Payer: Anthem Medicaid |
$1,210.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,744.62
|
| Rate for Payer: Cash Price |
$1,759.38
|
| Rate for Payer: Cigna Commercial |
$2,920.56
|
| Rate for Payer: First Health Commercial |
$3,342.81
|
| Rate for Payer: Humana Commercial |
$2,990.94
|
| Rate for Payer: Humana KY Medicaid |
$1,210.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,222.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,885.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,596.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,055.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,234.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,096.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,639.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,815.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,061.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,427.94
|
| Rate for Payer: PHCS Commercial |
$3,378.00
|
| Rate for Payer: United Healthcare All Payer |
$3,096.50
|
|
|
ULTIMA UNIPOLAR HEAD 41MM
|
Facility
|
OP
|
$3,518.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.62 |
| Max. Negotiated Rate |
$3,378.00 |
| Rate for Payer: Aetna Commercial |
$2,709.44
|
| Rate for Payer: Anthem Medicaid |
$1,210.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,744.62
|
| Rate for Payer: Cash Price |
$1,759.38
|
| Rate for Payer: Cigna Commercial |
$2,920.56
|
| Rate for Payer: First Health Commercial |
$3,342.81
|
| Rate for Payer: Humana Commercial |
$2,990.94
|
| Rate for Payer: Humana KY Medicaid |
$1,210.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,222.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,885.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,596.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,055.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,234.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,096.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,639.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,815.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,061.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,427.94
|
| Rate for Payer: PHCS Commercial |
$3,378.00
|
| Rate for Payer: United Healthcare All Payer |
$3,096.50
|
|
|
ULTIMA UNIPOLAR HEAD 41MM
|
Facility
|
IP
|
$3,518.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.62 |
| Max. Negotiated Rate |
$3,378.00 |
| Rate for Payer: Aetna Commercial |
$2,709.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,744.62
|
| Rate for Payer: Cash Price |
$1,759.38
|
| Rate for Payer: Cigna Commercial |
$2,920.56
|
| Rate for Payer: First Health Commercial |
$3,342.81
|
| Rate for Payer: Humana Commercial |
$2,990.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,885.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,596.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,055.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,096.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,639.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,815.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,061.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,427.94
|
| Rate for Payer: PHCS Commercial |
$3,378.00
|
| Rate for Payer: United Healthcare All Payer |
$3,096.50
|
|
|
ULTIMA UNIPOLAR HEAD 42MM
|
Facility
|
IP
|
$3,518.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.62 |
| Max. Negotiated Rate |
$3,378.00 |
| Rate for Payer: Aetna Commercial |
$2,709.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,744.62
|
| Rate for Payer: Cash Price |
$1,759.38
|
| Rate for Payer: Cigna Commercial |
$2,920.56
|
| Rate for Payer: First Health Commercial |
$3,342.81
|
| Rate for Payer: Humana Commercial |
$2,990.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,885.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,596.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,055.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,096.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,639.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,815.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,061.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,427.94
|
| Rate for Payer: PHCS Commercial |
$3,378.00
|
| Rate for Payer: United Healthcare All Payer |
$3,096.50
|
|
|
ULTIMA UNIPOLAR HEAD 42MM
|
Facility
|
OP
|
$3,518.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.62 |
| Max. Negotiated Rate |
$3,378.00 |
| Rate for Payer: Aetna Commercial |
$2,709.44
|
| Rate for Payer: Anthem Medicaid |
$1,210.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,744.62
|
| Rate for Payer: Cash Price |
$1,759.38
|
| Rate for Payer: Cigna Commercial |
$2,920.56
|
| Rate for Payer: First Health Commercial |
$3,342.81
|
| Rate for Payer: Humana Commercial |
$2,990.94
|
| Rate for Payer: Humana KY Medicaid |
$1,210.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,222.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,885.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,596.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,055.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,234.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,096.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,639.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,815.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,061.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,427.94
|
| Rate for Payer: PHCS Commercial |
$3,378.00
|
| Rate for Payer: United Healthcare All Payer |
$3,096.50
|
|
|
ULTIMA UNIPOLAR HEAD 43MM
|
Facility
|
OP
|
$3,518.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.62 |
| Max. Negotiated Rate |
$3,378.00 |
| Rate for Payer: Aetna Commercial |
$2,709.44
|
| Rate for Payer: Anthem Medicaid |
$1,210.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,744.62
|
| Rate for Payer: Cash Price |
$1,759.38
|
| Rate for Payer: Cigna Commercial |
$2,920.56
|
| Rate for Payer: First Health Commercial |
$3,342.81
|
| Rate for Payer: Humana Commercial |
$2,990.94
|
| Rate for Payer: Humana KY Medicaid |
$1,210.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,222.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,885.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,596.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,055.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,234.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,096.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,639.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,815.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,061.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,427.94
|
| Rate for Payer: PHCS Commercial |
$3,378.00
|
| Rate for Payer: United Healthcare All Payer |
$3,096.50
|
|
|
ULTIMA UNIPOLAR HEAD 43MM
|
Facility
|
IP
|
$3,518.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.62 |
| Max. Negotiated Rate |
$3,378.00 |
| Rate for Payer: Aetna Commercial |
$2,709.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,744.62
|
| Rate for Payer: Cash Price |
$1,759.38
|
| Rate for Payer: Cigna Commercial |
$2,920.56
|
| Rate for Payer: First Health Commercial |
$3,342.81
|
| Rate for Payer: Humana Commercial |
$2,990.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,885.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,596.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,055.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,096.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,639.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,815.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,061.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,427.94
|
| Rate for Payer: PHCS Commercial |
$3,378.00
|
| Rate for Payer: United Healthcare All Payer |
$3,096.50
|
|
|
ULTIMA UNIPOLAR HEAD 44MM
|
Facility
|
OP
|
$3,518.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.62 |
| Max. Negotiated Rate |
$3,378.00 |
| Rate for Payer: Aetna Commercial |
$2,709.44
|
| Rate for Payer: Anthem Medicaid |
$1,210.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,744.62
|
| Rate for Payer: Cash Price |
$1,759.38
|
| Rate for Payer: Cigna Commercial |
$2,920.56
|
| Rate for Payer: First Health Commercial |
$3,342.81
|
| Rate for Payer: Humana Commercial |
$2,990.94
|
| Rate for Payer: Humana KY Medicaid |
$1,210.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,222.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,885.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,596.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,055.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,234.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,096.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,639.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,815.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,061.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,427.94
|
| Rate for Payer: PHCS Commercial |
$3,378.00
|
| Rate for Payer: United Healthcare All Payer |
$3,096.50
|
|
|
ULTIMA UNIPOLAR HEAD 44MM
|
Facility
|
IP
|
$3,518.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.62 |
| Max. Negotiated Rate |
$3,378.00 |
| Rate for Payer: Aetna Commercial |
$2,709.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,744.62
|
| Rate for Payer: Cash Price |
$1,759.38
|
| Rate for Payer: Cigna Commercial |
$2,920.56
|
| Rate for Payer: First Health Commercial |
$3,342.81
|
| Rate for Payer: Humana Commercial |
$2,990.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,885.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,596.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,055.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,096.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,639.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,815.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,061.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,427.94
|
| Rate for Payer: PHCS Commercial |
$3,378.00
|
| Rate for Payer: United Healthcare All Payer |
$3,096.50
|
|
|
ULTIMA UNIPOLAR HEAD 45MM
|
Facility
|
OP
|
$3,518.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.62 |
| Max. Negotiated Rate |
$3,378.00 |
| Rate for Payer: Aetna Commercial |
$2,709.44
|
| Rate for Payer: Anthem Medicaid |
$1,210.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,744.62
|
| Rate for Payer: Cash Price |
$1,759.38
|
| Rate for Payer: Cigna Commercial |
$2,920.56
|
| Rate for Payer: First Health Commercial |
$3,342.81
|
| Rate for Payer: Humana Commercial |
$2,990.94
|
| Rate for Payer: Humana KY Medicaid |
$1,210.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,222.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,885.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,596.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,055.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,234.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,096.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,639.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,815.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,061.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,427.94
|
| Rate for Payer: PHCS Commercial |
$3,378.00
|
| Rate for Payer: United Healthcare All Payer |
$3,096.50
|
|
|
ULTIMA UNIPOLAR HEAD 45MM
|
Facility
|
IP
|
$3,518.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.62 |
| Max. Negotiated Rate |
$3,378.00 |
| Rate for Payer: Aetna Commercial |
$2,709.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,744.62
|
| Rate for Payer: Cash Price |
$1,759.38
|
| Rate for Payer: Cigna Commercial |
$2,920.56
|
| Rate for Payer: First Health Commercial |
$3,342.81
|
| Rate for Payer: Humana Commercial |
$2,990.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,885.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,596.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,055.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,096.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,639.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,815.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,061.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,427.94
|
| Rate for Payer: PHCS Commercial |
$3,378.00
|
| Rate for Payer: United Healthcare All Payer |
$3,096.50
|
|
|
ULTIMA UNIPOLAR HEAD 46MM
|
Facility
|
IP
|
$3,518.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.62 |
| Max. Negotiated Rate |
$3,378.00 |
| Rate for Payer: Aetna Commercial |
$2,709.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,744.62
|
| Rate for Payer: Cash Price |
$1,759.38
|
| Rate for Payer: Cigna Commercial |
$2,920.56
|
| Rate for Payer: First Health Commercial |
$3,342.81
|
| Rate for Payer: Humana Commercial |
$2,990.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,885.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,596.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,055.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,096.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,639.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,815.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,061.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,427.94
|
| Rate for Payer: PHCS Commercial |
$3,378.00
|
| Rate for Payer: United Healthcare All Payer |
$3,096.50
|
|
|
ULTIMA UNIPOLAR HEAD 46MM
|
Facility
|
OP
|
$3,518.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.62 |
| Max. Negotiated Rate |
$3,378.00 |
| Rate for Payer: Aetna Commercial |
$2,709.44
|
| Rate for Payer: Anthem Medicaid |
$1,210.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,744.62
|
| Rate for Payer: Cash Price |
$1,759.38
|
| Rate for Payer: Cigna Commercial |
$2,920.56
|
| Rate for Payer: First Health Commercial |
$3,342.81
|
| Rate for Payer: Humana Commercial |
$2,990.94
|
| Rate for Payer: Humana KY Medicaid |
$1,210.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,222.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,885.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,596.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,055.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,234.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,096.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,639.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,815.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,061.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,427.94
|
| Rate for Payer: PHCS Commercial |
$3,378.00
|
| Rate for Payer: United Healthcare All Payer |
$3,096.50
|
|
|
ULTIMA UNIPOLAR HEAD 47MM
|
Facility
|
IP
|
$3,518.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.62 |
| Max. Negotiated Rate |
$3,378.00 |
| Rate for Payer: Aetna Commercial |
$2,709.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,744.62
|
| Rate for Payer: Cash Price |
$1,759.38
|
| Rate for Payer: Cigna Commercial |
$2,920.56
|
| Rate for Payer: First Health Commercial |
$3,342.81
|
| Rate for Payer: Humana Commercial |
$2,990.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,885.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,596.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,055.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,096.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,639.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,815.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,061.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,427.94
|
| Rate for Payer: PHCS Commercial |
$3,378.00
|
| Rate for Payer: United Healthcare All Payer |
$3,096.50
|
|
|
ULTIMA UNIPOLAR HEAD 47MM
|
Facility
|
OP
|
$3,518.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.62 |
| Max. Negotiated Rate |
$3,378.00 |
| Rate for Payer: Aetna Commercial |
$2,709.44
|
| Rate for Payer: Anthem Medicaid |
$1,210.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,744.62
|
| Rate for Payer: Cash Price |
$1,759.38
|
| Rate for Payer: Cigna Commercial |
$2,920.56
|
| Rate for Payer: First Health Commercial |
$3,342.81
|
| Rate for Payer: Humana Commercial |
$2,990.94
|
| Rate for Payer: Humana KY Medicaid |
$1,210.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,222.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,885.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,596.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,055.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,234.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,096.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,639.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,815.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,061.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,427.94
|
| Rate for Payer: PHCS Commercial |
$3,378.00
|
| Rate for Payer: United Healthcare All Payer |
$3,096.50
|
|
