|
UNI EIUS TIB SMALL 10MM RM/LL
|
Facility
|
OP
|
$8,215.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,464.54 |
| Max. Negotiated Rate |
$7,886.52 |
| Rate for Payer: Aetna Commercial |
$6,325.64
|
| Rate for Payer: Anthem Medicaid |
$2,825.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,407.79
|
| Rate for Payer: Cash Price |
$4,107.56
|
| Rate for Payer: Cigna Commercial |
$6,818.55
|
| Rate for Payer: First Health Commercial |
$7,804.36
|
| Rate for Payer: Humana Commercial |
$6,982.85
|
| Rate for Payer: Humana KY Medicaid |
$2,825.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,853.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,736.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,062.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,464.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,881.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,229.31
|
| Rate for Payer: Ohio Health Group HMO |
$6,161.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,572.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,147.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,668.43
|
| Rate for Payer: PHCS Commercial |
$7,886.52
|
| Rate for Payer: United Healthcare All Payer |
$7,229.31
|
|
|
UNI EIUS TIB SMALL 12MM LM/RL
|
Facility
|
IP
|
$8,317.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,495.20 |
| Max. Negotiated Rate |
$7,984.63 |
| Rate for Payer: Aetna Commercial |
$6,404.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,487.51
|
| Rate for Payer: Cash Price |
$4,158.66
|
| Rate for Payer: Cigna Commercial |
$6,903.38
|
| Rate for Payer: First Health Commercial |
$7,901.45
|
| Rate for Payer: Humana Commercial |
$7,069.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,820.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,138.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,495.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,319.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,237.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,653.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,236.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,738.95
|
| Rate for Payer: PHCS Commercial |
$7,984.63
|
| Rate for Payer: United Healthcare All Payer |
$7,319.24
|
|
|
UNI EIUS TIB SMALL 12MM LM/RL
|
Facility
|
OP
|
$8,317.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,495.20 |
| Max. Negotiated Rate |
$7,984.63 |
| Rate for Payer: Aetna Commercial |
$6,404.34
|
| Rate for Payer: Anthem Medicaid |
$2,860.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,487.51
|
| Rate for Payer: Cash Price |
$4,158.66
|
| Rate for Payer: Cigna Commercial |
$6,903.38
|
| Rate for Payer: First Health Commercial |
$7,901.45
|
| Rate for Payer: Humana Commercial |
$7,069.72
|
| Rate for Payer: Humana KY Medicaid |
$2,860.33
|
| Rate for Payer: Kentucky WC Medicaid |
$2,889.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,820.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,138.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,495.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,917.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,319.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,237.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,653.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,236.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,738.95
|
| Rate for Payer: PHCS Commercial |
$7,984.63
|
| Rate for Payer: United Healthcare All Payer |
$7,319.24
|
|
|
UNI EIUS TIB SMALL 12MM RM/LL
|
Facility
|
IP
|
$8,317.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,495.20 |
| Max. Negotiated Rate |
$7,984.63 |
| Rate for Payer: Aetna Commercial |
$6,404.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,487.51
|
| Rate for Payer: Cash Price |
$4,158.66
|
| Rate for Payer: Cigna Commercial |
$6,903.38
|
| Rate for Payer: First Health Commercial |
$7,901.45
|
| Rate for Payer: Humana Commercial |
$7,069.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,820.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,138.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,495.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,319.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,237.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,653.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,236.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,738.95
|
| Rate for Payer: PHCS Commercial |
$7,984.63
|
| Rate for Payer: United Healthcare All Payer |
$7,319.24
|
|
|
UNI EIUS TIB SMALL 12MM RM/LL
|
Facility
|
OP
|
$8,317.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,495.20 |
| Max. Negotiated Rate |
$7,984.63 |
| Rate for Payer: Aetna Commercial |
$6,404.34
|
| Rate for Payer: Anthem Medicaid |
$2,860.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,487.51
|
| Rate for Payer: Cash Price |
$4,158.66
|
| Rate for Payer: Cigna Commercial |
$6,903.38
|
| Rate for Payer: First Health Commercial |
$7,901.45
|
| Rate for Payer: Humana Commercial |
$7,069.72
|
| Rate for Payer: Humana KY Medicaid |
$2,860.33
|
| Rate for Payer: Kentucky WC Medicaid |
$2,889.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,820.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,138.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,495.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,917.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,319.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,237.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,653.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,236.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,738.95
|
| Rate for Payer: PHCS Commercial |
$7,984.63
|
| Rate for Payer: United Healthcare All Payer |
$7,319.24
|
|
|
UNI EIUS TIB SMALL 8MM LM/RL
|
Facility
|
IP
|
$8,215.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,464.54 |
| Max. Negotiated Rate |
$7,886.52 |
| Rate for Payer: Aetna Commercial |
$6,325.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,407.79
|
| Rate for Payer: Cash Price |
$4,107.56
|
| Rate for Payer: Cigna Commercial |
$6,818.55
|
| Rate for Payer: First Health Commercial |
$7,804.36
|
| Rate for Payer: Humana Commercial |
$6,982.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,736.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,062.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,464.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,229.31
|
| Rate for Payer: Ohio Health Group HMO |
$6,161.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,572.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,147.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,668.43
|
| Rate for Payer: PHCS Commercial |
$7,886.52
|
| Rate for Payer: United Healthcare All Payer |
$7,229.31
|
|
|
UNI EIUS TIB SMALL 8MM LM/RL
|
Facility
|
OP
|
$8,215.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,464.54 |
| Max. Negotiated Rate |
$7,886.52 |
| Rate for Payer: Aetna Commercial |
$6,325.64
|
| Rate for Payer: Anthem Medicaid |
$2,825.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,407.79
|
| Rate for Payer: Cash Price |
$4,107.56
|
| Rate for Payer: Cigna Commercial |
$6,818.55
|
| Rate for Payer: First Health Commercial |
$7,804.36
|
| Rate for Payer: Humana Commercial |
$6,982.85
|
| Rate for Payer: Humana KY Medicaid |
$2,825.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,853.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,736.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,062.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,464.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,881.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,229.31
|
| Rate for Payer: Ohio Health Group HMO |
$6,161.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,572.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,147.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,668.43
|
| Rate for Payer: PHCS Commercial |
$7,886.52
|
| Rate for Payer: United Healthcare All Payer |
$7,229.31
|
|
|
UNI EIUS TIB SMALL 8MM RM/LL
|
Facility
|
IP
|
$8,215.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,464.54 |
| Max. Negotiated Rate |
$7,886.52 |
| Rate for Payer: Aetna Commercial |
$6,325.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,407.79
|
| Rate for Payer: Cash Price |
$4,107.56
|
| Rate for Payer: Cigna Commercial |
$6,818.55
|
| Rate for Payer: First Health Commercial |
$7,804.36
|
| Rate for Payer: Humana Commercial |
$6,982.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,736.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,062.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,464.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,229.31
|
| Rate for Payer: Ohio Health Group HMO |
$6,161.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,572.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,147.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,668.43
|
| Rate for Payer: PHCS Commercial |
$7,886.52
|
| Rate for Payer: United Healthcare All Payer |
$7,229.31
|
|
|
UNI EIUS TIB SMALL 8MM RM/LL
|
Facility
|
OP
|
$8,215.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,464.54 |
| Max. Negotiated Rate |
$7,886.52 |
| Rate for Payer: Aetna Commercial |
$6,325.64
|
| Rate for Payer: Anthem Medicaid |
$2,825.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,407.79
|
| Rate for Payer: Cash Price |
$4,107.56
|
| Rate for Payer: Cigna Commercial |
$6,818.55
|
| Rate for Payer: First Health Commercial |
$7,804.36
|
| Rate for Payer: Humana Commercial |
$6,982.85
|
| Rate for Payer: Humana KY Medicaid |
$2,825.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,853.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,736.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,062.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,464.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,881.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,229.31
|
| Rate for Payer: Ohio Health Group HMO |
$6,161.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,572.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,147.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,668.43
|
| Rate for Payer: PHCS Commercial |
$7,886.52
|
| Rate for Payer: United Healthcare All Payer |
$7,229.31
|
|
|
UNI EIUS TIB SMALL 9MM LM/RL
|
Facility
|
IP
|
$8,215.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,464.54 |
| Max. Negotiated Rate |
$7,886.52 |
| Rate for Payer: Aetna Commercial |
$6,325.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,407.79
|
| Rate for Payer: Cash Price |
$4,107.56
|
| Rate for Payer: Cigna Commercial |
$6,818.55
|
| Rate for Payer: First Health Commercial |
$7,804.36
|
| Rate for Payer: Humana Commercial |
$6,982.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,736.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,062.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,464.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,229.31
|
| Rate for Payer: Ohio Health Group HMO |
$6,161.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,572.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,147.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,668.43
|
| Rate for Payer: PHCS Commercial |
$7,886.52
|
| Rate for Payer: United Healthcare All Payer |
$7,229.31
|
|
|
UNI EIUS TIB SMALL 9MM LM/RL
|
Facility
|
OP
|
$8,215.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,464.54 |
| Max. Negotiated Rate |
$7,886.52 |
| Rate for Payer: Aetna Commercial |
$6,325.64
|
| Rate for Payer: Anthem Medicaid |
$2,825.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,407.79
|
| Rate for Payer: Cash Price |
$4,107.56
|
| Rate for Payer: Cigna Commercial |
$6,818.55
|
| Rate for Payer: First Health Commercial |
$7,804.36
|
| Rate for Payer: Humana Commercial |
$6,982.85
|
| Rate for Payer: Humana KY Medicaid |
$2,825.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,853.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,736.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,062.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,464.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,881.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,229.31
|
| Rate for Payer: Ohio Health Group HMO |
$6,161.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,572.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,147.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,668.43
|
| Rate for Payer: PHCS Commercial |
$7,886.52
|
| Rate for Payer: United Healthcare All Payer |
$7,229.31
|
|
|
UNI EIUS TIB SMALL 9MM RM/LL
|
Facility
|
IP
|
$8,215.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,464.54 |
| Max. Negotiated Rate |
$7,886.52 |
| Rate for Payer: Aetna Commercial |
$6,325.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,407.79
|
| Rate for Payer: Cash Price |
$4,107.56
|
| Rate for Payer: Cigna Commercial |
$6,818.55
|
| Rate for Payer: First Health Commercial |
$7,804.36
|
| Rate for Payer: Humana Commercial |
$6,982.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,736.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,062.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,464.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,229.31
|
| Rate for Payer: Ohio Health Group HMO |
$6,161.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,572.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,147.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,668.43
|
| Rate for Payer: PHCS Commercial |
$7,886.52
|
| Rate for Payer: United Healthcare All Payer |
$7,229.31
|
|
|
UNI EIUS TIB SMALL 9MM RM/LL
|
Facility
|
OP
|
$8,215.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,464.54 |
| Max. Negotiated Rate |
$7,886.52 |
| Rate for Payer: Aetna Commercial |
$6,325.64
|
| Rate for Payer: Anthem Medicaid |
$2,825.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,407.79
|
| Rate for Payer: Cash Price |
$4,107.56
|
| Rate for Payer: Cigna Commercial |
$6,818.55
|
| Rate for Payer: First Health Commercial |
$7,804.36
|
| Rate for Payer: Humana Commercial |
$6,982.85
|
| Rate for Payer: Humana KY Medicaid |
$2,825.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,853.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,736.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,062.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,464.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,881.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,229.31
|
| Rate for Payer: Ohio Health Group HMO |
$6,161.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,572.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,147.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,668.43
|
| Rate for Payer: PHCS Commercial |
$7,886.52
|
| Rate for Payer: United Healthcare All Payer |
$7,229.31
|
|
|
UNI EIUS TIB XLARGE 10MM LM/RL
|
Facility
|
IP
|
$8,317.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,495.20 |
| Max. Negotiated Rate |
$7,984.63 |
| Rate for Payer: Aetna Commercial |
$6,404.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,487.51
|
| Rate for Payer: Cash Price |
$4,158.66
|
| Rate for Payer: Cigna Commercial |
$6,903.38
|
| Rate for Payer: First Health Commercial |
$7,901.45
|
| Rate for Payer: Humana Commercial |
$7,069.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,820.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,138.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,495.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,319.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,237.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,653.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,236.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,738.95
|
| Rate for Payer: PHCS Commercial |
$7,984.63
|
| Rate for Payer: United Healthcare All Payer |
$7,319.24
|
|
|
UNI EIUS TIB XLARGE 10MM LM/RL
|
Facility
|
OP
|
$8,317.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,495.20 |
| Max. Negotiated Rate |
$7,984.63 |
| Rate for Payer: Aetna Commercial |
$6,404.34
|
| Rate for Payer: Anthem Medicaid |
$2,860.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,487.51
|
| Rate for Payer: Cash Price |
$4,158.66
|
| Rate for Payer: Cigna Commercial |
$6,903.38
|
| Rate for Payer: First Health Commercial |
$7,901.45
|
| Rate for Payer: Humana Commercial |
$7,069.72
|
| Rate for Payer: Humana KY Medicaid |
$2,860.33
|
| Rate for Payer: Kentucky WC Medicaid |
$2,889.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,820.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,138.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,495.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,917.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,319.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,237.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,653.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,236.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,738.95
|
| Rate for Payer: PHCS Commercial |
$7,984.63
|
| Rate for Payer: United Healthcare All Payer |
$7,319.24
|
|
|
UNI EIUS TIB XLARGE 10MM RM/LL
|
Facility
|
OP
|
$8,317.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,495.20 |
| Max. Negotiated Rate |
$7,984.63 |
| Rate for Payer: Aetna Commercial |
$6,404.34
|
| Rate for Payer: Anthem Medicaid |
$2,860.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,487.51
|
| Rate for Payer: Cash Price |
$4,158.66
|
| Rate for Payer: Cigna Commercial |
$6,903.38
|
| Rate for Payer: First Health Commercial |
$7,901.45
|
| Rate for Payer: Humana Commercial |
$7,069.72
|
| Rate for Payer: Humana KY Medicaid |
$2,860.33
|
| Rate for Payer: Kentucky WC Medicaid |
$2,889.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,820.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,138.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,495.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,917.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,319.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,237.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,653.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,236.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,738.95
|
| Rate for Payer: PHCS Commercial |
$7,984.63
|
| Rate for Payer: United Healthcare All Payer |
$7,319.24
|
|
|
UNI EIUS TIB XLARGE 10MM RM/LL
|
Facility
|
IP
|
$8,317.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,495.20 |
| Max. Negotiated Rate |
$7,984.63 |
| Rate for Payer: Aetna Commercial |
$6,404.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,487.51
|
| Rate for Payer: Cash Price |
$4,158.66
|
| Rate for Payer: Cigna Commercial |
$6,903.38
|
| Rate for Payer: First Health Commercial |
$7,901.45
|
| Rate for Payer: Humana Commercial |
$7,069.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,820.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,138.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,495.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,319.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,237.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,653.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,236.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,738.95
|
| Rate for Payer: PHCS Commercial |
$7,984.63
|
| Rate for Payer: United Healthcare All Payer |
$7,319.24
|
|
|
UNI EIUS TIB XLARGE 12MM LM/RL
|
Facility
|
IP
|
$8,317.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,495.20 |
| Max. Negotiated Rate |
$7,984.63 |
| Rate for Payer: Aetna Commercial |
$6,404.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,487.51
|
| Rate for Payer: Cash Price |
$4,158.66
|
| Rate for Payer: Cigna Commercial |
$6,903.38
|
| Rate for Payer: First Health Commercial |
$7,901.45
|
| Rate for Payer: Humana Commercial |
$7,069.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,820.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,138.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,495.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,319.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,237.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,653.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,236.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,738.95
|
| Rate for Payer: PHCS Commercial |
$7,984.63
|
| Rate for Payer: United Healthcare All Payer |
$7,319.24
|
|
|
UNI EIUS TIB XLARGE 12MM LM/RL
|
Facility
|
OP
|
$8,317.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,495.20 |
| Max. Negotiated Rate |
$7,984.63 |
| Rate for Payer: Aetna Commercial |
$6,404.34
|
| Rate for Payer: Anthem Medicaid |
$2,860.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,487.51
|
| Rate for Payer: Cash Price |
$4,158.66
|
| Rate for Payer: Cigna Commercial |
$6,903.38
|
| Rate for Payer: First Health Commercial |
$7,901.45
|
| Rate for Payer: Humana Commercial |
$7,069.72
|
| Rate for Payer: Humana KY Medicaid |
$2,860.33
|
| Rate for Payer: Kentucky WC Medicaid |
$2,889.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,820.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,138.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,495.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,917.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,319.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,237.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,653.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,236.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,738.95
|
| Rate for Payer: PHCS Commercial |
$7,984.63
|
| Rate for Payer: United Healthcare All Payer |
$7,319.24
|
|
|
UNI EIUS TIB XLARGE 12MM RM/LL
|
Facility
|
OP
|
$8,317.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,495.20 |
| Max. Negotiated Rate |
$7,984.63 |
| Rate for Payer: Aetna Commercial |
$6,404.34
|
| Rate for Payer: Anthem Medicaid |
$2,860.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,487.51
|
| Rate for Payer: Cash Price |
$4,158.66
|
| Rate for Payer: Cigna Commercial |
$6,903.38
|
| Rate for Payer: First Health Commercial |
$7,901.45
|
| Rate for Payer: Humana Commercial |
$7,069.72
|
| Rate for Payer: Humana KY Medicaid |
$2,860.33
|
| Rate for Payer: Kentucky WC Medicaid |
$2,889.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,820.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,138.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,495.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,917.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,319.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,237.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,653.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,236.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,738.95
|
| Rate for Payer: PHCS Commercial |
$7,984.63
|
| Rate for Payer: United Healthcare All Payer |
$7,319.24
|
|
|
UNI EIUS TIB XLARGE 12MM RM/LL
|
Facility
|
IP
|
$8,317.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,495.20 |
| Max. Negotiated Rate |
$7,984.63 |
| Rate for Payer: Aetna Commercial |
$6,404.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,487.51
|
| Rate for Payer: Cash Price |
$4,158.66
|
| Rate for Payer: Cigna Commercial |
$6,903.38
|
| Rate for Payer: First Health Commercial |
$7,901.45
|
| Rate for Payer: Humana Commercial |
$7,069.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,820.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,138.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,495.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,319.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,237.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,653.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,236.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,738.95
|
| Rate for Payer: PHCS Commercial |
$7,984.63
|
| Rate for Payer: United Healthcare All Payer |
$7,319.24
|
|
|
UNI EIUS TIB XLARGE 8MM LM/RL
|
Facility
|
OP
|
$8,317.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,495.20 |
| Max. Negotiated Rate |
$7,984.63 |
| Rate for Payer: Aetna Commercial |
$6,404.34
|
| Rate for Payer: Anthem Medicaid |
$2,860.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,487.51
|
| Rate for Payer: Cash Price |
$4,158.66
|
| Rate for Payer: Cigna Commercial |
$6,903.38
|
| Rate for Payer: First Health Commercial |
$7,901.45
|
| Rate for Payer: Humana Commercial |
$7,069.72
|
| Rate for Payer: Humana KY Medicaid |
$2,860.33
|
| Rate for Payer: Kentucky WC Medicaid |
$2,889.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,820.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,138.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,495.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,917.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,319.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,237.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,653.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,236.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,738.95
|
| Rate for Payer: PHCS Commercial |
$7,984.63
|
| Rate for Payer: United Healthcare All Payer |
$7,319.24
|
|
|
UNI EIUS TIB XLARGE 8MM LM/RL
|
Facility
|
IP
|
$8,317.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,495.20 |
| Max. Negotiated Rate |
$7,984.63 |
| Rate for Payer: Aetna Commercial |
$6,404.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,487.51
|
| Rate for Payer: Cash Price |
$4,158.66
|
| Rate for Payer: Cigna Commercial |
$6,903.38
|
| Rate for Payer: First Health Commercial |
$7,901.45
|
| Rate for Payer: Humana Commercial |
$7,069.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,820.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,138.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,495.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,319.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,237.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,653.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,236.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,738.95
|
| Rate for Payer: PHCS Commercial |
$7,984.63
|
| Rate for Payer: United Healthcare All Payer |
$7,319.24
|
|
|
UNI EIUS TIB XLARGE 8MM RM/LL
|
Facility
|
OP
|
$8,317.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,495.20 |
| Max. Negotiated Rate |
$7,984.63 |
| Rate for Payer: Aetna Commercial |
$6,404.34
|
| Rate for Payer: Anthem Medicaid |
$2,860.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,487.51
|
| Rate for Payer: Cash Price |
$4,158.66
|
| Rate for Payer: Cigna Commercial |
$6,903.38
|
| Rate for Payer: First Health Commercial |
$7,901.45
|
| Rate for Payer: Humana Commercial |
$7,069.72
|
| Rate for Payer: Humana KY Medicaid |
$2,860.33
|
| Rate for Payer: Kentucky WC Medicaid |
$2,889.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,820.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,138.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,495.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,917.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,319.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,237.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,653.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,236.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,738.95
|
| Rate for Payer: PHCS Commercial |
$7,984.63
|
| Rate for Payer: United Healthcare All Payer |
$7,319.24
|
|
|
UNI EIUS TIB XLARGE 8MM RM/LL
|
Facility
|
IP
|
$8,317.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,495.20 |
| Max. Negotiated Rate |
$7,984.63 |
| Rate for Payer: Aetna Commercial |
$6,404.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,487.51
|
| Rate for Payer: Cash Price |
$4,158.66
|
| Rate for Payer: Cigna Commercial |
$6,903.38
|
| Rate for Payer: First Health Commercial |
$7,901.45
|
| Rate for Payer: Humana Commercial |
$7,069.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,820.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,138.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,495.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,319.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,237.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,653.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,236.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,738.95
|
| Rate for Payer: PHCS Commercial |
$7,984.63
|
| Rate for Payer: United Healthcare All Payer |
$7,319.24
|
|
