|
UNITRAX ENDO HEAD 46MM
|
Facility
|
IP
|
$6,905.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,071.65 |
| Max. Negotiated Rate |
$6,629.28 |
| Rate for Payer: Aetna Commercial |
$5,317.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.29
|
| Rate for Payer: Cash Price |
$3,452.75
|
| Rate for Payer: Cigna Commercial |
$5,731.56
|
| Rate for Payer: First Health Commercial |
$6,560.23
|
| Rate for Payer: Humana Commercial |
$5,869.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,524.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,007.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,764.80
|
| Rate for Payer: PHCS Commercial |
$6,629.28
|
| Rate for Payer: United Healthcare All Payer |
$6,076.84
|
|
|
UNITRAX ENDO HEAD 46MM
|
Facility
|
OP
|
$6,905.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,071.65 |
| Max. Negotiated Rate |
$6,629.28 |
| Rate for Payer: Aetna Commercial |
$5,317.23
|
| Rate for Payer: Anthem Medicaid |
$2,374.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.29
|
| Rate for Payer: Cash Price |
$3,452.75
|
| Rate for Payer: Cigna Commercial |
$5,731.56
|
| Rate for Payer: First Health Commercial |
$6,560.23
|
| Rate for Payer: Humana Commercial |
$5,869.68
|
| Rate for Payer: Humana KY Medicaid |
$2,374.80
|
| Rate for Payer: Kentucky WC Medicaid |
$2,398.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,422.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,524.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,007.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,764.80
|
| Rate for Payer: PHCS Commercial |
$6,629.28
|
| Rate for Payer: United Healthcare All Payer |
$6,076.84
|
|
|
UNITRAX ENDO HEAD 47MM
|
Facility
|
IP
|
$6,905.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,071.65 |
| Max. Negotiated Rate |
$6,629.28 |
| Rate for Payer: Aetna Commercial |
$5,317.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.29
|
| Rate for Payer: Cash Price |
$3,452.75
|
| Rate for Payer: Cigna Commercial |
$5,731.56
|
| Rate for Payer: First Health Commercial |
$6,560.23
|
| Rate for Payer: Humana Commercial |
$5,869.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,524.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,007.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,764.80
|
| Rate for Payer: PHCS Commercial |
$6,629.28
|
| Rate for Payer: United Healthcare All Payer |
$6,076.84
|
|
|
UNITRAX ENDO HEAD 47MM
|
Facility
|
OP
|
$6,905.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,071.65 |
| Max. Negotiated Rate |
$6,629.28 |
| Rate for Payer: Aetna Commercial |
$5,317.23
|
| Rate for Payer: Anthem Medicaid |
$2,374.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.29
|
| Rate for Payer: Cash Price |
$3,452.75
|
| Rate for Payer: Cigna Commercial |
$5,731.56
|
| Rate for Payer: First Health Commercial |
$6,560.23
|
| Rate for Payer: Humana Commercial |
$5,869.68
|
| Rate for Payer: Humana KY Medicaid |
$2,374.80
|
| Rate for Payer: Kentucky WC Medicaid |
$2,398.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,422.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,524.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,007.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,764.80
|
| Rate for Payer: PHCS Commercial |
$6,629.28
|
| Rate for Payer: United Healthcare All Payer |
$6,076.84
|
|
|
UNITRAX ENDO HEAD 48MM
|
Facility
|
IP
|
$6,905.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,071.65 |
| Max. Negotiated Rate |
$6,629.28 |
| Rate for Payer: Aetna Commercial |
$5,317.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.29
|
| Rate for Payer: Cash Price |
$3,452.75
|
| Rate for Payer: Cigna Commercial |
$5,731.56
|
| Rate for Payer: First Health Commercial |
$6,560.23
|
| Rate for Payer: Humana Commercial |
$5,869.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,524.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,007.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,764.80
|
| Rate for Payer: PHCS Commercial |
$6,629.28
|
| Rate for Payer: United Healthcare All Payer |
$6,076.84
|
|
|
UNITRAX ENDO HEAD 48MM
|
Facility
|
OP
|
$6,905.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,071.65 |
| Max. Negotiated Rate |
$6,629.28 |
| Rate for Payer: Aetna Commercial |
$5,317.23
|
| Rate for Payer: Anthem Medicaid |
$2,374.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.29
|
| Rate for Payer: Cash Price |
$3,452.75
|
| Rate for Payer: Cigna Commercial |
$5,731.56
|
| Rate for Payer: First Health Commercial |
$6,560.23
|
| Rate for Payer: Humana Commercial |
$5,869.68
|
| Rate for Payer: Humana KY Medicaid |
$2,374.80
|
| Rate for Payer: Kentucky WC Medicaid |
$2,398.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,422.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,524.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,007.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,764.80
|
| Rate for Payer: PHCS Commercial |
$6,629.28
|
| Rate for Payer: United Healthcare All Payer |
$6,076.84
|
|
|
UNITRAX ENDO HEAD 49MM
|
Facility
|
IP
|
$6,905.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,071.65 |
| Max. Negotiated Rate |
$6,629.28 |
| Rate for Payer: Aetna Commercial |
$5,317.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.29
|
| Rate for Payer: Cash Price |
$3,452.75
|
| Rate for Payer: Cigna Commercial |
$5,731.56
|
| Rate for Payer: First Health Commercial |
$6,560.23
|
| Rate for Payer: Humana Commercial |
$5,869.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,524.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,007.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,764.80
|
| Rate for Payer: PHCS Commercial |
$6,629.28
|
| Rate for Payer: United Healthcare All Payer |
$6,076.84
|
|
|
UNITRAX ENDO HEAD 49MM
|
Facility
|
OP
|
$6,905.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,071.65 |
| Max. Negotiated Rate |
$6,629.28 |
| Rate for Payer: Aetna Commercial |
$5,317.23
|
| Rate for Payer: Anthem Medicaid |
$2,374.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.29
|
| Rate for Payer: Cash Price |
$3,452.75
|
| Rate for Payer: Cigna Commercial |
$5,731.56
|
| Rate for Payer: First Health Commercial |
$6,560.23
|
| Rate for Payer: Humana Commercial |
$5,869.68
|
| Rate for Payer: Humana KY Medicaid |
$2,374.80
|
| Rate for Payer: Kentucky WC Medicaid |
$2,398.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,422.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,524.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,007.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,764.80
|
| Rate for Payer: PHCS Commercial |
$6,629.28
|
| Rate for Payer: United Healthcare All Payer |
$6,076.84
|
|
|
UNITRAX ENDO HEAD 50MM
|
Facility
|
IP
|
$6,905.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,071.65 |
| Max. Negotiated Rate |
$6,629.28 |
| Rate for Payer: Aetna Commercial |
$5,317.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.29
|
| Rate for Payer: Cash Price |
$3,452.75
|
| Rate for Payer: Cigna Commercial |
$5,731.56
|
| Rate for Payer: First Health Commercial |
$6,560.23
|
| Rate for Payer: Humana Commercial |
$5,869.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,524.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,007.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,764.80
|
| Rate for Payer: PHCS Commercial |
$6,629.28
|
| Rate for Payer: United Healthcare All Payer |
$6,076.84
|
|
|
UNITRAX ENDO HEAD 50MM
|
Facility
|
OP
|
$6,905.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,071.65 |
| Max. Negotiated Rate |
$6,629.28 |
| Rate for Payer: Aetna Commercial |
$5,317.23
|
| Rate for Payer: Anthem Medicaid |
$2,374.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.29
|
| Rate for Payer: Cash Price |
$3,452.75
|
| Rate for Payer: Cigna Commercial |
$5,731.56
|
| Rate for Payer: First Health Commercial |
$6,560.23
|
| Rate for Payer: Humana Commercial |
$5,869.68
|
| Rate for Payer: Humana KY Medicaid |
$2,374.80
|
| Rate for Payer: Kentucky WC Medicaid |
$2,398.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,422.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,524.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,007.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,764.80
|
| Rate for Payer: PHCS Commercial |
$6,629.28
|
| Rate for Payer: United Healthcare All Payer |
$6,076.84
|
|
|
UNITRAX ENDO HEAD 51MM
|
Facility
|
IP
|
$6,905.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,071.65 |
| Max. Negotiated Rate |
$6,629.28 |
| Rate for Payer: Aetna Commercial |
$5,317.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.29
|
| Rate for Payer: Cash Price |
$3,452.75
|
| Rate for Payer: Cigna Commercial |
$5,731.56
|
| Rate for Payer: First Health Commercial |
$6,560.23
|
| Rate for Payer: Humana Commercial |
$5,869.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,524.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,007.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,764.80
|
| Rate for Payer: PHCS Commercial |
$6,629.28
|
| Rate for Payer: United Healthcare All Payer |
$6,076.84
|
|
|
UNITRAX ENDO HEAD 51MM
|
Facility
|
OP
|
$6,905.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,071.65 |
| Max. Negotiated Rate |
$6,629.28 |
| Rate for Payer: Aetna Commercial |
$5,317.23
|
| Rate for Payer: Anthem Medicaid |
$2,374.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.29
|
| Rate for Payer: Cash Price |
$3,452.75
|
| Rate for Payer: Cigna Commercial |
$5,731.56
|
| Rate for Payer: First Health Commercial |
$6,560.23
|
| Rate for Payer: Humana Commercial |
$5,869.68
|
| Rate for Payer: Humana KY Medicaid |
$2,374.80
|
| Rate for Payer: Kentucky WC Medicaid |
$2,398.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,422.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,524.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,007.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,764.80
|
| Rate for Payer: PHCS Commercial |
$6,629.28
|
| Rate for Payer: United Healthcare All Payer |
$6,076.84
|
|
|
UNITRAX ENDO HEAD 52MM
|
Facility
|
OP
|
$6,905.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,071.65 |
| Max. Negotiated Rate |
$6,629.28 |
| Rate for Payer: Aetna Commercial |
$5,317.23
|
| Rate for Payer: Anthem Medicaid |
$2,374.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.29
|
| Rate for Payer: Cash Price |
$3,452.75
|
| Rate for Payer: Cigna Commercial |
$5,731.56
|
| Rate for Payer: First Health Commercial |
$6,560.23
|
| Rate for Payer: Humana Commercial |
$5,869.68
|
| Rate for Payer: Humana KY Medicaid |
$2,374.80
|
| Rate for Payer: Kentucky WC Medicaid |
$2,398.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,422.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,524.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,007.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,764.80
|
| Rate for Payer: PHCS Commercial |
$6,629.28
|
| Rate for Payer: United Healthcare All Payer |
$6,076.84
|
|
|
UNITRAX ENDO HEAD 52MM
|
Facility
|
IP
|
$6,905.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,071.65 |
| Max. Negotiated Rate |
$6,629.28 |
| Rate for Payer: Aetna Commercial |
$5,317.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.29
|
| Rate for Payer: Cash Price |
$3,452.75
|
| Rate for Payer: Cigna Commercial |
$5,731.56
|
| Rate for Payer: First Health Commercial |
$6,560.23
|
| Rate for Payer: Humana Commercial |
$5,869.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,524.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,007.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,764.80
|
| Rate for Payer: PHCS Commercial |
$6,629.28
|
| Rate for Payer: United Healthcare All Payer |
$6,076.84
|
|
|
UNITRAX ENDO HEAD 53MM
|
Facility
|
OP
|
$6,905.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,071.65 |
| Max. Negotiated Rate |
$6,629.28 |
| Rate for Payer: Aetna Commercial |
$5,317.23
|
| Rate for Payer: Anthem Medicaid |
$2,374.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.29
|
| Rate for Payer: Cash Price |
$3,452.75
|
| Rate for Payer: Cigna Commercial |
$5,731.56
|
| Rate for Payer: First Health Commercial |
$6,560.23
|
| Rate for Payer: Humana Commercial |
$5,869.68
|
| Rate for Payer: Humana KY Medicaid |
$2,374.80
|
| Rate for Payer: Kentucky WC Medicaid |
$2,398.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,422.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,524.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,007.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,764.80
|
| Rate for Payer: PHCS Commercial |
$6,629.28
|
| Rate for Payer: United Healthcare All Payer |
$6,076.84
|
|
|
UNITRAX ENDO HEAD 53MM
|
Facility
|
IP
|
$6,905.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,071.65 |
| Max. Negotiated Rate |
$6,629.28 |
| Rate for Payer: Aetna Commercial |
$5,317.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.29
|
| Rate for Payer: Cash Price |
$3,452.75
|
| Rate for Payer: Cigna Commercial |
$5,731.56
|
| Rate for Payer: First Health Commercial |
$6,560.23
|
| Rate for Payer: Humana Commercial |
$5,869.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,524.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,007.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,764.80
|
| Rate for Payer: PHCS Commercial |
$6,629.28
|
| Rate for Payer: United Healthcare All Payer |
$6,076.84
|
|
|
UNITRAX ENDO HEAD 54MM
|
Facility
|
IP
|
$6,905.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,071.65 |
| Max. Negotiated Rate |
$6,629.28 |
| Rate for Payer: Aetna Commercial |
$5,317.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.29
|
| Rate for Payer: Cash Price |
$3,452.75
|
| Rate for Payer: Cigna Commercial |
$5,731.56
|
| Rate for Payer: First Health Commercial |
$6,560.23
|
| Rate for Payer: Humana Commercial |
$5,869.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,524.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,007.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,764.80
|
| Rate for Payer: PHCS Commercial |
$6,629.28
|
| Rate for Payer: United Healthcare All Payer |
$6,076.84
|
|
|
UNITRAX ENDO HEAD 54MM
|
Facility
|
OP
|
$6,905.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,071.65 |
| Max. Negotiated Rate |
$6,629.28 |
| Rate for Payer: Aetna Commercial |
$5,317.23
|
| Rate for Payer: Anthem Medicaid |
$2,374.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.29
|
| Rate for Payer: Cash Price |
$3,452.75
|
| Rate for Payer: Cigna Commercial |
$5,731.56
|
| Rate for Payer: First Health Commercial |
$6,560.23
|
| Rate for Payer: Humana Commercial |
$5,869.68
|
| Rate for Payer: Humana KY Medicaid |
$2,374.80
|
| Rate for Payer: Kentucky WC Medicaid |
$2,398.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,422.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,524.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,007.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,764.80
|
| Rate for Payer: PHCS Commercial |
$6,629.28
|
| Rate for Payer: United Healthcare All Payer |
$6,076.84
|
|
|
UNITRAX ENDO HEAD 55MM
|
Facility
|
OP
|
$6,905.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,071.65 |
| Max. Negotiated Rate |
$6,629.28 |
| Rate for Payer: Aetna Commercial |
$5,317.23
|
| Rate for Payer: Anthem Medicaid |
$2,374.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.29
|
| Rate for Payer: Cash Price |
$3,452.75
|
| Rate for Payer: Cigna Commercial |
$5,731.56
|
| Rate for Payer: First Health Commercial |
$6,560.23
|
| Rate for Payer: Humana Commercial |
$5,869.68
|
| Rate for Payer: Humana KY Medicaid |
$2,374.80
|
| Rate for Payer: Kentucky WC Medicaid |
$2,398.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,422.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,524.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,007.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,764.80
|
| Rate for Payer: PHCS Commercial |
$6,629.28
|
| Rate for Payer: United Healthcare All Payer |
$6,076.84
|
|
|
UNITRAX ENDO HEAD 55MM
|
Facility
|
IP
|
$6,905.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,071.65 |
| Max. Negotiated Rate |
$6,629.28 |
| Rate for Payer: Aetna Commercial |
$5,317.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.29
|
| Rate for Payer: Cash Price |
$3,452.75
|
| Rate for Payer: Cigna Commercial |
$5,731.56
|
| Rate for Payer: First Health Commercial |
$6,560.23
|
| Rate for Payer: Humana Commercial |
$5,869.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,524.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,007.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,764.80
|
| Rate for Payer: PHCS Commercial |
$6,629.28
|
| Rate for Payer: United Healthcare All Payer |
$6,076.84
|
|
|
UNITRAX ENDO HEAD 56MM
|
Facility
|
IP
|
$3,290.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$987.00 |
| Max. Negotiated Rate |
$3,158.40 |
| Rate for Payer: Aetna Commercial |
$2,533.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,566.20
|
| Rate for Payer: Cash Price |
$1,645.00
|
| Rate for Payer: Cigna Commercial |
$2,730.70
|
| Rate for Payer: First Health Commercial |
$3,125.50
|
| Rate for Payer: Humana Commercial |
$2,796.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,697.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,428.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$987.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,895.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,467.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,632.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,862.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,270.10
|
| Rate for Payer: PHCS Commercial |
$3,158.40
|
| Rate for Payer: United Healthcare All Payer |
$2,895.20
|
|
|
UNITRAX ENDO HEAD 56MM
|
Facility
|
OP
|
$3,290.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$987.00 |
| Max. Negotiated Rate |
$3,158.40 |
| Rate for Payer: Aetna Commercial |
$2,533.30
|
| Rate for Payer: Anthem Medicaid |
$1,131.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,566.20
|
| Rate for Payer: Cash Price |
$1,645.00
|
| Rate for Payer: Cigna Commercial |
$2,730.70
|
| Rate for Payer: First Health Commercial |
$3,125.50
|
| Rate for Payer: Humana Commercial |
$2,796.50
|
| Rate for Payer: Humana KY Medicaid |
$1,131.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,142.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,697.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,428.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$987.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,154.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,895.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,467.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,632.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,862.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,270.10
|
| Rate for Payer: PHCS Commercial |
$3,158.40
|
| Rate for Payer: United Healthcare All Payer |
$2,895.20
|
|
|
UNITRAX ENDO HEAD 58MM
|
Facility
|
OP
|
$6,905.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,071.65 |
| Max. Negotiated Rate |
$6,629.28 |
| Rate for Payer: Aetna Commercial |
$5,317.23
|
| Rate for Payer: Anthem Medicaid |
$2,374.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.29
|
| Rate for Payer: Cash Price |
$3,452.75
|
| Rate for Payer: Cigna Commercial |
$5,731.56
|
| Rate for Payer: First Health Commercial |
$6,560.23
|
| Rate for Payer: Humana Commercial |
$5,869.68
|
| Rate for Payer: Humana KY Medicaid |
$2,374.80
|
| Rate for Payer: Kentucky WC Medicaid |
$2,398.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,422.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,524.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,007.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,764.80
|
| Rate for Payer: PHCS Commercial |
$6,629.28
|
| Rate for Payer: United Healthcare All Payer |
$6,076.84
|
|
|
UNITRAX ENDO HEAD 58MM
|
Facility
|
IP
|
$6,905.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,071.65 |
| Max. Negotiated Rate |
$6,629.28 |
| Rate for Payer: Aetna Commercial |
$5,317.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.29
|
| Rate for Payer: Cash Price |
$3,452.75
|
| Rate for Payer: Cigna Commercial |
$5,731.56
|
| Rate for Payer: First Health Commercial |
$6,560.23
|
| Rate for Payer: Humana Commercial |
$5,869.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,524.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,007.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,764.80
|
| Rate for Payer: PHCS Commercial |
$6,629.28
|
| Rate for Payer: United Healthcare All Payer |
$6,076.84
|
|
|
UNIVERSAL FIT HEARING PROTECT
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS V5299
|
| Hospital Charge Code |
47000120
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
