|
UNIVERSAL FIT HEARING PROTECT
|
Facility
|
OP
|
$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 Medicaid |
$103.17
|
| 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: Humana KY Medicaid |
$103.17
|
| Rate for Payer: Kentucky WC Medicaid |
$104.22
|
| 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: Molina Healthcare Medicaid |
$105.24
|
| 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
|
|
|
UNIVERSAL FIT HEAR PROTECT SP
|
Professional
|
Both
|
$300.00
|
|
| Hospital Charge Code |
47000122
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
|
|
UNIVERSAL HEAD 26MM ID 41MM OD
|
Facility
|
IP
|
$5,010.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,503.15 |
| Max. Negotiated Rate |
$4,810.08 |
| Rate for Payer: Aetna Commercial |
$3,858.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,908.19
|
| Rate for Payer: Cash Price |
$2,505.25
|
| Rate for Payer: Cigna Commercial |
$4,158.72
|
| Rate for Payer: First Health Commercial |
$4,759.98
|
| Rate for Payer: Humana Commercial |
$4,258.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,108.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,697.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,503.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,409.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,757.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,008.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,359.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,457.24
|
| Rate for Payer: PHCS Commercial |
$4,810.08
|
| Rate for Payer: United Healthcare All Payer |
$4,409.24
|
|
|
UNIVERSAL HEAD 26MM ID 41MM OD
|
Facility
|
OP
|
$5,010.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,503.15 |
| Max. Negotiated Rate |
$4,810.08 |
| Rate for Payer: Aetna Commercial |
$3,858.09
|
| Rate for Payer: Anthem Medicaid |
$1,723.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,908.19
|
| Rate for Payer: Cash Price |
$2,505.25
|
| Rate for Payer: Cigna Commercial |
$4,158.72
|
| Rate for Payer: First Health Commercial |
$4,759.98
|
| Rate for Payer: Humana Commercial |
$4,258.93
|
| Rate for Payer: Humana KY Medicaid |
$1,723.11
|
| Rate for Payer: Kentucky WC Medicaid |
$1,740.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,108.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,697.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,503.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,757.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,409.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,757.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,008.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,359.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,457.24
|
| Rate for Payer: PHCS Commercial |
$4,810.08
|
| Rate for Payer: United Healthcare All Payer |
$4,409.24
|
|
|
UNIVERSAL HEAD 26MM ID 42MM OD
|
Facility
|
OP
|
$5,010.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,503.15 |
| Max. Negotiated Rate |
$4,810.08 |
| Rate for Payer: Aetna Commercial |
$3,858.09
|
| Rate for Payer: Anthem Medicaid |
$1,723.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,908.19
|
| Rate for Payer: Cash Price |
$2,505.25
|
| Rate for Payer: Cigna Commercial |
$4,158.72
|
| Rate for Payer: First Health Commercial |
$4,759.98
|
| Rate for Payer: Humana Commercial |
$4,258.93
|
| Rate for Payer: Humana KY Medicaid |
$1,723.11
|
| Rate for Payer: Kentucky WC Medicaid |
$1,740.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,108.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,697.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,503.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,757.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,409.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,757.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,008.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,359.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,457.24
|
| Rate for Payer: PHCS Commercial |
$4,810.08
|
| Rate for Payer: United Healthcare All Payer |
$4,409.24
|
|
|
UNIVERSAL HEAD 26MM ID 42MM OD
|
Facility
|
IP
|
$5,010.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,503.15 |
| Max. Negotiated Rate |
$4,810.08 |
| Rate for Payer: Aetna Commercial |
$3,858.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,908.19
|
| Rate for Payer: Cash Price |
$2,505.25
|
| Rate for Payer: Cigna Commercial |
$4,158.72
|
| Rate for Payer: First Health Commercial |
$4,759.98
|
| Rate for Payer: Humana Commercial |
$4,258.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,108.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,697.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,503.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,409.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,757.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,008.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,359.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,457.24
|
| Rate for Payer: PHCS Commercial |
$4,810.08
|
| Rate for Payer: United Healthcare All Payer |
$4,409.24
|
|
|
UNIVERSAL HEAD 26MM ID 43MM OD
|
Facility
|
OP
|
$5,010.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,503.15 |
| Max. Negotiated Rate |
$4,810.08 |
| Rate for Payer: Aetna Commercial |
$3,858.09
|
| Rate for Payer: Anthem Medicaid |
$1,723.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,908.19
|
| Rate for Payer: Cash Price |
$2,505.25
|
| Rate for Payer: Cigna Commercial |
$4,158.72
|
| Rate for Payer: First Health Commercial |
$4,759.98
|
| Rate for Payer: Humana Commercial |
$4,258.93
|
| Rate for Payer: Humana KY Medicaid |
$1,723.11
|
| Rate for Payer: Kentucky WC Medicaid |
$1,740.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,108.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,697.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,503.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,757.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,409.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,757.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,008.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,359.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,457.24
|
| Rate for Payer: PHCS Commercial |
$4,810.08
|
| Rate for Payer: United Healthcare All Payer |
$4,409.24
|
|
|
UNIVERSAL HEAD 26MM ID 43MM OD
|
Facility
|
IP
|
$5,010.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,503.15 |
| Max. Negotiated Rate |
$4,810.08 |
| Rate for Payer: Aetna Commercial |
$3,858.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,908.19
|
| Rate for Payer: Cash Price |
$2,505.25
|
| Rate for Payer: Cigna Commercial |
$4,158.72
|
| Rate for Payer: First Health Commercial |
$4,759.98
|
| Rate for Payer: Humana Commercial |
$4,258.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,108.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,697.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,503.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,409.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,757.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,008.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,359.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,457.24
|
| Rate for Payer: PHCS Commercial |
$4,810.08
|
| Rate for Payer: United Healthcare All Payer |
$4,409.24
|
|
|
UNIVERSAL HEAD 26MM ID 44MM OD
|
Facility
|
IP
|
$6,793.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,037.92 |
| Max. Negotiated Rate |
$6,521.36 |
| Rate for Payer: Aetna Commercial |
$5,230.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,298.60
|
| Rate for Payer: Cash Price |
$3,396.54
|
| Rate for Payer: Cigna Commercial |
$5,638.26
|
| Rate for Payer: First Health Commercial |
$6,453.43
|
| Rate for Payer: Humana Commercial |
$5,774.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,570.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,013.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,037.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,977.91
|
| Rate for Payer: Ohio Health Group HMO |
$5,094.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,434.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,909.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,687.23
|
| Rate for Payer: PHCS Commercial |
$6,521.36
|
| Rate for Payer: United Healthcare All Payer |
$5,977.91
|
|
|
UNIVERSAL HEAD 26MM ID 44MM OD
|
Facility
|
OP
|
$6,793.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,037.92 |
| Max. Negotiated Rate |
$6,521.36 |
| Rate for Payer: Aetna Commercial |
$5,230.67
|
| Rate for Payer: Anthem Medicaid |
$2,336.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,298.60
|
| Rate for Payer: Cash Price |
$3,396.54
|
| Rate for Payer: Cigna Commercial |
$5,638.26
|
| Rate for Payer: First Health Commercial |
$6,453.43
|
| Rate for Payer: Humana Commercial |
$5,774.12
|
| Rate for Payer: Humana KY Medicaid |
$2,336.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,359.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,570.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,013.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,037.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,383.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,977.91
|
| Rate for Payer: Ohio Health Group HMO |
$5,094.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,434.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,909.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,687.23
|
| Rate for Payer: PHCS Commercial |
$6,521.36
|
| Rate for Payer: United Healthcare All Payer |
$5,977.91
|
|
|
UNIVERSAL HEAD 26MM ID 45MM OD
|
Facility
|
IP
|
$6,906.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,072.09 |
| Max. Negotiated Rate |
$6,630.68 |
| Rate for Payer: Aetna Commercial |
$5,318.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,387.43
|
| Rate for Payer: Cash Price |
$3,453.48
|
| Rate for Payer: Cigna Commercial |
$5,732.78
|
| Rate for Payer: First Health Commercial |
$6,561.61
|
| Rate for Payer: Humana Commercial |
$5,870.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,663.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,097.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,072.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,078.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,180.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,525.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,009.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,765.80
|
| Rate for Payer: PHCS Commercial |
$6,630.68
|
| Rate for Payer: United Healthcare All Payer |
$6,078.12
|
|
|
UNIVERSAL HEAD 26MM ID 45MM OD
|
Facility
|
OP
|
$6,906.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,072.09 |
| Max. Negotiated Rate |
$6,630.68 |
| Rate for Payer: Aetna Commercial |
$5,318.36
|
| Rate for Payer: Anthem Medicaid |
$2,375.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,387.43
|
| Rate for Payer: Cash Price |
$3,453.48
|
| Rate for Payer: Cigna Commercial |
$5,732.78
|
| Rate for Payer: First Health Commercial |
$6,561.61
|
| Rate for Payer: Humana Commercial |
$5,870.92
|
| Rate for Payer: Humana KY Medicaid |
$2,375.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,399.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,663.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,097.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,072.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,422.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,078.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,180.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,525.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,009.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,765.80
|
| Rate for Payer: PHCS Commercial |
$6,630.68
|
| Rate for Payer: United Healthcare All Payer |
$6,078.12
|
|
|
UNIVERSAL HEAD 26MM ID 46MM OD
|
Facility
|
OP
|
$6,793.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,037.92 |
| Max. Negotiated Rate |
$6,521.36 |
| Rate for Payer: Aetna Commercial |
$5,230.67
|
| Rate for Payer: Anthem Medicaid |
$2,336.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,298.60
|
| Rate for Payer: Cash Price |
$3,396.54
|
| Rate for Payer: Cigna Commercial |
$5,638.26
|
| Rate for Payer: First Health Commercial |
$6,453.43
|
| Rate for Payer: Humana Commercial |
$5,774.12
|
| Rate for Payer: Humana KY Medicaid |
$2,336.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,359.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,570.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,013.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,037.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,383.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,977.91
|
| Rate for Payer: Ohio Health Group HMO |
$5,094.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,434.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,909.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,687.23
|
| Rate for Payer: PHCS Commercial |
$6,521.36
|
| Rate for Payer: United Healthcare All Payer |
$5,977.91
|
|
|
UNIVERSAL HEAD 26MM ID 46MM OD
|
Facility
|
IP
|
$6,793.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,037.92 |
| Max. Negotiated Rate |
$6,521.36 |
| Rate for Payer: Aetna Commercial |
$5,230.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,298.60
|
| Rate for Payer: Cash Price |
$3,396.54
|
| Rate for Payer: Cigna Commercial |
$5,638.26
|
| Rate for Payer: First Health Commercial |
$6,453.43
|
| Rate for Payer: Humana Commercial |
$5,774.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,570.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,013.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,037.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,977.91
|
| Rate for Payer: Ohio Health Group HMO |
$5,094.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,434.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,909.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,687.23
|
| Rate for Payer: PHCS Commercial |
$6,521.36
|
| Rate for Payer: United Healthcare All Payer |
$5,977.91
|
|
|
UNIVERSAL HEAD 26MM ID 47MM OD
|
Facility
|
IP
|
$6,793.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,037.92 |
| Max. Negotiated Rate |
$6,521.36 |
| Rate for Payer: Aetna Commercial |
$5,230.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,298.60
|
| Rate for Payer: Cash Price |
$3,396.54
|
| Rate for Payer: Cigna Commercial |
$5,638.26
|
| Rate for Payer: First Health Commercial |
$6,453.43
|
| Rate for Payer: Humana Commercial |
$5,774.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,570.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,013.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,037.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,977.91
|
| Rate for Payer: Ohio Health Group HMO |
$5,094.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,434.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,909.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,687.23
|
| Rate for Payer: PHCS Commercial |
$6,521.36
|
| Rate for Payer: United Healthcare All Payer |
$5,977.91
|
|
|
UNIVERSAL HEAD 26MM ID 47MM OD
|
Facility
|
OP
|
$6,793.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,037.92 |
| Max. Negotiated Rate |
$6,521.36 |
| Rate for Payer: Aetna Commercial |
$5,230.67
|
| Rate for Payer: Anthem Medicaid |
$2,336.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,298.60
|
| Rate for Payer: Cash Price |
$3,396.54
|
| Rate for Payer: Cigna Commercial |
$5,638.26
|
| Rate for Payer: First Health Commercial |
$6,453.43
|
| Rate for Payer: Humana Commercial |
$5,774.12
|
| Rate for Payer: Humana KY Medicaid |
$2,336.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,359.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,570.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,013.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,037.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,383.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,977.91
|
| Rate for Payer: Ohio Health Group HMO |
$5,094.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,434.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,909.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,687.23
|
| Rate for Payer: PHCS Commercial |
$6,521.36
|
| Rate for Payer: United Healthcare All Payer |
$5,977.91
|
|
|
UNIVERSAL HEAD 26MM ID 48MM OD
|
Facility
|
IP
|
$6,793.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,037.92 |
| Max. Negotiated Rate |
$6,521.36 |
| Rate for Payer: Aetna Commercial |
$5,230.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,298.60
|
| Rate for Payer: Cash Price |
$3,396.54
|
| Rate for Payer: Cigna Commercial |
$5,638.26
|
| Rate for Payer: First Health Commercial |
$6,453.43
|
| Rate for Payer: Humana Commercial |
$5,774.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,570.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,013.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,037.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,977.91
|
| Rate for Payer: Ohio Health Group HMO |
$5,094.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,434.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,909.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,687.23
|
| Rate for Payer: PHCS Commercial |
$6,521.36
|
| Rate for Payer: United Healthcare All Payer |
$5,977.91
|
|
|
UNIVERSAL HEAD 26MM ID 48MM OD
|
Facility
|
OP
|
$6,793.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,037.92 |
| Max. Negotiated Rate |
$6,521.36 |
| Rate for Payer: Aetna Commercial |
$5,230.67
|
| Rate for Payer: Anthem Medicaid |
$2,336.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,298.60
|
| Rate for Payer: Cash Price |
$3,396.54
|
| Rate for Payer: Cigna Commercial |
$5,638.26
|
| Rate for Payer: First Health Commercial |
$6,453.43
|
| Rate for Payer: Humana Commercial |
$5,774.12
|
| Rate for Payer: Humana KY Medicaid |
$2,336.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,359.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,570.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,013.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,037.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,383.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,977.91
|
| Rate for Payer: Ohio Health Group HMO |
$5,094.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,434.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,909.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,687.23
|
| Rate for Payer: PHCS Commercial |
$6,521.36
|
| Rate for Payer: United Healthcare All Payer |
$5,977.91
|
|
|
UNIVERSAL HEAD 26MM ID 49MM OD
|
Facility
|
IP
|
$6,793.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,037.92 |
| Max. Negotiated Rate |
$6,521.36 |
| Rate for Payer: Aetna Commercial |
$5,230.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,298.60
|
| Rate for Payer: Cash Price |
$3,396.54
|
| Rate for Payer: Cigna Commercial |
$5,638.26
|
| Rate for Payer: First Health Commercial |
$6,453.43
|
| Rate for Payer: Humana Commercial |
$5,774.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,570.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,013.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,037.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,977.91
|
| Rate for Payer: Ohio Health Group HMO |
$5,094.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,434.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,909.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,687.23
|
| Rate for Payer: PHCS Commercial |
$6,521.36
|
| Rate for Payer: United Healthcare All Payer |
$5,977.91
|
|
|
UNIVERSAL HEAD 26MM ID 49MM OD
|
Facility
|
OP
|
$6,793.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,037.92 |
| Max. Negotiated Rate |
$6,521.36 |
| Rate for Payer: Aetna Commercial |
$5,230.67
|
| Rate for Payer: Anthem Medicaid |
$2,336.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,298.60
|
| Rate for Payer: Cash Price |
$3,396.54
|
| Rate for Payer: Cigna Commercial |
$5,638.26
|
| Rate for Payer: First Health Commercial |
$6,453.43
|
| Rate for Payer: Humana Commercial |
$5,774.12
|
| Rate for Payer: Humana KY Medicaid |
$2,336.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,359.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,570.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,013.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,037.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,383.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,977.91
|
| Rate for Payer: Ohio Health Group HMO |
$5,094.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,434.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,909.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,687.23
|
| Rate for Payer: PHCS Commercial |
$6,521.36
|
| Rate for Payer: United Healthcare All Payer |
$5,977.91
|
|
|
UNIVERSAL HEAD 26MM ID 50MM OD
|
Facility
|
OP
|
$6,793.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,037.92 |
| Max. Negotiated Rate |
$6,521.36 |
| Rate for Payer: Aetna Commercial |
$5,230.67
|
| Rate for Payer: Anthem Medicaid |
$2,336.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,298.60
|
| Rate for Payer: Cash Price |
$3,396.54
|
| Rate for Payer: Cigna Commercial |
$5,638.26
|
| Rate for Payer: First Health Commercial |
$6,453.43
|
| Rate for Payer: Humana Commercial |
$5,774.12
|
| Rate for Payer: Humana KY Medicaid |
$2,336.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,359.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,570.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,013.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,037.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,383.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,977.91
|
| Rate for Payer: Ohio Health Group HMO |
$5,094.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,434.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,909.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,687.23
|
| Rate for Payer: PHCS Commercial |
$6,521.36
|
| Rate for Payer: United Healthcare All Payer |
$5,977.91
|
|
|
UNIVERSAL HEAD 26MM ID 50MM OD
|
Facility
|
IP
|
$6,793.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,037.92 |
| Max. Negotiated Rate |
$6,521.36 |
| Rate for Payer: Aetna Commercial |
$5,230.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,298.60
|
| Rate for Payer: Cash Price |
$3,396.54
|
| Rate for Payer: Cigna Commercial |
$5,638.26
|
| Rate for Payer: First Health Commercial |
$6,453.43
|
| Rate for Payer: Humana Commercial |
$5,774.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,570.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,013.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,037.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,977.91
|
| Rate for Payer: Ohio Health Group HMO |
$5,094.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,434.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,909.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,687.23
|
| Rate for Payer: PHCS Commercial |
$6,521.36
|
| Rate for Payer: United Healthcare All Payer |
$5,977.91
|
|
|
UNIVERSAL HEAD 26MM ID 51MM OD
|
Facility
|
IP
|
$6,793.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,037.92 |
| Max. Negotiated Rate |
$6,521.36 |
| Rate for Payer: Aetna Commercial |
$5,230.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,298.60
|
| Rate for Payer: Cash Price |
$3,396.54
|
| Rate for Payer: Cigna Commercial |
$5,638.26
|
| Rate for Payer: First Health Commercial |
$6,453.43
|
| Rate for Payer: Humana Commercial |
$5,774.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,570.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,013.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,037.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,977.91
|
| Rate for Payer: Ohio Health Group HMO |
$5,094.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,434.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,909.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,687.23
|
| Rate for Payer: PHCS Commercial |
$6,521.36
|
| Rate for Payer: United Healthcare All Payer |
$5,977.91
|
|
|
UNIVERSAL HEAD 26MM ID 51MM OD
|
Facility
|
OP
|
$6,793.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,037.92 |
| Max. Negotiated Rate |
$6,521.36 |
| Rate for Payer: Aetna Commercial |
$5,230.67
|
| Rate for Payer: Anthem Medicaid |
$2,336.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,298.60
|
| Rate for Payer: Cash Price |
$3,396.54
|
| Rate for Payer: Cigna Commercial |
$5,638.26
|
| Rate for Payer: First Health Commercial |
$6,453.43
|
| Rate for Payer: Humana Commercial |
$5,774.12
|
| Rate for Payer: Humana KY Medicaid |
$2,336.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,359.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,570.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,013.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,037.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,383.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,977.91
|
| Rate for Payer: Ohio Health Group HMO |
$5,094.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,434.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,909.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,687.23
|
| Rate for Payer: PHCS Commercial |
$6,521.36
|
| Rate for Payer: United Healthcare All Payer |
$5,977.91
|
|
|
UNIVERSAL HEAD 26MM ID 52MM OD
|
Facility
|
OP
|
$6,793.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,037.92 |
| Max. Negotiated Rate |
$6,521.36 |
| Rate for Payer: Aetna Commercial |
$5,230.67
|
| Rate for Payer: Anthem Medicaid |
$2,336.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,298.60
|
| Rate for Payer: Cash Price |
$3,396.54
|
| Rate for Payer: Cigna Commercial |
$5,638.26
|
| Rate for Payer: First Health Commercial |
$6,453.43
|
| Rate for Payer: Humana Commercial |
$5,774.12
|
| Rate for Payer: Humana KY Medicaid |
$2,336.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,359.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,570.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,013.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,037.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,383.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,977.91
|
| Rate for Payer: Ohio Health Group HMO |
$5,094.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,434.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,909.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,687.23
|
| Rate for Payer: PHCS Commercial |
$6,521.36
|
| Rate for Payer: United Healthcare All Payer |
$5,977.91
|
|
