|
UNIVERSAL HEAD 26MM ID 52MM 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 53MM 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 53MM 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 54MM 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 54MM 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 55MM 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 55MM 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 56MM OD
|
Facility
|
IP
|
$6,667.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,000.26 |
| Max. Negotiated Rate |
$6,400.82 |
| Rate for Payer: Aetna Commercial |
$5,133.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,200.67
|
| Rate for Payer: Cash Price |
$3,333.76
|
| Rate for Payer: Cigna Commercial |
$5,534.04
|
| Rate for Payer: First Health Commercial |
$6,334.14
|
| Rate for Payer: Humana Commercial |
$5,667.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,467.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,920.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,867.42
|
| Rate for Payer: Ohio Health Group HMO |
$5,000.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,334.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,800.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,600.59
|
| Rate for Payer: PHCS Commercial |
$6,400.82
|
| Rate for Payer: United Healthcare All Payer |
$5,867.42
|
|
|
UNIVERSAL HEAD 26MM ID 56MM OD
|
Facility
|
OP
|
$6,667.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,000.26 |
| Max. Negotiated Rate |
$6,400.82 |
| Rate for Payer: Aetna Commercial |
$5,133.99
|
| Rate for Payer: Anthem Medicaid |
$2,292.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,200.67
|
| Rate for Payer: Cash Price |
$3,333.76
|
| Rate for Payer: Cigna Commercial |
$5,534.04
|
| Rate for Payer: First Health Commercial |
$6,334.14
|
| Rate for Payer: Humana Commercial |
$5,667.39
|
| Rate for Payer: Humana KY Medicaid |
$2,292.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,316.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,467.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,920.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,338.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,867.42
|
| Rate for Payer: Ohio Health Group HMO |
$5,000.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,334.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,800.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,600.59
|
| Rate for Payer: PHCS Commercial |
$6,400.82
|
| Rate for Payer: United Healthcare All Payer |
$5,867.42
|
|
|
UNIVERSAL HEAD 26MM ID 58MM OD
|
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
|
|
|
UNIVERSAL HEAD 26MM ID 58MM OD
|
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 HEAD 26MM ID 61MM 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 61MM 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 28MM ID 44MM 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 28MM ID 44MM 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 28MM ID 45MM 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 28MM ID 45MM 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 28MM ID 46MM 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 28MM ID 46MM 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 28MM ID 47MM 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 28MM ID 47MM 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 28MM ID 48MM 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 28MM ID 48MM 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 28MM ID 49MM 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 28MM ID 49MM 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
|
|
