|
UNIVERSAL HEAD 28MM ID 50MM 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 50MM 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 51MM 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 51MM 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 52MM 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 52MM 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 53MM 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 53MM 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 54MM 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 54MM 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 55MM OD
|
Facility
|
IP
|
$5,040.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,512.27 |
| Max. Negotiated Rate |
$4,839.27 |
| Rate for Payer: Aetna Commercial |
$3,881.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,931.91
|
| Rate for Payer: Cash Price |
$2,520.46
|
| Rate for Payer: Cigna Commercial |
$4,183.96
|
| Rate for Payer: First Health Commercial |
$4,788.86
|
| Rate for Payer: Humana Commercial |
$4,284.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,133.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,720.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,512.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,436.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,780.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,032.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,385.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,478.23
|
| Rate for Payer: PHCS Commercial |
$4,839.27
|
| Rate for Payer: United Healthcare All Payer |
$4,436.00
|
|
|
UNIVERSAL HEAD 28MM ID 55MM OD
|
Facility
|
OP
|
$5,040.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,512.27 |
| Max. Negotiated Rate |
$4,839.27 |
| Rate for Payer: Aetna Commercial |
$3,881.50
|
| Rate for Payer: Anthem Medicaid |
$1,733.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,931.91
|
| Rate for Payer: Cash Price |
$2,520.46
|
| Rate for Payer: Cigna Commercial |
$4,183.96
|
| Rate for Payer: First Health Commercial |
$4,788.86
|
| Rate for Payer: Humana Commercial |
$4,284.77
|
| Rate for Payer: Humana KY Medicaid |
$1,733.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,751.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,133.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,720.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,512.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,768.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,436.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,780.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,032.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,385.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,478.23
|
| Rate for Payer: PHCS Commercial |
$4,839.27
|
| Rate for Payer: United Healthcare All Payer |
$4,436.00
|
|
|
UNIVERSAL HEAD 28MM ID 56MM OD
|
Facility
|
IP
|
$5,040.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,512.27 |
| Max. Negotiated Rate |
$4,839.27 |
| Rate for Payer: Aetna Commercial |
$3,881.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,931.91
|
| Rate for Payer: Cash Price |
$2,520.46
|
| Rate for Payer: Cigna Commercial |
$4,183.96
|
| Rate for Payer: First Health Commercial |
$4,788.86
|
| Rate for Payer: Humana Commercial |
$4,284.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,133.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,720.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,512.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,436.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,780.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,032.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,385.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,478.23
|
| Rate for Payer: PHCS Commercial |
$4,839.27
|
| Rate for Payer: United Healthcare All Payer |
$4,436.00
|
|
|
UNIVERSAL HEAD 28MM ID 56MM OD
|
Facility
|
OP
|
$5,040.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,512.27 |
| Max. Negotiated Rate |
$4,839.27 |
| Rate for Payer: Aetna Commercial |
$3,881.50
|
| Rate for Payer: Anthem Medicaid |
$1,733.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,931.91
|
| Rate for Payer: Cash Price |
$2,520.46
|
| Rate for Payer: Cigna Commercial |
$4,183.96
|
| Rate for Payer: First Health Commercial |
$4,788.86
|
| Rate for Payer: Humana Commercial |
$4,284.77
|
| Rate for Payer: Humana KY Medicaid |
$1,733.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,751.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,133.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,720.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,512.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,768.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,436.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,780.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,032.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,385.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,478.23
|
| Rate for Payer: PHCS Commercial |
$4,839.27
|
| Rate for Payer: United Healthcare All Payer |
$4,436.00
|
|
|
UNIVERSAL HEAD 28MM 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 28MM 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 28MM ID 61MM 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 28MM ID 61MM 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 STEM 115*10MM FLUTED
|
Facility
|
IP
|
$12,655.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,796.72 |
| Max. Negotiated Rate |
$12,149.50 |
| Rate for Payer: Aetna Commercial |
$9,744.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,871.47
|
| Rate for Payer: Cash Price |
$6,327.87
|
| Rate for Payer: Cigna Commercial |
$10,504.26
|
| Rate for Payer: First Health Commercial |
$12,022.94
|
| Rate for Payer: Humana Commercial |
$10,757.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,377.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,339.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,796.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,137.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,491.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,124.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,010.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,732.45
|
| Rate for Payer: PHCS Commercial |
$12,149.50
|
| Rate for Payer: United Healthcare All Payer |
$11,137.04
|
|
|
UNIVERSAL STEM 115*10MM FLUTED
|
Facility
|
OP
|
$12,655.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,796.72 |
| Max. Negotiated Rate |
$12,149.50 |
| Rate for Payer: Aetna Commercial |
$9,744.91
|
| Rate for Payer: Anthem Medicaid |
$4,352.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,871.47
|
| Rate for Payer: Cash Price |
$6,327.87
|
| Rate for Payer: Cigna Commercial |
$10,504.26
|
| Rate for Payer: First Health Commercial |
$12,022.94
|
| Rate for Payer: Humana Commercial |
$10,757.37
|
| Rate for Payer: Humana KY Medicaid |
$4,352.31
|
| Rate for Payer: Kentucky WC Medicaid |
$4,396.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,377.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,339.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,796.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,439.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,137.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,491.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,124.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,010.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,732.45
|
| Rate for Payer: PHCS Commercial |
$12,149.50
|
| Rate for Payer: United Healthcare All Payer |
$11,137.04
|
|
|
UNIVERSAL STEM 115*12MM FLUTED
|
Facility
|
OP
|
$12,655.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,796.72 |
| Max. Negotiated Rate |
$12,149.50 |
| Rate for Payer: Aetna Commercial |
$9,744.91
|
| Rate for Payer: Anthem Medicaid |
$4,352.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,871.47
|
| Rate for Payer: Cash Price |
$6,327.87
|
| Rate for Payer: Cigna Commercial |
$10,504.26
|
| Rate for Payer: First Health Commercial |
$12,022.94
|
| Rate for Payer: Humana Commercial |
$10,757.37
|
| Rate for Payer: Humana KY Medicaid |
$4,352.31
|
| Rate for Payer: Kentucky WC Medicaid |
$4,396.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,377.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,339.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,796.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,439.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,137.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,491.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,124.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,010.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,732.45
|
| Rate for Payer: PHCS Commercial |
$12,149.50
|
| Rate for Payer: United Healthcare All Payer |
$11,137.04
|
|
|
UNIVERSAL STEM 115*12MM FLUTED
|
Facility
|
IP
|
$12,655.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,796.72 |
| Max. Negotiated Rate |
$12,149.50 |
| Rate for Payer: Aetna Commercial |
$9,744.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,871.47
|
| Rate for Payer: Cash Price |
$6,327.87
|
| Rate for Payer: Cigna Commercial |
$10,504.26
|
| Rate for Payer: First Health Commercial |
$12,022.94
|
| Rate for Payer: Humana Commercial |
$10,757.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,377.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,339.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,796.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,137.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,491.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,124.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,010.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,732.45
|
| Rate for Payer: PHCS Commercial |
$12,149.50
|
| Rate for Payer: United Healthcare All Payer |
$11,137.04
|
|
|
UNIVERSAL STEM 115*14MM FLUTED
|
Facility
|
OP
|
$14,259.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,277.86 |
| Max. Negotiated Rate |
$13,689.14 |
| Rate for Payer: Aetna Commercial |
$10,979.83
|
| Rate for Payer: Anthem Medicaid |
$4,903.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,122.43
|
| Rate for Payer: Cash Price |
$7,129.76
|
| Rate for Payer: Cigna Commercial |
$11,835.40
|
| Rate for Payer: First Health Commercial |
$13,546.54
|
| Rate for Payer: Humana Commercial |
$12,120.59
|
| Rate for Payer: Humana KY Medicaid |
$4,903.85
|
| Rate for Payer: Kentucky WC Medicaid |
$4,953.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,692.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,523.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,277.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,002.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,548.38
|
| Rate for Payer: Ohio Health Group HMO |
$10,694.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,407.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,405.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,839.07
|
| Rate for Payer: PHCS Commercial |
$13,689.14
|
| Rate for Payer: United Healthcare All Payer |
$12,548.38
|
|
|
UNIVERSAL STEM 115*14MM FLUTED
|
Facility
|
IP
|
$14,259.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,277.86 |
| Max. Negotiated Rate |
$13,689.14 |
| Rate for Payer: Aetna Commercial |
$10,979.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,122.43
|
| Rate for Payer: Cash Price |
$7,129.76
|
| Rate for Payer: Cigna Commercial |
$11,835.40
|
| Rate for Payer: First Health Commercial |
$13,546.54
|
| Rate for Payer: Humana Commercial |
$12,120.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,692.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,523.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,277.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,548.38
|
| Rate for Payer: Ohio Health Group HMO |
$10,694.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,407.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,405.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,839.07
|
| Rate for Payer: PHCS Commercial |
$13,689.14
|
| Rate for Payer: United Healthcare All Payer |
$12,548.38
|
|
|
UNIVERSAL STEM 115*16MM FLUTED
|
Facility
|
IP
|
$12,655.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,796.72 |
| Max. Negotiated Rate |
$12,149.50 |
| Rate for Payer: Aetna Commercial |
$9,744.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,871.47
|
| Rate for Payer: Cash Price |
$6,327.87
|
| Rate for Payer: Cigna Commercial |
$10,504.26
|
| Rate for Payer: First Health Commercial |
$12,022.94
|
| Rate for Payer: Humana Commercial |
$10,757.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,377.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,339.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,796.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,137.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,491.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,124.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,010.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,732.45
|
| Rate for Payer: PHCS Commercial |
$12,149.50
|
| Rate for Payer: United Healthcare All Payer |
$11,137.04
|
|
