|
C-TAPER HEAD 32MM + 2.5
|
Facility
|
OP
|
$5,257.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$683.49 |
| Max. Negotiated Rate |
$5,047.30 |
| Rate for Payer: Aetna Commercial |
$4,048.35
|
| Rate for Payer: Anthem Medicaid |
$1,808.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,100.93
|
| Rate for Payer: Cash Price |
$2,628.80
|
| Rate for Payer: Cigna Commercial |
$4,363.81
|
| Rate for Payer: First Health Commercial |
$4,994.72
|
| Rate for Payer: Humana Commercial |
$4,468.96
|
| Rate for Payer: Humana KY Medicaid |
$1,808.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,826.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,311.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,880.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,577.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,844.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,626.69
|
| Rate for Payer: Ohio Health Group HMO |
$3,943.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,051.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$683.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,629.86
|
| Rate for Payer: PHCS Commercial |
$5,047.30
|
| Rate for Payer: United Healthcare All Payer |
$4,626.69
|
|
|
C-TAPER HEAD 32MM + 2.5
|
Facility
|
IP
|
$5,257.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$683.49 |
| Max. Negotiated Rate |
$5,047.30 |
| Rate for Payer: Aetna Commercial |
$4,048.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,100.93
|
| Rate for Payer: Cash Price |
$2,628.80
|
| Rate for Payer: Cigna Commercial |
$4,363.81
|
| Rate for Payer: First Health Commercial |
$4,994.72
|
| Rate for Payer: Humana Commercial |
$4,468.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,311.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,880.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,577.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,626.69
|
| Rate for Payer: Ohio Health Group HMO |
$3,943.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,051.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$683.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,629.86
|
| Rate for Payer: PHCS Commercial |
$5,047.30
|
| Rate for Payer: United Healthcare All Payer |
$4,626.69
|
|
|
C-TAPER HEAD LFIT 22MM +0MM
|
Facility
|
OP
|
$5,455.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$709.15 |
| Max. Negotiated Rate |
$5,236.80 |
| Rate for Payer: Aetna Commercial |
$4,200.35
|
| Rate for Payer: Anthem Medicaid |
$1,875.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,254.90
|
| Rate for Payer: Cash Price |
$2,727.50
|
| Rate for Payer: Cigna Commercial |
$4,527.65
|
| Rate for Payer: First Health Commercial |
$5,182.25
|
| Rate for Payer: Humana Commercial |
$4,636.75
|
| Rate for Payer: Humana KY Medicaid |
$1,875.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,895.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,473.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,025.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,636.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,913.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,800.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,091.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,091.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,691.05
|
| Rate for Payer: PHCS Commercial |
$5,236.80
|
| Rate for Payer: United Healthcare All Payer |
$4,800.40
|
|
|
C-TAPER HEAD LFIT 22MM +0MM
|
Facility
|
IP
|
$5,455.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$709.15 |
| Max. Negotiated Rate |
$5,236.80 |
| Rate for Payer: Aetna Commercial |
$4,200.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,254.90
|
| Rate for Payer: Cash Price |
$2,727.50
|
| Rate for Payer: Cigna Commercial |
$4,527.65
|
| Rate for Payer: First Health Commercial |
$5,182.25
|
| Rate for Payer: Humana Commercial |
$4,636.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,473.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,025.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,636.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,800.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,091.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,091.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,691.05
|
| Rate for Payer: PHCS Commercial |
$5,236.80
|
| Rate for Payer: United Healthcare All Payer |
$4,800.40
|
|
|
C-TAPER HEAD LFIT 22MM +10MM
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
C-TAPER HEAD LFIT 22MM +10MM
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
C-TAPER HEAD LFIT 22MM +5MM
|
Facility
|
OP
|
$4,700.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$611.05 |
| Max. Negotiated Rate |
$4,512.38 |
| Rate for Payer: Aetna Commercial |
$3,619.31
|
| Rate for Payer: Anthem Medicaid |
$1,616.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,666.31
|
| Rate for Payer: Cash Price |
$2,350.20
|
| Rate for Payer: Cigna Commercial |
$3,901.33
|
| Rate for Payer: First Health Commercial |
$4,465.38
|
| Rate for Payer: Humana Commercial |
$3,995.34
|
| Rate for Payer: Humana KY Medicaid |
$1,616.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,632.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,854.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,468.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,410.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,648.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,136.35
|
| Rate for Payer: Ohio Health Group HMO |
$3,525.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$940.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$611.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,457.12
|
| Rate for Payer: PHCS Commercial |
$4,512.38
|
| Rate for Payer: United Healthcare All Payer |
$4,136.35
|
|
|
C-TAPER HEAD LFIT 22MM +5MM
|
Facility
|
IP
|
$4,700.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$611.05 |
| Max. Negotiated Rate |
$4,512.38 |
| Rate for Payer: Aetna Commercial |
$3,619.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,666.31
|
| Rate for Payer: Cash Price |
$2,350.20
|
| Rate for Payer: Cigna Commercial |
$3,901.33
|
| Rate for Payer: First Health Commercial |
$4,465.38
|
| Rate for Payer: Humana Commercial |
$3,995.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,854.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,468.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,410.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,136.35
|
| Rate for Payer: Ohio Health Group HMO |
$3,525.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$940.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$611.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,457.12
|
| Rate for Payer: PHCS Commercial |
$4,512.38
|
| Rate for Payer: United Healthcare All Payer |
$4,136.35
|
|
|
C-TAPER HEAD LFIT 26MM +0MM
|
Facility
|
IP
|
$5,455.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$709.15 |
| Max. Negotiated Rate |
$5,236.80 |
| Rate for Payer: Aetna Commercial |
$4,200.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,254.90
|
| Rate for Payer: Cash Price |
$2,727.50
|
| Rate for Payer: Cigna Commercial |
$4,527.65
|
| Rate for Payer: First Health Commercial |
$5,182.25
|
| Rate for Payer: Humana Commercial |
$4,636.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,473.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,025.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,636.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,800.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,091.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,091.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,691.05
|
| Rate for Payer: PHCS Commercial |
$5,236.80
|
| Rate for Payer: United Healthcare All Payer |
$4,800.40
|
|
|
C-TAPER HEAD LFIT 26MM +0MM
|
Facility
|
OP
|
$5,455.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$709.15 |
| Max. Negotiated Rate |
$5,236.80 |
| Rate for Payer: Aetna Commercial |
$4,200.35
|
| Rate for Payer: Anthem Medicaid |
$1,875.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,254.90
|
| Rate for Payer: Cash Price |
$2,727.50
|
| Rate for Payer: Cigna Commercial |
$4,527.65
|
| Rate for Payer: First Health Commercial |
$5,182.25
|
| Rate for Payer: Humana Commercial |
$4,636.75
|
| Rate for Payer: Humana KY Medicaid |
$1,875.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,895.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,473.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,025.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,636.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,913.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,800.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,091.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,091.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,691.05
|
| Rate for Payer: PHCS Commercial |
$5,236.80
|
| Rate for Payer: United Healthcare All Payer |
$4,800.40
|
|
|
C-TAPER HEAD LFIT 26MM +10MM
|
Facility
|
OP
|
$4,398.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$571.74 |
| Max. Negotiated Rate |
$4,222.08 |
| Rate for Payer: Aetna Commercial |
$3,386.46
|
| Rate for Payer: Anthem Medicaid |
$1,512.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,430.44
|
| Rate for Payer: Cash Price |
$2,199.00
|
| Rate for Payer: Cigna Commercial |
$3,650.34
|
| Rate for Payer: First Health Commercial |
$4,178.10
|
| Rate for Payer: Humana Commercial |
$3,738.30
|
| Rate for Payer: Humana KY Medicaid |
$1,512.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,527.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,606.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,245.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,319.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,542.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,870.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,298.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$879.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$571.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,363.38
|
| Rate for Payer: PHCS Commercial |
$4,222.08
|
| Rate for Payer: United Healthcare All Payer |
$3,870.24
|
|
|
C-TAPER HEAD LFIT 26MM +10MM
|
Facility
|
IP
|
$4,398.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$571.74 |
| Max. Negotiated Rate |
$4,222.08 |
| Rate for Payer: Aetna Commercial |
$3,386.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,430.44
|
| Rate for Payer: Cash Price |
$2,199.00
|
| Rate for Payer: Cigna Commercial |
$3,650.34
|
| Rate for Payer: First Health Commercial |
$4,178.10
|
| Rate for Payer: Humana Commercial |
$3,738.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,606.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,245.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,319.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,870.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,298.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$879.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$571.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,363.38
|
| Rate for Payer: PHCS Commercial |
$4,222.08
|
| Rate for Payer: United Healthcare All Payer |
$3,870.24
|
|
|
C-TAPER HEAD LFIT 26MM +5MM
|
Facility
|
OP
|
$5,455.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$709.15 |
| Max. Negotiated Rate |
$5,236.80 |
| Rate for Payer: Aetna Commercial |
$4,200.35
|
| Rate for Payer: Anthem Medicaid |
$1,875.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,254.90
|
| Rate for Payer: Cash Price |
$2,727.50
|
| Rate for Payer: Cigna Commercial |
$4,527.65
|
| Rate for Payer: First Health Commercial |
$5,182.25
|
| Rate for Payer: Humana Commercial |
$4,636.75
|
| Rate for Payer: Humana KY Medicaid |
$1,875.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,895.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,473.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,025.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,636.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,913.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,800.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,091.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,091.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,691.05
|
| Rate for Payer: PHCS Commercial |
$5,236.80
|
| Rate for Payer: United Healthcare All Payer |
$4,800.40
|
|
|
C-TAPER HEAD LFIT 26MM +5MM
|
Facility
|
IP
|
$5,455.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$709.15 |
| Max. Negotiated Rate |
$5,236.80 |
| Rate for Payer: Aetna Commercial |
$4,200.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,254.90
|
| Rate for Payer: Cash Price |
$2,727.50
|
| Rate for Payer: Cigna Commercial |
$4,527.65
|
| Rate for Payer: First Health Commercial |
$5,182.25
|
| Rate for Payer: Humana Commercial |
$4,636.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,473.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,025.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,636.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,800.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,091.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,091.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,691.05
|
| Rate for Payer: PHCS Commercial |
$5,236.80
|
| Rate for Payer: United Healthcare All Payer |
$4,800.40
|
|
|
C-TAPER HEAD LFIT 28MM +10MM
|
Facility
|
OP
|
$5,455.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$709.15 |
| Max. Negotiated Rate |
$5,236.80 |
| Rate for Payer: Aetna Commercial |
$4,200.35
|
| Rate for Payer: Anthem Medicaid |
$1,875.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,254.90
|
| Rate for Payer: Cash Price |
$2,727.50
|
| Rate for Payer: Cigna Commercial |
$4,527.65
|
| Rate for Payer: First Health Commercial |
$5,182.25
|
| Rate for Payer: Humana Commercial |
$4,636.75
|
| Rate for Payer: Humana KY Medicaid |
$1,875.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,895.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,473.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,025.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,636.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,913.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,800.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,091.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,091.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,691.05
|
| Rate for Payer: PHCS Commercial |
$5,236.80
|
| Rate for Payer: United Healthcare All Payer |
$4,800.40
|
|
|
C-TAPER HEAD LFIT 28MM +10MM
|
Facility
|
IP
|
$5,455.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$709.15 |
| Max. Negotiated Rate |
$5,236.80 |
| Rate for Payer: Aetna Commercial |
$4,200.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,254.90
|
| Rate for Payer: Cash Price |
$2,727.50
|
| Rate for Payer: Cigna Commercial |
$4,527.65
|
| Rate for Payer: First Health Commercial |
$5,182.25
|
| Rate for Payer: Humana Commercial |
$4,636.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,473.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,025.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,636.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,800.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,091.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,091.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,691.05
|
| Rate for Payer: PHCS Commercial |
$5,236.80
|
| Rate for Payer: United Healthcare All Payer |
$4,800.40
|
|
|
C-TAPER HEAD LFIT 28MM -3MM
|
Facility
|
IP
|
$4,498.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$584.86 |
| Max. Negotiated Rate |
$4,318.98 |
| Rate for Payer: Aetna Commercial |
$3,464.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,509.17
|
| Rate for Payer: Cash Price |
$2,249.47
|
| Rate for Payer: Cigna Commercial |
$3,734.12
|
| Rate for Payer: First Health Commercial |
$4,273.99
|
| Rate for Payer: Humana Commercial |
$3,824.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,689.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,320.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,349.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,959.07
|
| Rate for Payer: Ohio Health Group HMO |
$3,374.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$899.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$584.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,394.67
|
| Rate for Payer: PHCS Commercial |
$4,318.98
|
| Rate for Payer: United Healthcare All Payer |
$3,959.07
|
|
|
C-TAPER HEAD LFIT 28MM -3MM
|
Facility
|
OP
|
$4,498.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$584.86 |
| Max. Negotiated Rate |
$4,318.98 |
| Rate for Payer: Aetna Commercial |
$3,464.18
|
| Rate for Payer: Anthem Medicaid |
$1,547.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,509.17
|
| Rate for Payer: Cash Price |
$2,249.47
|
| Rate for Payer: Cigna Commercial |
$3,734.12
|
| Rate for Payer: First Health Commercial |
$4,273.99
|
| Rate for Payer: Humana Commercial |
$3,824.10
|
| Rate for Payer: Humana KY Medicaid |
$1,547.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,562.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,689.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,320.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,349.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,578.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,959.07
|
| Rate for Payer: Ohio Health Group HMO |
$3,374.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$899.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$584.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,394.67
|
| Rate for Payer: PHCS Commercial |
$4,318.98
|
| Rate for Payer: United Healthcare All Payer |
$3,959.07
|
|
|
C-TAPER HEAD LFIT 28MM +5MM
|
Facility
|
IP
|
$5,455.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$709.15 |
| Max. Negotiated Rate |
$5,236.80 |
| Rate for Payer: Aetna Commercial |
$4,200.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,254.90
|
| Rate for Payer: Cash Price |
$2,727.50
|
| Rate for Payer: Cigna Commercial |
$4,527.65
|
| Rate for Payer: First Health Commercial |
$5,182.25
|
| Rate for Payer: Humana Commercial |
$4,636.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,473.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,025.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,636.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,800.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,091.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,091.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,691.05
|
| Rate for Payer: PHCS Commercial |
$5,236.80
|
| Rate for Payer: United Healthcare All Payer |
$4,800.40
|
|
|
C-TAPER HEAD LFIT 28MM +5MM
|
Facility
|
OP
|
$5,455.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$709.15 |
| Max. Negotiated Rate |
$5,236.80 |
| Rate for Payer: Aetna Commercial |
$4,200.35
|
| Rate for Payer: Anthem Medicaid |
$1,875.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,254.90
|
| Rate for Payer: Cash Price |
$2,727.50
|
| Rate for Payer: Cigna Commercial |
$4,527.65
|
| Rate for Payer: First Health Commercial |
$5,182.25
|
| Rate for Payer: Humana Commercial |
$4,636.75
|
| Rate for Payer: Humana KY Medicaid |
$1,875.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,895.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,473.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,025.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,636.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,913.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,800.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,091.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,091.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,691.05
|
| Rate for Payer: PHCS Commercial |
$5,236.80
|
| Rate for Payer: United Healthcare All Payer |
$4,800.40
|
|
|
C-TAPER HEAD LFIT 32MM +0MM
|
Facility
|
OP
|
$4,398.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$571.74 |
| Max. Negotiated Rate |
$4,222.08 |
| Rate for Payer: Aetna Commercial |
$3,386.46
|
| Rate for Payer: Anthem Medicaid |
$1,512.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,430.44
|
| Rate for Payer: Cash Price |
$2,199.00
|
| Rate for Payer: Cigna Commercial |
$3,650.34
|
| Rate for Payer: First Health Commercial |
$4,178.10
|
| Rate for Payer: Humana Commercial |
$3,738.30
|
| Rate for Payer: Humana KY Medicaid |
$1,512.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,527.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,606.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,245.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,319.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,542.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,870.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,298.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$879.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$571.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,363.38
|
| Rate for Payer: PHCS Commercial |
$4,222.08
|
| Rate for Payer: United Healthcare All Payer |
$3,870.24
|
|
|
C-TAPER HEAD LFIT 32MM +0MM
|
Facility
|
IP
|
$4,398.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$571.74 |
| Max. Negotiated Rate |
$4,222.08 |
| Rate for Payer: Aetna Commercial |
$3,386.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,430.44
|
| Rate for Payer: Cash Price |
$2,199.00
|
| Rate for Payer: Cigna Commercial |
$3,650.34
|
| Rate for Payer: First Health Commercial |
$4,178.10
|
| Rate for Payer: Humana Commercial |
$3,738.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,606.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,245.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,319.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,870.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,298.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$879.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$571.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,363.38
|
| Rate for Payer: PHCS Commercial |
$4,222.08
|
| Rate for Payer: United Healthcare All Payer |
$3,870.24
|
|
|
C-TAPER HEAD LFIT 32MM +10MM
|
Facility
|
OP
|
$4,398.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$571.74 |
| Max. Negotiated Rate |
$4,222.08 |
| Rate for Payer: Aetna Commercial |
$3,386.46
|
| Rate for Payer: Anthem Medicaid |
$1,512.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,430.44
|
| Rate for Payer: Cash Price |
$2,199.00
|
| Rate for Payer: Cigna Commercial |
$3,650.34
|
| Rate for Payer: First Health Commercial |
$4,178.10
|
| Rate for Payer: Humana Commercial |
$3,738.30
|
| Rate for Payer: Humana KY Medicaid |
$1,512.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,527.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,606.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,245.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,319.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,542.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,870.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,298.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$879.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$571.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,363.38
|
| Rate for Payer: PHCS Commercial |
$4,222.08
|
| Rate for Payer: United Healthcare All Payer |
$3,870.24
|
|
|
C-TAPER HEAD LFIT 32MM +10MM
|
Facility
|
IP
|
$4,398.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$571.74 |
| Max. Negotiated Rate |
$4,222.08 |
| Rate for Payer: Aetna Commercial |
$3,386.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,430.44
|
| Rate for Payer: Cash Price |
$2,199.00
|
| Rate for Payer: Cigna Commercial |
$3,650.34
|
| Rate for Payer: First Health Commercial |
$4,178.10
|
| Rate for Payer: Humana Commercial |
$3,738.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,606.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,245.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,319.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,870.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,298.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$879.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$571.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,363.38
|
| Rate for Payer: PHCS Commercial |
$4,222.08
|
| Rate for Payer: United Healthcare All Payer |
$3,870.24
|
|
|
C-TAPER HEAD LFIT 32MM +5MM
|
Facility
|
IP
|
$5,257.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$683.49 |
| Max. Negotiated Rate |
$5,047.30 |
| Rate for Payer: Aetna Commercial |
$4,048.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,100.93
|
| Rate for Payer: Cash Price |
$2,628.80
|
| Rate for Payer: Cigna Commercial |
$4,363.81
|
| Rate for Payer: First Health Commercial |
$4,994.72
|
| Rate for Payer: Humana Commercial |
$4,468.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,311.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,880.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,577.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,626.69
|
| Rate for Payer: Ohio Health Group HMO |
$3,943.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,051.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$683.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,629.86
|
| Rate for Payer: PHCS Commercial |
$5,047.30
|
| Rate for Payer: United Healthcare All Payer |
$4,626.69
|
|
