|
C-TAPER HEAD 28MM +2.5
|
Facility
|
OP
|
$5,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.25 |
| Max. Negotiated Rate |
$5,268.00 |
| Rate for Payer: Aetna Commercial |
$4,225.38
|
| Rate for Payer: Anthem Medicaid |
$1,887.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,280.25
|
| Rate for Payer: Cash Price |
$2,743.75
|
| Rate for Payer: Cigna Commercial |
$4,554.62
|
| Rate for Payer: First Health Commercial |
$5,213.12
|
| Rate for Payer: Humana Commercial |
$4,664.38
|
| Rate for Payer: Humana KY Medicaid |
$1,887.15
|
| Rate for Payer: Kentucky WC Medicaid |
$1,906.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,499.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,049.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,646.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,925.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,829.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,115.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,774.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,786.38
|
| Rate for Payer: PHCS Commercial |
$5,268.00
|
| Rate for Payer: United Healthcare All Payer |
$4,829.00
|
|
|
C-TAPER HEAD 28MM +7.5
|
Facility
|
IP
|
$5,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.25 |
| Max. Negotiated Rate |
$5,268.00 |
| Rate for Payer: Aetna Commercial |
$4,225.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,280.25
|
| Rate for Payer: Cash Price |
$2,743.75
|
| Rate for Payer: Cigna Commercial |
$4,554.62
|
| Rate for Payer: First Health Commercial |
$5,213.12
|
| Rate for Payer: Humana Commercial |
$4,664.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,499.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,049.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,646.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,829.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,115.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,774.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,786.38
|
| Rate for Payer: PHCS Commercial |
$5,268.00
|
| Rate for Payer: United Healthcare All Payer |
$4,829.00
|
|
|
C-TAPER HEAD 28MM +7.5
|
Facility
|
OP
|
$5,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.25 |
| Max. Negotiated Rate |
$5,268.00 |
| Rate for Payer: Aetna Commercial |
$4,225.38
|
| Rate for Payer: Anthem Medicaid |
$1,887.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,280.25
|
| Rate for Payer: Cash Price |
$2,743.75
|
| Rate for Payer: Cigna Commercial |
$4,554.62
|
| Rate for Payer: First Health Commercial |
$5,213.12
|
| Rate for Payer: Humana Commercial |
$4,664.38
|
| Rate for Payer: Humana KY Medicaid |
$1,887.15
|
| Rate for Payer: Kentucky WC Medicaid |
$1,906.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,499.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,049.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,646.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,925.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,829.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,115.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,774.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,786.38
|
| Rate for Payer: PHCS Commercial |
$5,268.00
|
| Rate for Payer: United Healthcare All Payer |
$4,829.00
|
|
|
C-TAPER HEAD 32MM + 2.5
|
Facility
|
OP
|
$5,276.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,582.80 |
| Max. Negotiated Rate |
$5,064.96 |
| Rate for Payer: Aetna Commercial |
$4,062.52
|
| Rate for Payer: Anthem Medicaid |
$1,814.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,115.28
|
| Rate for Payer: Cash Price |
$2,638.00
|
| Rate for Payer: Cigna Commercial |
$4,379.08
|
| Rate for Payer: First Health Commercial |
$5,012.20
|
| Rate for Payer: Humana Commercial |
$4,484.60
|
| Rate for Payer: Humana KY Medicaid |
$1,814.42
|
| Rate for Payer: Kentucky WC Medicaid |
$1,832.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,326.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,893.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,850.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,642.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,957.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,220.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,590.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,640.44
|
| Rate for Payer: PHCS Commercial |
$5,064.96
|
| Rate for Payer: United Healthcare All Payer |
$4,642.88
|
|
|
C-TAPER HEAD 32MM + 2.5
|
Facility
|
IP
|
$5,276.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,582.80 |
| Max. Negotiated Rate |
$5,064.96 |
| Rate for Payer: Aetna Commercial |
$4,062.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,115.28
|
| Rate for Payer: Cash Price |
$2,638.00
|
| Rate for Payer: Cigna Commercial |
$4,379.08
|
| Rate for Payer: First Health Commercial |
$5,012.20
|
| Rate for Payer: Humana Commercial |
$4,484.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,326.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,893.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,642.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,957.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,220.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,590.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,640.44
|
| Rate for Payer: PHCS Commercial |
$5,064.96
|
| Rate for Payer: United Healthcare All Payer |
$4,642.88
|
|
|
C-TAPER HEAD LFIT 22MM +0MM
|
Facility
|
OP
|
$5,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.25 |
| Max. Negotiated Rate |
$5,268.00 |
| Rate for Payer: Aetna Commercial |
$4,225.38
|
| Rate for Payer: Anthem Medicaid |
$1,887.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,280.25
|
| Rate for Payer: Cash Price |
$2,743.75
|
| Rate for Payer: Cigna Commercial |
$4,554.62
|
| Rate for Payer: First Health Commercial |
$5,213.12
|
| Rate for Payer: Humana Commercial |
$4,664.38
|
| Rate for Payer: Humana KY Medicaid |
$1,887.15
|
| Rate for Payer: Kentucky WC Medicaid |
$1,906.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,499.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,049.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,646.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,925.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,829.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,115.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,774.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,786.38
|
| Rate for Payer: PHCS Commercial |
$5,268.00
|
| Rate for Payer: United Healthcare All Payer |
$4,829.00
|
|
|
C-TAPER HEAD LFIT 22MM +0MM
|
Facility
|
IP
|
$5,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.25 |
| Max. Negotiated Rate |
$5,268.00 |
| Rate for Payer: Aetna Commercial |
$4,225.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,280.25
|
| Rate for Payer: Cash Price |
$2,743.75
|
| Rate for Payer: Cigna Commercial |
$4,554.62
|
| Rate for Payer: First Health Commercial |
$5,213.12
|
| Rate for Payer: Humana Commercial |
$4,664.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,499.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,049.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,646.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,829.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,115.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,774.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,786.38
|
| Rate for Payer: PHCS Commercial |
$5,268.00
|
| Rate for Payer: United Healthcare All Payer |
$4,829.00
|
|
|
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 |
$1,500.00 |
| 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 |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| 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
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| 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 |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| 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
|
$4,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,403.70 |
| Max. Negotiated Rate |
$4,491.84 |
| Rate for Payer: Aetna Commercial |
$3,602.83
|
| Rate for Payer: Anthem Medicaid |
$1,609.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,649.62
|
| Rate for Payer: Cash Price |
$2,339.50
|
| Rate for Payer: Cigna Commercial |
$3,883.57
|
| Rate for Payer: First Health Commercial |
$4,445.05
|
| Rate for Payer: Humana Commercial |
$3,977.15
|
| Rate for Payer: Humana KY Medicaid |
$1,609.11
|
| Rate for Payer: Kentucky WC Medicaid |
$1,625.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,836.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,453.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,403.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,641.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,117.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,509.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,743.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,070.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,228.51
|
| Rate for Payer: PHCS Commercial |
$4,491.84
|
| Rate for Payer: United Healthcare All Payer |
$4,117.52
|
|
|
C-TAPER HEAD LFIT 22MM +5MM
|
Facility
|
IP
|
$4,679.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,403.70 |
| Max. Negotiated Rate |
$4,491.84 |
| Rate for Payer: Aetna Commercial |
$3,602.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,649.62
|
| Rate for Payer: Cash Price |
$2,339.50
|
| Rate for Payer: Cigna Commercial |
$3,883.57
|
| Rate for Payer: First Health Commercial |
$4,445.05
|
| Rate for Payer: Humana Commercial |
$3,977.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,836.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,453.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,403.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,117.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,509.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,743.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,070.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,228.51
|
| Rate for Payer: PHCS Commercial |
$4,491.84
|
| Rate for Payer: United Healthcare All Payer |
$4,117.52
|
|
|
C-TAPER HEAD LFIT 26MM +0MM
|
Facility
|
OP
|
$5,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.25 |
| Max. Negotiated Rate |
$5,268.00 |
| Rate for Payer: Aetna Commercial |
$4,225.38
|
| Rate for Payer: Anthem Medicaid |
$1,887.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,280.25
|
| Rate for Payer: Cash Price |
$2,743.75
|
| Rate for Payer: Cigna Commercial |
$4,554.62
|
| Rate for Payer: First Health Commercial |
$5,213.12
|
| Rate for Payer: Humana Commercial |
$4,664.38
|
| Rate for Payer: Humana KY Medicaid |
$1,887.15
|
| Rate for Payer: Kentucky WC Medicaid |
$1,906.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,499.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,049.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,646.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,925.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,829.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,115.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,774.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,786.38
|
| Rate for Payer: PHCS Commercial |
$5,268.00
|
| Rate for Payer: United Healthcare All Payer |
$4,829.00
|
|
|
C-TAPER HEAD LFIT 26MM +0MM
|
Facility
|
IP
|
$5,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.25 |
| Max. Negotiated Rate |
$5,268.00 |
| Rate for Payer: Aetna Commercial |
$4,225.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,280.25
|
| Rate for Payer: Cash Price |
$2,743.75
|
| Rate for Payer: Cigna Commercial |
$4,554.62
|
| Rate for Payer: First Health Commercial |
$5,213.12
|
| Rate for Payer: Humana Commercial |
$4,664.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,499.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,049.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,646.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,829.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,115.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,774.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,786.38
|
| Rate for Payer: PHCS Commercial |
$5,268.00
|
| Rate for Payer: United Healthcare All Payer |
$4,829.00
|
|
|
C-TAPER HEAD LFIT 26MM +10MM
|
Facility
|
OP
|
$4,355.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,306.50 |
| Max. Negotiated Rate |
$4,180.80 |
| Rate for Payer: Aetna Commercial |
$3,353.35
|
| Rate for Payer: Anthem Medicaid |
$1,497.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,396.90
|
| Rate for Payer: Cash Price |
$2,177.50
|
| Rate for Payer: Cigna Commercial |
$3,614.65
|
| Rate for Payer: First Health Commercial |
$4,137.25
|
| Rate for Payer: Humana Commercial |
$3,701.75
|
| Rate for Payer: Humana KY Medicaid |
$1,497.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,512.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,571.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,213.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,306.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,527.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,832.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,266.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,484.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,788.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,004.95
|
| Rate for Payer: PHCS Commercial |
$4,180.80
|
| Rate for Payer: United Healthcare All Payer |
$3,832.40
|
|
|
C-TAPER HEAD LFIT 26MM +10MM
|
Facility
|
IP
|
$4,355.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,306.50 |
| Max. Negotiated Rate |
$4,180.80 |
| Rate for Payer: Aetna Commercial |
$3,353.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,396.90
|
| Rate for Payer: Cash Price |
$2,177.50
|
| Rate for Payer: Cigna Commercial |
$3,614.65
|
| Rate for Payer: First Health Commercial |
$4,137.25
|
| Rate for Payer: Humana Commercial |
$3,701.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,571.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,213.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,306.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,832.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,266.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,484.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,788.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,004.95
|
| Rate for Payer: PHCS Commercial |
$4,180.80
|
| Rate for Payer: United Healthcare All Payer |
$3,832.40
|
|
|
C-TAPER HEAD LFIT 26MM +5MM
|
Facility
|
OP
|
$5,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.25 |
| Max. Negotiated Rate |
$5,268.00 |
| Rate for Payer: Aetna Commercial |
$4,225.38
|
| Rate for Payer: Anthem Medicaid |
$1,887.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,280.25
|
| Rate for Payer: Cash Price |
$2,743.75
|
| Rate for Payer: Cigna Commercial |
$4,554.62
|
| Rate for Payer: First Health Commercial |
$5,213.12
|
| Rate for Payer: Humana Commercial |
$4,664.38
|
| Rate for Payer: Humana KY Medicaid |
$1,887.15
|
| Rate for Payer: Kentucky WC Medicaid |
$1,906.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,499.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,049.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,646.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,925.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,829.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,115.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,774.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,786.38
|
| Rate for Payer: PHCS Commercial |
$5,268.00
|
| Rate for Payer: United Healthcare All Payer |
$4,829.00
|
|
|
C-TAPER HEAD LFIT 26MM +5MM
|
Facility
|
IP
|
$5,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.25 |
| Max. Negotiated Rate |
$5,268.00 |
| Rate for Payer: Aetna Commercial |
$4,225.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,280.25
|
| Rate for Payer: Cash Price |
$2,743.75
|
| Rate for Payer: Cigna Commercial |
$4,554.62
|
| Rate for Payer: First Health Commercial |
$5,213.12
|
| Rate for Payer: Humana Commercial |
$4,664.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,499.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,049.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,646.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,829.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,115.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,774.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,786.38
|
| Rate for Payer: PHCS Commercial |
$5,268.00
|
| Rate for Payer: United Healthcare All Payer |
$4,829.00
|
|
|
C-TAPER HEAD LFIT 28MM +10MM
|
Facility
|
OP
|
$5,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.25 |
| Max. Negotiated Rate |
$5,268.00 |
| Rate for Payer: Aetna Commercial |
$4,225.38
|
| Rate for Payer: Anthem Medicaid |
$1,887.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,280.25
|
| Rate for Payer: Cash Price |
$2,743.75
|
| Rate for Payer: Cigna Commercial |
$4,554.62
|
| Rate for Payer: First Health Commercial |
$5,213.12
|
| Rate for Payer: Humana Commercial |
$4,664.38
|
| Rate for Payer: Humana KY Medicaid |
$1,887.15
|
| Rate for Payer: Kentucky WC Medicaid |
$1,906.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,499.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,049.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,646.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,925.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,829.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,115.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,774.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,786.38
|
| Rate for Payer: PHCS Commercial |
$5,268.00
|
| Rate for Payer: United Healthcare All Payer |
$4,829.00
|
|
|
C-TAPER HEAD LFIT 28MM +10MM
|
Facility
|
IP
|
$5,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.25 |
| Max. Negotiated Rate |
$5,268.00 |
| Rate for Payer: Aetna Commercial |
$4,225.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,280.25
|
| Rate for Payer: Cash Price |
$2,743.75
|
| Rate for Payer: Cigna Commercial |
$4,554.62
|
| Rate for Payer: First Health Commercial |
$5,213.12
|
| Rate for Payer: Humana Commercial |
$4,664.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,499.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,049.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,646.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,829.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,115.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,774.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,786.38
|
| Rate for Payer: PHCS Commercial |
$5,268.00
|
| Rate for Payer: United Healthcare All Payer |
$4,829.00
|
|
|
C-TAPER HEAD LFIT 28MM -3MM
|
Facility
|
IP
|
$4,463.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,338.94 |
| Max. Negotiated Rate |
$4,284.62 |
| Rate for Payer: Aetna Commercial |
$3,436.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,481.26
|
| Rate for Payer: Cash Price |
$2,231.57
|
| Rate for Payer: Cigna Commercial |
$3,704.41
|
| Rate for Payer: First Health Commercial |
$4,239.99
|
| Rate for Payer: Humana Commercial |
$3,793.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,659.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,293.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,338.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,927.57
|
| Rate for Payer: Ohio Health Group HMO |
$3,347.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,570.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,882.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,079.57
|
| Rate for Payer: PHCS Commercial |
$4,284.62
|
| Rate for Payer: United Healthcare All Payer |
$3,927.57
|
|
|
C-TAPER HEAD LFIT 28MM -3MM
|
Facility
|
OP
|
$4,463.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,338.94 |
| Max. Negotiated Rate |
$4,284.62 |
| Rate for Payer: Aetna Commercial |
$3,436.63
|
| Rate for Payer: Anthem Medicaid |
$1,534.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,481.26
|
| Rate for Payer: Cash Price |
$2,231.57
|
| Rate for Payer: Cigna Commercial |
$3,704.41
|
| Rate for Payer: First Health Commercial |
$4,239.99
|
| Rate for Payer: Humana Commercial |
$3,793.68
|
| Rate for Payer: Humana KY Medicaid |
$1,534.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,550.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,659.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,293.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,338.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,565.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,927.57
|
| Rate for Payer: Ohio Health Group HMO |
$3,347.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,570.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,882.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,079.57
|
| Rate for Payer: PHCS Commercial |
$4,284.62
|
| Rate for Payer: United Healthcare All Payer |
$3,927.57
|
|
|
C-TAPER HEAD LFIT 28MM +5MM
|
Facility
|
IP
|
$5,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.25 |
| Max. Negotiated Rate |
$5,268.00 |
| Rate for Payer: Aetna Commercial |
$4,225.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,280.25
|
| Rate for Payer: Cash Price |
$2,743.75
|
| Rate for Payer: Cigna Commercial |
$4,554.62
|
| Rate for Payer: First Health Commercial |
$5,213.12
|
| Rate for Payer: Humana Commercial |
$4,664.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,499.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,049.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,646.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,829.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,115.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,774.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,786.38
|
| Rate for Payer: PHCS Commercial |
$5,268.00
|
| Rate for Payer: United Healthcare All Payer |
$4,829.00
|
|
|
C-TAPER HEAD LFIT 28MM +5MM
|
Facility
|
OP
|
$5,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.25 |
| Max. Negotiated Rate |
$5,268.00 |
| Rate for Payer: Aetna Commercial |
$4,225.38
|
| Rate for Payer: Anthem Medicaid |
$1,887.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,280.25
|
| Rate for Payer: Cash Price |
$2,743.75
|
| Rate for Payer: Cigna Commercial |
$4,554.62
|
| Rate for Payer: First Health Commercial |
$5,213.12
|
| Rate for Payer: Humana Commercial |
$4,664.38
|
| Rate for Payer: Humana KY Medicaid |
$1,887.15
|
| Rate for Payer: Kentucky WC Medicaid |
$1,906.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,499.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,049.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,646.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,925.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,829.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,115.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,774.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,786.38
|
| Rate for Payer: PHCS Commercial |
$5,268.00
|
| Rate for Payer: United Healthcare All Payer |
$4,829.00
|
|
|
C-TAPER HEAD LFIT 32MM +0MM
|
Facility
|
IP
|
$4,355.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,306.50 |
| Max. Negotiated Rate |
$4,180.80 |
| Rate for Payer: Aetna Commercial |
$3,353.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,396.90
|
| Rate for Payer: Cash Price |
$2,177.50
|
| Rate for Payer: Cigna Commercial |
$3,614.65
|
| Rate for Payer: First Health Commercial |
$4,137.25
|
| Rate for Payer: Humana Commercial |
$3,701.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,571.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,213.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,306.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,832.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,266.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,484.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,788.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,004.95
|
| Rate for Payer: PHCS Commercial |
$4,180.80
|
| Rate for Payer: United Healthcare All Payer |
$3,832.40
|
|
|
C-TAPER HEAD LFIT 32MM +0MM
|
Facility
|
OP
|
$4,355.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,306.50 |
| Max. Negotiated Rate |
$4,180.80 |
| Rate for Payer: Aetna Commercial |
$3,353.35
|
| Rate for Payer: Anthem Medicaid |
$1,497.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,396.90
|
| Rate for Payer: Cash Price |
$2,177.50
|
| Rate for Payer: Cigna Commercial |
$3,614.65
|
| Rate for Payer: First Health Commercial |
$4,137.25
|
| Rate for Payer: Humana Commercial |
$3,701.75
|
| Rate for Payer: Humana KY Medicaid |
$1,497.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,512.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,571.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,213.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,306.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,527.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,832.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,266.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,484.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,788.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,004.95
|
| Rate for Payer: PHCS Commercial |
$4,180.80
|
| Rate for Payer: United Healthcare All Payer |
$3,832.40
|
|
