|
C-TAPER HEAD LFIT 32MM +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 32MM +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 32MM +5MM
|
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 32MM +5MM
|
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 LFIT 32MM -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 -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 36MM +0
|
Facility
|
OP
|
$8,548.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,564.40 |
| Max. Negotiated Rate |
$8,206.08 |
| Rate for Payer: Aetna Commercial |
$6,581.96
|
| Rate for Payer: Anthem Medicaid |
$2,939.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,667.44
|
| Rate for Payer: Cash Price |
$4,274.00
|
| Rate for Payer: Cigna Commercial |
$7,094.84
|
| Rate for Payer: First Health Commercial |
$8,120.60
|
| Rate for Payer: Humana Commercial |
$7,265.80
|
| Rate for Payer: Humana KY Medicaid |
$2,939.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,969.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,009.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,308.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,564.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,998.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,522.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,411.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,838.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,436.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,898.12
|
| Rate for Payer: PHCS Commercial |
$8,206.08
|
| Rate for Payer: United Healthcare All Payer |
$7,522.24
|
|
|
C-TAPER HEAD LFIT 36MM +0
|
Facility
|
IP
|
$8,548.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,564.40 |
| Max. Negotiated Rate |
$8,206.08 |
| Rate for Payer: Aetna Commercial |
$6,581.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,667.44
|
| Rate for Payer: Cash Price |
$4,274.00
|
| Rate for Payer: Cigna Commercial |
$7,094.84
|
| Rate for Payer: First Health Commercial |
$8,120.60
|
| Rate for Payer: Humana Commercial |
$7,265.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,009.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,308.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,564.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,522.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,411.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,838.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,436.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,898.12
|
| Rate for Payer: PHCS Commercial |
$8,206.08
|
| Rate for Payer: United Healthcare All Payer |
$7,522.24
|
|
|
C-TAPER HEAD LFIT 36MM +10
|
Facility
|
IP
|
$5,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,635.00 |
| Max. Negotiated Rate |
$5,232.00 |
| Rate for Payer: Aetna Commercial |
$4,196.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,251.00
|
| Rate for Payer: Cash Price |
$2,725.00
|
| Rate for Payer: Cigna Commercial |
$4,523.50
|
| Rate for Payer: First Health Commercial |
$5,177.50
|
| Rate for Payer: Humana Commercial |
$4,632.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,469.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,022.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,635.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,796.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,087.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,741.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,760.50
|
| Rate for Payer: PHCS Commercial |
$5,232.00
|
| Rate for Payer: United Healthcare All Payer |
$4,796.00
|
|
|
C-TAPER HEAD LFIT 36MM +10
|
Facility
|
OP
|
$5,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,635.00 |
| Max. Negotiated Rate |
$5,232.00 |
| Rate for Payer: Aetna Commercial |
$4,196.50
|
| Rate for Payer: Anthem Medicaid |
$1,874.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,251.00
|
| Rate for Payer: Cash Price |
$2,725.00
|
| Rate for Payer: Cigna Commercial |
$4,523.50
|
| Rate for Payer: First Health Commercial |
$5,177.50
|
| Rate for Payer: Humana Commercial |
$4,632.50
|
| Rate for Payer: Humana KY Medicaid |
$1,874.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,893.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,469.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,022.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,635.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,911.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,796.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,087.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,741.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,760.50
|
| Rate for Payer: PHCS Commercial |
$5,232.00
|
| Rate for Payer: United Healthcare All Payer |
$4,796.00
|
|
|
C-TAPER HEAD LFIT 36MM -2.5
|
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 LFIT 36MM -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 LFIT 36MM +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 LFIT 36MM +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 LFIT 36MM -5
|
Facility
|
IP
|
$6,682.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,004.64 |
| Max. Negotiated Rate |
$6,414.84 |
| Rate for Payer: Aetna Commercial |
$5,145.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,212.05
|
| Rate for Payer: Cash Price |
$3,341.06
|
| Rate for Payer: Cigna Commercial |
$5,546.16
|
| Rate for Payer: First Health Commercial |
$6,348.01
|
| Rate for Payer: Humana Commercial |
$5,679.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,479.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,931.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,004.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,880.27
|
| Rate for Payer: Ohio Health Group HMO |
$5,011.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,345.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,813.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,610.66
|
| Rate for Payer: PHCS Commercial |
$6,414.84
|
| Rate for Payer: United Healthcare All Payer |
$5,880.27
|
|
|
C-TAPER HEAD LFIT 36MM -5
|
Facility
|
OP
|
$6,682.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,004.64 |
| Max. Negotiated Rate |
$6,414.84 |
| Rate for Payer: Aetna Commercial |
$5,145.23
|
| Rate for Payer: Anthem Medicaid |
$2,297.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,212.05
|
| Rate for Payer: Cash Price |
$3,341.06
|
| Rate for Payer: Cigna Commercial |
$5,546.16
|
| Rate for Payer: First Health Commercial |
$6,348.01
|
| Rate for Payer: Humana Commercial |
$5,679.80
|
| Rate for Payer: Humana KY Medicaid |
$2,297.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,321.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,479.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,931.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,004.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,344.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,880.27
|
| Rate for Payer: Ohio Health Group HMO |
$5,011.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,345.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,813.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,610.66
|
| Rate for Payer: PHCS Commercial |
$6,414.84
|
| Rate for Payer: United Healthcare All Payer |
$5,880.27
|
|
|
C-TAPER HEAD LFIT 40MM +0
|
Facility
|
IP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
C-TAPER HEAD LFIT 40MM +0
|
Facility
|
OP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem Medicaid |
$3,416.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Humana KY Medicaid |
$3,416.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,451.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,485.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
C-TAPER HEAD LFIT 40MM +10
|
Facility
|
OP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem Medicaid |
$3,416.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Humana KY Medicaid |
$3,416.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,451.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,485.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
C-TAPER HEAD LFIT 40MM +10
|
Facility
|
IP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
C-TAPER HEAD LFIT 40MM +2.5
|
Facility
|
OP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem Medicaid |
$3,416.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Humana KY Medicaid |
$3,416.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,451.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,485.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
C-TAPER HEAD LFIT 40MM +2.5
|
Facility
|
IP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
C-TAPER HEAD LFIT 40MM -2.5
|
Facility
|
IP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
C-TAPER HEAD LFIT 40MM -2.5
|
Facility
|
OP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem Medicaid |
$3,416.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Humana KY Medicaid |
$3,416.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,451.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,485.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
|
C-TAPER HEAD LFIT 40MM +5
|
Facility
|
OP
|
$9,935.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,980.50 |
| Max. Negotiated Rate |
$9,537.60 |
| Rate for Payer: Aetna Commercial |
$7,649.95
|
| Rate for Payer: Anthem Medicaid |
$3,416.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,749.30
|
| Rate for Payer: Cash Price |
$4,967.50
|
| Rate for Payer: Cigna Commercial |
$8,246.05
|
| Rate for Payer: First Health Commercial |
$9,438.25
|
| Rate for Payer: Humana Commercial |
$8,444.75
|
| Rate for Payer: Humana KY Medicaid |
$3,416.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,451.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,146.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,332.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,980.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,485.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,742.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,451.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,948.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,643.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,855.15
|
| Rate for Payer: PHCS Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Payer |
$8,742.80
|
|
