|
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
|
|
|
C-TAPER HEAD LFIT 40MM +7.5
|
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 +7.5
|
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 44MM +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 44MM +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 44MM -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 44MM -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 NECK EXTENSION
|
Facility
|
IP
|
$1,938.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.52 |
| Max. Negotiated Rate |
$1,860.86 |
| Rate for Payer: Aetna Commercial |
$1,492.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,511.95
|
| Rate for Payer: Cash Price |
$969.20
|
| Rate for Payer: Cigna Commercial |
$1,608.87
|
| Rate for Payer: First Health Commercial |
$1,841.48
|
| Rate for Payer: Humana Commercial |
$1,647.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,589.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,430.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$581.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,705.79
|
| Rate for Payer: Ohio Health Group HMO |
$1,453.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,550.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,686.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,337.50
|
| Rate for Payer: PHCS Commercial |
$1,860.86
|
| Rate for Payer: United Healthcare All Payer |
$1,705.79
|
|
|
C-TAPER NECK EXTENSION
|
Facility
|
OP
|
$1,938.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.52 |
| Max. Negotiated Rate |
$1,860.86 |
| Rate for Payer: Aetna Commercial |
$1,492.57
|
| Rate for Payer: Anthem Medicaid |
$666.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,511.95
|
| Rate for Payer: Cash Price |
$969.20
|
| Rate for Payer: Cigna Commercial |
$1,608.87
|
| Rate for Payer: First Health Commercial |
$1,841.48
|
| Rate for Payer: Humana Commercial |
$1,647.64
|
| Rate for Payer: Humana KY Medicaid |
$666.62
|
| Rate for Payer: Kentucky WC Medicaid |
$673.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,589.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,430.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$581.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$679.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,705.79
|
| Rate for Payer: Ohio Health Group HMO |
$1,453.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,550.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,686.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,337.50
|
| Rate for Payer: PHCS Commercial |
$1,860.86
|
| Rate for Payer: United Healthcare All Payer |
$1,705.79
|
|
|
C-TAPER UNITRAX SLEEVE +0
|
Facility
|
IP
|
$2,087.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$626.21 |
| Max. Negotiated Rate |
$2,003.87 |
| Rate for Payer: Aetna Commercial |
$1,607.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,628.14
|
| Rate for Payer: Cash Price |
$1,043.68
|
| Rate for Payer: Cigna Commercial |
$1,732.51
|
| Rate for Payer: First Health Commercial |
$1,982.99
|
| Rate for Payer: Humana Commercial |
$1,774.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,711.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,540.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,836.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,565.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,669.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,816.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,440.28
|
| Rate for Payer: PHCS Commercial |
$2,003.87
|
| Rate for Payer: United Healthcare All Payer |
$1,836.88
|
|
|
C-TAPER UNITRAX SLEEVE +0
|
Facility
|
OP
|
$2,087.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$626.21 |
| Max. Negotiated Rate |
$2,003.87 |
| Rate for Payer: Aetna Commercial |
$1,607.27
|
| Rate for Payer: Anthem Medicaid |
$717.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,628.14
|
| Rate for Payer: Cash Price |
$1,043.68
|
| Rate for Payer: Cigna Commercial |
$1,732.51
|
| Rate for Payer: First Health Commercial |
$1,982.99
|
| Rate for Payer: Humana Commercial |
$1,774.26
|
| Rate for Payer: Humana KY Medicaid |
$717.84
|
| Rate for Payer: Kentucky WC Medicaid |
$725.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,711.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,540.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$732.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,836.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,565.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,669.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,816.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,440.28
|
| Rate for Payer: PHCS Commercial |
$2,003.87
|
| Rate for Payer: United Healthcare All Payer |
$1,836.88
|
|
|
C-TAPER UNITRAX SLEEVE +10
|
Facility
|
OP
|
$2,087.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$626.21 |
| Max. Negotiated Rate |
$2,003.87 |
| Rate for Payer: Aetna Commercial |
$1,607.27
|
| Rate for Payer: Anthem Medicaid |
$717.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,628.14
|
| Rate for Payer: Cash Price |
$1,043.68
|
| Rate for Payer: Cigna Commercial |
$1,732.51
|
| Rate for Payer: First Health Commercial |
$1,982.99
|
| Rate for Payer: Humana Commercial |
$1,774.26
|
| Rate for Payer: Humana KY Medicaid |
$717.84
|
| Rate for Payer: Kentucky WC Medicaid |
$725.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,711.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,540.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$732.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,836.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,565.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,669.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,816.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,440.28
|
| Rate for Payer: PHCS Commercial |
$2,003.87
|
| Rate for Payer: United Healthcare All Payer |
$1,836.88
|
|
|
C-TAPER UNITRAX SLEEVE +10
|
Facility
|
IP
|
$2,087.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$626.21 |
| Max. Negotiated Rate |
$2,003.87 |
| Rate for Payer: Aetna Commercial |
$1,607.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,628.14
|
| Rate for Payer: Cash Price |
$1,043.68
|
| Rate for Payer: Cigna Commercial |
$1,732.51
|
| Rate for Payer: First Health Commercial |
$1,982.99
|
| Rate for Payer: Humana Commercial |
$1,774.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,711.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,540.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,836.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,565.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,669.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,816.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,440.28
|
| Rate for Payer: PHCS Commercial |
$2,003.87
|
| Rate for Payer: United Healthcare All Payer |
$1,836.88
|
|
|
C-TAPER UNITRAX SLEEVE -3
|
Facility
|
OP
|
$2,087.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$626.21 |
| Max. Negotiated Rate |
$2,003.87 |
| Rate for Payer: Aetna Commercial |
$1,607.27
|
| Rate for Payer: Anthem Medicaid |
$717.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,628.14
|
| Rate for Payer: Cash Price |
$1,043.68
|
| Rate for Payer: Cigna Commercial |
$1,732.51
|
| Rate for Payer: First Health Commercial |
$1,982.99
|
| Rate for Payer: Humana Commercial |
$1,774.26
|
| Rate for Payer: Humana KY Medicaid |
$717.84
|
| Rate for Payer: Kentucky WC Medicaid |
$725.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,711.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,540.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$732.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,836.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,565.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,669.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,816.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,440.28
|
| Rate for Payer: PHCS Commercial |
$2,003.87
|
| Rate for Payer: United Healthcare All Payer |
$1,836.88
|
|
|
C-TAPER UNITRAX SLEEVE -3
|
Facility
|
IP
|
$2,087.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$626.21 |
| Max. Negotiated Rate |
$2,003.87 |
| Rate for Payer: Aetna Commercial |
$1,607.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,628.14
|
| Rate for Payer: Cash Price |
$1,043.68
|
| Rate for Payer: Cigna Commercial |
$1,732.51
|
| Rate for Payer: First Health Commercial |
$1,982.99
|
| Rate for Payer: Humana Commercial |
$1,774.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,711.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,540.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,836.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,565.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,669.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,816.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,440.28
|
| Rate for Payer: PHCS Commercial |
$2,003.87
|
| Rate for Payer: United Healthcare All Payer |
$1,836.88
|
|
|
C-TAPER UNITRAX SLEEVE +5
|
Facility
|
OP
|
$2,087.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$626.21 |
| Max. Negotiated Rate |
$2,003.87 |
| Rate for Payer: Aetna Commercial |
$1,607.27
|
| Rate for Payer: Anthem Medicaid |
$717.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,628.14
|
| Rate for Payer: Cash Price |
$1,043.68
|
| Rate for Payer: Cigna Commercial |
$1,732.51
|
| Rate for Payer: First Health Commercial |
$1,982.99
|
| Rate for Payer: Humana Commercial |
$1,774.26
|
| Rate for Payer: Humana KY Medicaid |
$717.84
|
| Rate for Payer: Kentucky WC Medicaid |
$725.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,711.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,540.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$732.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,836.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,565.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,669.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,816.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,440.28
|
| Rate for Payer: PHCS Commercial |
$2,003.87
|
| Rate for Payer: United Healthcare All Payer |
$1,836.88
|
|
|
C-TAPER UNITRAX SLEEVE +5
|
Facility
|
IP
|
$2,087.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$626.21 |
| Max. Negotiated Rate |
$2,003.87 |
| Rate for Payer: Aetna Commercial |
$1,607.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,628.14
|
| Rate for Payer: Cash Price |
$1,043.68
|
| Rate for Payer: Cigna Commercial |
$1,732.51
|
| Rate for Payer: First Health Commercial |
$1,982.99
|
| Rate for Payer: Humana Commercial |
$1,774.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,711.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,540.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,836.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,565.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,669.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,816.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,440.28
|
| Rate for Payer: PHCS Commercial |
$2,003.87
|
| Rate for Payer: United Healthcare All Payer |
$1,836.88
|
|
|
CTA UPPER EXTREMITY
|
Facility
|
IP
|
$2,666.00
|
|
|
Service Code
|
HCPCS 73206
|
| Hospital Charge Code |
35000005
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$799.80 |
| Max. Negotiated Rate |
$2,559.36 |
| Rate for Payer: Aetna Commercial |
$2,052.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,079.48
|
| Rate for Payer: Cash Price |
$1,333.00
|
| Rate for Payer: Cigna Commercial |
$2,212.78
|
| Rate for Payer: First Health Commercial |
$2,532.70
|
| Rate for Payer: Humana Commercial |
$2,266.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,186.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,967.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$799.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,346.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,999.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,132.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,319.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,839.54
|
| Rate for Payer: PHCS Commercial |
$2,559.36
|
| Rate for Payer: United Healthcare All Payer |
$2,346.08
|
|
|
CTA UPPER EXTREMITY
|
Professional
|
Both
|
$3,129.00
|
|
|
Service Code
|
HCPCS 73206
|
| Hospital Charge Code |
35000091
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$114.43 |
| Max. Negotiated Rate |
$1,877.40 |
| Rate for Payer: Aetna Commercial |
$676.36
|
| Rate for Payer: Ambetter Exchange |
$272.45
|
| Rate for Payer: Anthem Medicaid |
$246.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$272.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$272.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$326.94
|
| Rate for Payer: Cash Price |
$1,564.50
|
| Rate for Payer: Cash Price |
$1,564.50
|
| Rate for Payer: Cigna Commercial |
$741.57
|
| Rate for Payer: Healthspan PPO |
$464.76
|
| Rate for Payer: Humana Medicaid |
$246.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$114.43
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$272.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$272.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$251.34
|
| Rate for Payer: Molina Healthcare Passport |
$246.41
|
| Rate for Payer: Multiplan PHCS |
$1,877.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$354.19
|
| Rate for Payer: UHCCP Medicaid |
$1,095.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$248.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$272.45
|
|
|
CTA UPPER EXTREMITY
|
Facility
|
IP
|
$3,129.00
|
|
|
Service Code
|
HCPCS 73206
|
| Hospital Charge Code |
35000091
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$938.70 |
| Max. Negotiated Rate |
$3,003.84 |
| Rate for Payer: Aetna Commercial |
$2,409.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,440.62
|
| Rate for Payer: Cash Price |
$1,564.50
|
| Rate for Payer: Cigna Commercial |
$2,597.07
|
| Rate for Payer: First Health Commercial |
$2,972.55
|
| Rate for Payer: Humana Commercial |
$2,659.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,565.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,309.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$938.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,753.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,346.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,503.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,722.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,159.01
|
| Rate for Payer: PHCS Commercial |
$3,003.84
|
| Rate for Payer: United Healthcare All Payer |
$2,753.52
|
|
|
CTA UPPER EXTREMITY
|
Facility
|
OP
|
$2,666.00
|
|
|
Service Code
|
HCPCS 73206
|
| Hospital Charge Code |
35000005
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$2,559.36 |
| Rate for Payer: Aetna Commercial |
$2,052.82
|
| Rate for Payer: Anthem Medicaid |
$916.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,079.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$1,333.00
|
| Rate for Payer: Cash Price |
$1,333.00
|
| Rate for Payer: Cigna Commercial |
$2,212.78
|
| Rate for Payer: First Health Commercial |
$2,532.70
|
| Rate for Payer: Humana Commercial |
$2,266.10
|
| Rate for Payer: Humana KY Medicaid |
$916.84
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$926.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,186.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,967.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$935.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,346.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,999.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,132.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,319.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,839.54
|
| Rate for Payer: PHCS Commercial |
$2,559.36
|
| Rate for Payer: United Healthcare All Payer |
$2,346.08
|
|
|
CTA UPPER EXTREMITY
|
Facility
|
OP
|
$3,129.00
|
|
|
Service Code
|
HCPCS 73206
|
| Hospital Charge Code |
35000091
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$3,003.84 |
| Rate for Payer: Aetna Commercial |
$2,409.33
|
| Rate for Payer: Anthem Medicaid |
$1,076.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,440.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$1,564.50
|
| Rate for Payer: Cash Price |
$1,564.50
|
| Rate for Payer: Cigna Commercial |
$2,597.07
|
| Rate for Payer: First Health Commercial |
$2,972.55
|
| Rate for Payer: Humana Commercial |
$2,659.65
|
| Rate for Payer: Humana KY Medicaid |
$1,076.06
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,087.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,565.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,309.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,097.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,753.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,346.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,503.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,722.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,159.01
|
| Rate for Payer: PHCS Commercial |
$3,003.84
|
| Rate for Payer: United Healthcare All Payer |
$2,753.52
|
|
|
CTA UPPER EXTREMITY(P
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS 73206
|
| Hospital Charge Code |
350P0091
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$101.50 |
| Max. Negotiated Rate |
$741.57 |
| Rate for Payer: Aetna Commercial |
$676.36
|
| Rate for Payer: Ambetter Exchange |
$272.45
|
| Rate for Payer: Anthem Medicaid |
$246.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$272.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$272.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$326.94
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cigna Commercial |
$741.57
|
| Rate for Payer: Healthspan PPO |
$464.76
|
| Rate for Payer: Humana Medicaid |
$246.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$114.43
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$272.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$272.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$251.34
|
| Rate for Payer: Molina Healthcare Passport |
$246.41
|
| Rate for Payer: Multiplan PHCS |
$174.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$354.19
|
| Rate for Payer: UHCCP Medicaid |
$101.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$248.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$272.45
|
|
|
CTA UPPER EXTREMITY(T
|
Facility
|
OP
|
$2,839.00
|
|
|
Service Code
|
HCPCS 73206
|
| Hospital Charge Code |
350T0091
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$2,725.44 |
| Rate for Payer: Aetna Commercial |
$2,186.03
|
| Rate for Payer: Anthem Medicaid |
$976.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,214.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$1,419.50
|
| Rate for Payer: Cash Price |
$1,419.50
|
| Rate for Payer: Cigna Commercial |
$2,356.37
|
| Rate for Payer: First Health Commercial |
$2,697.05
|
| Rate for Payer: Humana Commercial |
$2,413.15
|
| Rate for Payer: Humana KY Medicaid |
$976.33
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$986.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,327.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,095.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$995.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,498.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,129.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,271.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,469.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,958.91
|
| Rate for Payer: PHCS Commercial |
$2,725.44
|
| Rate for Payer: United Healthcare All Payer |
$2,498.32
|
|
|
CTA UPPER EXTREMITY(T
|
Facility
|
IP
|
$2,839.00
|
|
|
Service Code
|
HCPCS 73206
|
| Hospital Charge Code |
350T0091
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$851.70 |
| Max. Negotiated Rate |
$2,725.44 |
| Rate for Payer: Aetna Commercial |
$2,186.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,214.42
|
| Rate for Payer: Cash Price |
$1,419.50
|
| Rate for Payer: Cigna Commercial |
$2,356.37
|
| Rate for Payer: First Health Commercial |
$2,697.05
|
| Rate for Payer: Humana Commercial |
$2,413.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,327.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,095.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$851.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,498.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,129.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,271.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,469.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,958.91
|
| Rate for Payer: PHCS Commercial |
$2,725.44
|
| Rate for Payer: United Healthcare All Payer |
$2,498.32
|
|
