|
ECH STR FEM REAMER SZ 13.0MM
|
Facility
|
IP
|
$3,855.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,156.54 |
| Max. Negotiated Rate |
$3,700.92 |
| Rate for Payer: Aetna Commercial |
$2,968.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,006.99
|
| Rate for Payer: Cash Price |
$1,927.56
|
| Rate for Payer: Cigna Commercial |
$3,199.75
|
| Rate for Payer: First Health Commercial |
$3,662.36
|
| Rate for Payer: Humana Commercial |
$3,276.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,161.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,392.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,891.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,084.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,353.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.03
|
| Rate for Payer: PHCS Commercial |
$3,700.92
|
| Rate for Payer: United Healthcare All Payer |
$3,392.51
|
|
|
ECH STR FEM REAMER SZ 13.5MM
|
Facility
|
OP
|
$3,855.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,156.54 |
| Max. Negotiated Rate |
$3,700.92 |
| Rate for Payer: Aetna Commercial |
$2,968.44
|
| Rate for Payer: Anthem Medicaid |
$1,325.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,006.99
|
| Rate for Payer: Cash Price |
$1,927.56
|
| Rate for Payer: Cigna Commercial |
$3,199.75
|
| Rate for Payer: First Health Commercial |
$3,662.36
|
| Rate for Payer: Humana Commercial |
$3,276.85
|
| Rate for Payer: Humana KY Medicaid |
$1,325.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,339.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,161.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,352.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,392.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,891.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,084.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,353.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.03
|
| Rate for Payer: PHCS Commercial |
$3,700.92
|
| Rate for Payer: United Healthcare All Payer |
$3,392.51
|
|
|
ECH STR FEM REAMER SZ 13.5MM
|
Facility
|
IP
|
$3,855.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,156.54 |
| Max. Negotiated Rate |
$3,700.92 |
| Rate for Payer: Aetna Commercial |
$2,968.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,006.99
|
| Rate for Payer: Cash Price |
$1,927.56
|
| Rate for Payer: Cigna Commercial |
$3,199.75
|
| Rate for Payer: First Health Commercial |
$3,662.36
|
| Rate for Payer: Humana Commercial |
$3,276.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,161.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,392.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,891.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,084.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,353.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.03
|
| Rate for Payer: PHCS Commercial |
$3,700.92
|
| Rate for Payer: United Healthcare All Payer |
$3,392.51
|
|
|
ECH STR FEM REAMER SZ 14.0MM
|
Facility
|
IP
|
$3,855.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,156.54 |
| Max. Negotiated Rate |
$3,700.92 |
| Rate for Payer: Aetna Commercial |
$2,968.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,006.99
|
| Rate for Payer: Cash Price |
$1,927.56
|
| Rate for Payer: Cigna Commercial |
$3,199.75
|
| Rate for Payer: First Health Commercial |
$3,662.36
|
| Rate for Payer: Humana Commercial |
$3,276.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,161.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,392.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,891.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,084.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,353.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.03
|
| Rate for Payer: PHCS Commercial |
$3,700.92
|
| Rate for Payer: United Healthcare All Payer |
$3,392.51
|
|
|
ECH STR FEM REAMER SZ 14.0MM
|
Facility
|
OP
|
$3,855.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,156.54 |
| Max. Negotiated Rate |
$3,700.92 |
| Rate for Payer: Aetna Commercial |
$2,968.44
|
| Rate for Payer: Anthem Medicaid |
$1,325.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,006.99
|
| Rate for Payer: Cash Price |
$1,927.56
|
| Rate for Payer: Cigna Commercial |
$3,199.75
|
| Rate for Payer: First Health Commercial |
$3,662.36
|
| Rate for Payer: Humana Commercial |
$3,276.85
|
| Rate for Payer: Humana KY Medicaid |
$1,325.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,339.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,161.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,352.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,392.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,891.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,084.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,353.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.03
|
| Rate for Payer: PHCS Commercial |
$3,700.92
|
| Rate for Payer: United Healthcare All Payer |
$3,392.51
|
|
|
ECH STR FEM REAMER SZ 14.5MM
|
Facility
|
OP
|
$3,855.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,156.54 |
| Max. Negotiated Rate |
$3,700.92 |
| Rate for Payer: Aetna Commercial |
$2,968.44
|
| Rate for Payer: Anthem Medicaid |
$1,325.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,006.99
|
| Rate for Payer: Cash Price |
$1,927.56
|
| Rate for Payer: Cigna Commercial |
$3,199.75
|
| Rate for Payer: First Health Commercial |
$3,662.36
|
| Rate for Payer: Humana Commercial |
$3,276.85
|
| Rate for Payer: Humana KY Medicaid |
$1,325.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,339.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,161.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,352.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,392.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,891.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,084.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,353.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.03
|
| Rate for Payer: PHCS Commercial |
$3,700.92
|
| Rate for Payer: United Healthcare All Payer |
$3,392.51
|
|
|
ECH STR FEM REAMER SZ 14.5MM
|
Facility
|
IP
|
$3,855.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,156.54 |
| Max. Negotiated Rate |
$3,700.92 |
| Rate for Payer: Aetna Commercial |
$2,968.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,006.99
|
| Rate for Payer: Cash Price |
$1,927.56
|
| Rate for Payer: Cigna Commercial |
$3,199.75
|
| Rate for Payer: First Health Commercial |
$3,662.36
|
| Rate for Payer: Humana Commercial |
$3,276.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,161.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,392.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,891.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,084.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,353.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.03
|
| Rate for Payer: PHCS Commercial |
$3,700.92
|
| Rate for Payer: United Healthcare All Payer |
$3,392.51
|
|
|
ECH STR FEM REAMER SZ 15.0MM
|
Facility
|
IP
|
$3,855.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,156.54 |
| Max. Negotiated Rate |
$3,700.92 |
| Rate for Payer: Aetna Commercial |
$2,968.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,006.99
|
| Rate for Payer: Cash Price |
$1,927.56
|
| Rate for Payer: Cigna Commercial |
$3,199.75
|
| Rate for Payer: First Health Commercial |
$3,662.36
|
| Rate for Payer: Humana Commercial |
$3,276.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,161.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,392.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,891.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,084.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,353.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.03
|
| Rate for Payer: PHCS Commercial |
$3,700.92
|
| Rate for Payer: United Healthcare All Payer |
$3,392.51
|
|
|
ECH STR FEM REAMER SZ 15.0MM
|
Facility
|
OP
|
$3,855.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,156.54 |
| Max. Negotiated Rate |
$3,700.92 |
| Rate for Payer: Aetna Commercial |
$2,968.44
|
| Rate for Payer: Anthem Medicaid |
$1,325.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,006.99
|
| Rate for Payer: Cash Price |
$1,927.56
|
| Rate for Payer: Cigna Commercial |
$3,199.75
|
| Rate for Payer: First Health Commercial |
$3,662.36
|
| Rate for Payer: Humana Commercial |
$3,276.85
|
| Rate for Payer: Humana KY Medicaid |
$1,325.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,339.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,161.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,352.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,392.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,891.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,084.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,353.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.03
|
| Rate for Payer: PHCS Commercial |
$3,700.92
|
| Rate for Payer: United Healthcare All Payer |
$3,392.51
|
|
|
ECH STR FEM REAMER SZ 15.5MM
|
Facility
|
OP
|
$3,855.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,156.54 |
| Max. Negotiated Rate |
$3,700.92 |
| Rate for Payer: Aetna Commercial |
$2,968.44
|
| Rate for Payer: Anthem Medicaid |
$1,325.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,006.99
|
| Rate for Payer: Cash Price |
$1,927.56
|
| Rate for Payer: Cigna Commercial |
$3,199.75
|
| Rate for Payer: First Health Commercial |
$3,662.36
|
| Rate for Payer: Humana Commercial |
$3,276.85
|
| Rate for Payer: Humana KY Medicaid |
$1,325.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,339.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,161.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,352.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,392.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,891.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,084.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,353.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.03
|
| Rate for Payer: PHCS Commercial |
$3,700.92
|
| Rate for Payer: United Healthcare All Payer |
$3,392.51
|
|
|
ECH STR FEM REAMER SZ 15.5MM
|
Facility
|
IP
|
$3,855.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,156.54 |
| Max. Negotiated Rate |
$3,700.92 |
| Rate for Payer: Aetna Commercial |
$2,968.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,006.99
|
| Rate for Payer: Cash Price |
$1,927.56
|
| Rate for Payer: Cigna Commercial |
$3,199.75
|
| Rate for Payer: First Health Commercial |
$3,662.36
|
| Rate for Payer: Humana Commercial |
$3,276.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,161.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,392.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,891.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,084.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,353.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.03
|
| Rate for Payer: PHCS Commercial |
$3,700.92
|
| Rate for Payer: United Healthcare All Payer |
$3,392.51
|
|
|
ECH STR FEM REAMER SZ 16.0MM
|
Facility
|
IP
|
$3,855.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,156.54 |
| Max. Negotiated Rate |
$3,700.92 |
| Rate for Payer: Aetna Commercial |
$2,968.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,006.99
|
| Rate for Payer: Cash Price |
$1,927.56
|
| Rate for Payer: Cigna Commercial |
$3,199.75
|
| Rate for Payer: First Health Commercial |
$3,662.36
|
| Rate for Payer: Humana Commercial |
$3,276.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,161.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,392.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,891.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,084.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,353.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.03
|
| Rate for Payer: PHCS Commercial |
$3,700.92
|
| Rate for Payer: United Healthcare All Payer |
$3,392.51
|
|
|
ECH STR FEM REAMER SZ 16.0MM
|
Facility
|
OP
|
$3,855.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,156.54 |
| Max. Negotiated Rate |
$3,700.92 |
| Rate for Payer: Aetna Commercial |
$2,968.44
|
| Rate for Payer: Anthem Medicaid |
$1,325.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,006.99
|
| Rate for Payer: Cash Price |
$1,927.56
|
| Rate for Payer: Cigna Commercial |
$3,199.75
|
| Rate for Payer: First Health Commercial |
$3,662.36
|
| Rate for Payer: Humana Commercial |
$3,276.85
|
| Rate for Payer: Humana KY Medicaid |
$1,325.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,339.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,161.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,352.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,392.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,891.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,084.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,353.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.03
|
| Rate for Payer: PHCS Commercial |
$3,700.92
|
| Rate for Payer: United Healthcare All Payer |
$3,392.51
|
|
|
ECH STR FEM REAMER SZ 16.5MM
|
Facility
|
OP
|
$3,855.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,156.54 |
| Max. Negotiated Rate |
$3,700.92 |
| Rate for Payer: Aetna Commercial |
$2,968.44
|
| Rate for Payer: Anthem Medicaid |
$1,325.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,006.99
|
| Rate for Payer: Cash Price |
$1,927.56
|
| Rate for Payer: Cigna Commercial |
$3,199.75
|
| Rate for Payer: First Health Commercial |
$3,662.36
|
| Rate for Payer: Humana Commercial |
$3,276.85
|
| Rate for Payer: Humana KY Medicaid |
$1,325.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,339.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,161.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,352.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,392.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,891.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,084.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,353.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.03
|
| Rate for Payer: PHCS Commercial |
$3,700.92
|
| Rate for Payer: United Healthcare All Payer |
$3,392.51
|
|
|
ECH STR FEM REAMER SZ 16.5MM
|
Facility
|
IP
|
$3,855.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,156.54 |
| Max. Negotiated Rate |
$3,700.92 |
| Rate for Payer: Aetna Commercial |
$2,968.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,006.99
|
| Rate for Payer: Cash Price |
$1,927.56
|
| Rate for Payer: Cigna Commercial |
$3,199.75
|
| Rate for Payer: First Health Commercial |
$3,662.36
|
| Rate for Payer: Humana Commercial |
$3,276.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,161.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,392.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,891.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,084.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,353.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.03
|
| Rate for Payer: PHCS Commercial |
$3,700.92
|
| Rate for Payer: United Healthcare All Payer |
$3,392.51
|
|
|
ECH STR FEM REAMER SZ 17.0MM
|
Facility
|
OP
|
$3,855.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,156.54 |
| Max. Negotiated Rate |
$3,700.92 |
| Rate for Payer: Aetna Commercial |
$2,968.44
|
| Rate for Payer: Anthem Medicaid |
$1,325.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,006.99
|
| Rate for Payer: Cash Price |
$1,927.56
|
| Rate for Payer: Cigna Commercial |
$3,199.75
|
| Rate for Payer: First Health Commercial |
$3,662.36
|
| Rate for Payer: Humana Commercial |
$3,276.85
|
| Rate for Payer: Humana KY Medicaid |
$1,325.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,339.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,161.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,352.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,392.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,891.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,084.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,353.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.03
|
| Rate for Payer: PHCS Commercial |
$3,700.92
|
| Rate for Payer: United Healthcare All Payer |
$3,392.51
|
|
|
ECH STR FEM REAMER SZ 17.0MM
|
Facility
|
IP
|
$3,855.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,156.54 |
| Max. Negotiated Rate |
$3,700.92 |
| Rate for Payer: Aetna Commercial |
$2,968.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,006.99
|
| Rate for Payer: Cash Price |
$1,927.56
|
| Rate for Payer: Cigna Commercial |
$3,199.75
|
| Rate for Payer: First Health Commercial |
$3,662.36
|
| Rate for Payer: Humana Commercial |
$3,276.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,161.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,392.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,891.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,084.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,353.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.03
|
| Rate for Payer: PHCS Commercial |
$3,700.92
|
| Rate for Payer: United Healthcare All Payer |
$3,392.51
|
|
|
ECH STR FEM REAMER SZ 17.5MM
|
Facility
|
IP
|
$3,855.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,156.54 |
| Max. Negotiated Rate |
$3,700.92 |
| Rate for Payer: Aetna Commercial |
$2,968.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,006.99
|
| Rate for Payer: Cash Price |
$1,927.56
|
| Rate for Payer: Cigna Commercial |
$3,199.75
|
| Rate for Payer: First Health Commercial |
$3,662.36
|
| Rate for Payer: Humana Commercial |
$3,276.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,161.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,392.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,891.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,084.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,353.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.03
|
| Rate for Payer: PHCS Commercial |
$3,700.92
|
| Rate for Payer: United Healthcare All Payer |
$3,392.51
|
|
|
ECH STR FEM REAMER SZ 17.5MM
|
Facility
|
OP
|
$3,855.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,156.54 |
| Max. Negotiated Rate |
$3,700.92 |
| Rate for Payer: Aetna Commercial |
$2,968.44
|
| Rate for Payer: Anthem Medicaid |
$1,325.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,006.99
|
| Rate for Payer: Cash Price |
$1,927.56
|
| Rate for Payer: Cigna Commercial |
$3,199.75
|
| Rate for Payer: First Health Commercial |
$3,662.36
|
| Rate for Payer: Humana Commercial |
$3,276.85
|
| Rate for Payer: Humana KY Medicaid |
$1,325.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,339.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,161.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,352.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,392.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,891.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,084.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,353.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.03
|
| Rate for Payer: PHCS Commercial |
$3,700.92
|
| Rate for Payer: United Healthcare All Payer |
$3,392.51
|
|
|
ECH STR FEM REAMER SZ 18.0MM
|
Facility
|
IP
|
$3,855.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,156.54 |
| Max. Negotiated Rate |
$3,700.92 |
| Rate for Payer: Aetna Commercial |
$2,968.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,006.99
|
| Rate for Payer: Cash Price |
$1,927.56
|
| Rate for Payer: Cigna Commercial |
$3,199.75
|
| Rate for Payer: First Health Commercial |
$3,662.36
|
| Rate for Payer: Humana Commercial |
$3,276.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,161.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,392.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,891.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,084.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,353.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.03
|
| Rate for Payer: PHCS Commercial |
$3,700.92
|
| Rate for Payer: United Healthcare All Payer |
$3,392.51
|
|
|
ECH STR FEM REAMER SZ 18.0MM
|
Facility
|
OP
|
$3,855.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,156.54 |
| Max. Negotiated Rate |
$3,700.92 |
| Rate for Payer: Aetna Commercial |
$2,968.44
|
| Rate for Payer: Anthem Medicaid |
$1,325.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,006.99
|
| Rate for Payer: Cash Price |
$1,927.56
|
| Rate for Payer: Cigna Commercial |
$3,199.75
|
| Rate for Payer: First Health Commercial |
$3,662.36
|
| Rate for Payer: Humana Commercial |
$3,276.85
|
| Rate for Payer: Humana KY Medicaid |
$1,325.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,339.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,161.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,352.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,392.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,891.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,084.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,353.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.03
|
| Rate for Payer: PHCS Commercial |
$3,700.92
|
| Rate for Payer: United Healthcare All Payer |
$3,392.51
|
|
|
ECH STR FEM REAMER SZ 18.5MM
|
Facility
|
OP
|
$3,855.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,156.54 |
| Max. Negotiated Rate |
$3,700.92 |
| Rate for Payer: Aetna Commercial |
$2,968.44
|
| Rate for Payer: Anthem Medicaid |
$1,325.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,006.99
|
| Rate for Payer: Cash Price |
$1,927.56
|
| Rate for Payer: Cigna Commercial |
$3,199.75
|
| Rate for Payer: First Health Commercial |
$3,662.36
|
| Rate for Payer: Humana Commercial |
$3,276.85
|
| Rate for Payer: Humana KY Medicaid |
$1,325.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,339.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,161.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,352.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,392.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,891.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,084.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,353.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.03
|
| Rate for Payer: PHCS Commercial |
$3,700.92
|
| Rate for Payer: United Healthcare All Payer |
$3,392.51
|
|
|
ECH STR FEM REAMER SZ 18.5MM
|
Facility
|
IP
|
$3,855.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,156.54 |
| Max. Negotiated Rate |
$3,700.92 |
| Rate for Payer: Aetna Commercial |
$2,968.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,006.99
|
| Rate for Payer: Cash Price |
$1,927.56
|
| Rate for Payer: Cigna Commercial |
$3,199.75
|
| Rate for Payer: First Health Commercial |
$3,662.36
|
| Rate for Payer: Humana Commercial |
$3,276.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,161.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,392.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,891.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,084.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,353.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.03
|
| Rate for Payer: PHCS Commercial |
$3,700.92
|
| Rate for Payer: United Healthcare All Payer |
$3,392.51
|
|
|
ECH STR FEM REAMER SZ 19.0MM
|
Facility
|
OP
|
$3,855.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,156.54 |
| Max. Negotiated Rate |
$3,700.92 |
| Rate for Payer: Aetna Commercial |
$2,968.44
|
| Rate for Payer: Anthem Medicaid |
$1,325.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,006.99
|
| Rate for Payer: Cash Price |
$1,927.56
|
| Rate for Payer: Cigna Commercial |
$3,199.75
|
| Rate for Payer: First Health Commercial |
$3,662.36
|
| Rate for Payer: Humana Commercial |
$3,276.85
|
| Rate for Payer: Humana KY Medicaid |
$1,325.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,339.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,161.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,352.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,392.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,891.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,084.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,353.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.03
|
| Rate for Payer: PHCS Commercial |
$3,700.92
|
| Rate for Payer: United Healthcare All Payer |
$3,392.51
|
|
|
ECH STR FEM REAMER SZ 19.0MM
|
Facility
|
IP
|
$3,855.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,156.54 |
| Max. Negotiated Rate |
$3,700.92 |
| Rate for Payer: Aetna Commercial |
$2,968.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,006.99
|
| Rate for Payer: Cash Price |
$1,927.56
|
| Rate for Payer: Cigna Commercial |
$3,199.75
|
| Rate for Payer: First Health Commercial |
$3,662.36
|
| Rate for Payer: Humana Commercial |
$3,276.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,161.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,392.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,891.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,084.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,353.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.03
|
| Rate for Payer: PHCS Commercial |
$3,700.92
|
| Rate for Payer: United Healthcare All Payer |
$3,392.51
|
|
