|
ECH STR FEM REAMER SZ 19.5MM
|
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 19.5MM
|
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 20.0MM
|
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 20.0MM
|
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 20.5MM
|
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 20.5MM
|
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 21.0MM
|
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 21.0MM
|
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 21.5MM
|
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 21.5MM
|
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 22.0MM
|
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 22.0MM
|
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 8.0MM
|
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 8.0MM
|
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 8.5MM
|
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 8.5MM
|
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 9.0MM
|
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 9.0MM
|
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 9.5MM
|
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 9.5MM
|
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
|
|
|
ECLIPSE CAGE SCREW 30MM
|
Facility
|
IP
|
$19,135.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,740.57 |
| Max. Negotiated Rate |
$18,369.84 |
| Rate for Payer: Aetna Commercial |
$14,734.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,925.50
|
| Rate for Payer: Cash Price |
$9,567.62
|
| Rate for Payer: Cigna Commercial |
$15,882.26
|
| Rate for Payer: First Health Commercial |
$18,178.49
|
| Rate for Payer: Humana Commercial |
$16,264.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,690.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,121.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,740.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,839.02
|
| Rate for Payer: Ohio Health Group HMO |
$14,351.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,308.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,647.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,203.32
|
| Rate for Payer: PHCS Commercial |
$18,369.84
|
| Rate for Payer: United Healthcare All Payer |
$16,839.02
|
|
|
ECLIPSE CAGE SCREW 30MM
|
Facility
|
OP
|
$19,135.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,740.57 |
| Max. Negotiated Rate |
$18,369.84 |
| Rate for Payer: Aetna Commercial |
$14,734.14
|
| Rate for Payer: Anthem Medicaid |
$6,580.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,925.50
|
| Rate for Payer: Cash Price |
$9,567.62
|
| Rate for Payer: Cigna Commercial |
$15,882.26
|
| Rate for Payer: First Health Commercial |
$18,178.49
|
| Rate for Payer: Humana Commercial |
$16,264.96
|
| Rate for Payer: Humana KY Medicaid |
$6,580.61
|
| Rate for Payer: Kentucky WC Medicaid |
$6,647.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,690.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,121.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,740.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,712.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,839.02
|
| Rate for Payer: Ohio Health Group HMO |
$14,351.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,308.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,647.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,203.32
|
| Rate for Payer: PHCS Commercial |
$18,369.84
|
| Rate for Payer: United Healthcare All Payer |
$16,839.02
|
|
|
ECLIPSE CAGE SCREW 35MM
|
Facility
|
OP
|
$21,593.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,478.12 |
| Max. Negotiated Rate |
$20,730.00 |
| Rate for Payer: Aetna Commercial |
$16,627.19
|
| Rate for Payer: Anthem Medicaid |
$7,426.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,843.12
|
| Rate for Payer: Cash Price |
$10,796.88
|
| Rate for Payer: Cigna Commercial |
$17,922.81
|
| Rate for Payer: First Health Commercial |
$20,514.06
|
| Rate for Payer: Humana Commercial |
$18,354.69
|
| Rate for Payer: Humana KY Medicaid |
$7,426.09
|
| Rate for Payer: Kentucky WC Medicaid |
$7,501.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,706.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,936.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,478.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,575.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,002.50
|
| Rate for Payer: Ohio Health Group HMO |
$16,195.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,275.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,786.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,899.69
|
| Rate for Payer: PHCS Commercial |
$20,730.00
|
| Rate for Payer: United Healthcare All Payer |
$19,002.50
|
|
|
ECLIPSE CAGE SCREW 35MM
|
Facility
|
IP
|
$21,593.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,478.12 |
| Max. Negotiated Rate |
$20,730.00 |
| Rate for Payer: Aetna Commercial |
$16,627.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,843.12
|
| Rate for Payer: Cash Price |
$10,796.88
|
| Rate for Payer: Cigna Commercial |
$17,922.81
|
| Rate for Payer: First Health Commercial |
$20,514.06
|
| Rate for Payer: Humana Commercial |
$18,354.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,706.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,936.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,478.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,002.50
|
| Rate for Payer: Ohio Health Group HMO |
$16,195.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,275.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,786.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,899.69
|
| Rate for Payer: PHCS Commercial |
$20,730.00
|
| Rate for Payer: United Healthcare All Payer |
$19,002.50
|
|
|
ECLIPSE CAGE SCREW 40MM
|
Facility
|
OP
|
$21,593.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,478.12 |
| Max. Negotiated Rate |
$20,730.00 |
| Rate for Payer: Aetna Commercial |
$16,627.19
|
| Rate for Payer: Anthem Medicaid |
$7,426.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,843.12
|
| Rate for Payer: Cash Price |
$10,796.88
|
| Rate for Payer: Cigna Commercial |
$17,922.81
|
| Rate for Payer: First Health Commercial |
$20,514.06
|
| Rate for Payer: Humana Commercial |
$18,354.69
|
| Rate for Payer: Humana KY Medicaid |
$7,426.09
|
| Rate for Payer: Kentucky WC Medicaid |
$7,501.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,706.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,936.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,478.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,575.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,002.50
|
| Rate for Payer: Ohio Health Group HMO |
$16,195.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,275.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,786.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,899.69
|
| Rate for Payer: PHCS Commercial |
$20,730.00
|
| Rate for Payer: United Healthcare All Payer |
$19,002.50
|
|
