|
ANCHOR 3.8*0.5CM SWIFTLOCK
|
Facility
|
OP
|
$1,775.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$532.50 |
| Max. Negotiated Rate |
$1,704.00 |
| Rate for Payer: Aetna Commercial |
$1,366.75
|
| Rate for Payer: Anthem Medicaid |
$610.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,384.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,473.25
|
| Rate for Payer: First Health Commercial |
$1,686.25
|
| Rate for Payer: Humana Commercial |
$1,508.75
|
| Rate for Payer: Humana KY Medicaid |
$610.42
|
| Rate for Payer: Kentucky WC Medicaid |
$616.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,455.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,309.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$532.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$622.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,562.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,331.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,544.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.75
|
| Rate for Payer: PHCS Commercial |
$1,704.00
|
| Rate for Payer: United Healthcare All Payer |
$1,562.00
|
|
|
ANCHOR 3.8*0.5CM SWIFTLOCK
|
Facility
|
IP
|
$1,775.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$532.50 |
| Max. Negotiated Rate |
$1,704.00 |
| Rate for Payer: Aetna Commercial |
$1,366.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,384.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,473.25
|
| Rate for Payer: First Health Commercial |
$1,686.25
|
| Rate for Payer: Humana Commercial |
$1,508.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,455.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,309.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$532.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,562.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,331.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,544.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.75
|
| Rate for Payer: PHCS Commercial |
$1,704.00
|
| Rate for Payer: United Healthcare All Payer |
$1,562.00
|
|
|
ANCHORAGE CP LAP PLATE 0DEG L
|
Facility
|
OP
|
$9,916.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,975.03 |
| Max. Negotiated Rate |
$9,520.08 |
| Rate for Payer: Aetna Commercial |
$7,635.90
|
| Rate for Payer: Anthem Medicaid |
$3,410.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,735.06
|
| Rate for Payer: Cash Price |
$4,958.38
|
| Rate for Payer: Cigna Commercial |
$8,230.90
|
| Rate for Payer: First Health Commercial |
$9,420.91
|
| Rate for Payer: Humana Commercial |
$8,429.24
|
| Rate for Payer: Humana KY Medicaid |
$3,410.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3,445.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,131.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,318.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,478.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,726.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,437.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,627.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,842.56
|
| Rate for Payer: PHCS Commercial |
$9,520.08
|
| Rate for Payer: United Healthcare All Payer |
$8,726.74
|
|
|
ANCHORAGE CP LAP PLATE 0DEG L
|
Facility
|
IP
|
$9,916.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,975.03 |
| Max. Negotiated Rate |
$9,520.08 |
| Rate for Payer: Aetna Commercial |
$7,635.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,735.06
|
| Rate for Payer: Cash Price |
$4,958.38
|
| Rate for Payer: Cigna Commercial |
$8,230.90
|
| Rate for Payer: First Health Commercial |
$9,420.91
|
| Rate for Payer: Humana Commercial |
$8,429.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,131.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,318.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,726.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,437.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,627.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,842.56
|
| Rate for Payer: PHCS Commercial |
$9,520.08
|
| Rate for Payer: United Healthcare All Payer |
$8,726.74
|
|
|
ANCHORAGE CP LAP PLATE 0DEG R
|
Facility
|
IP
|
$9,916.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,975.03 |
| Max. Negotiated Rate |
$9,520.08 |
| Rate for Payer: Aetna Commercial |
$7,635.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,735.06
|
| Rate for Payer: Cash Price |
$4,958.38
|
| Rate for Payer: Cigna Commercial |
$8,230.90
|
| Rate for Payer: First Health Commercial |
$9,420.91
|
| Rate for Payer: Humana Commercial |
$8,429.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,131.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,318.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,726.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,437.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,627.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,842.56
|
| Rate for Payer: PHCS Commercial |
$9,520.08
|
| Rate for Payer: United Healthcare All Payer |
$8,726.74
|
|
|
ANCHORAGE CP LAP PLATE 0DEG R
|
Facility
|
OP
|
$9,916.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,975.03 |
| Max. Negotiated Rate |
$9,520.08 |
| Rate for Payer: Aetna Commercial |
$7,635.90
|
| Rate for Payer: Anthem Medicaid |
$3,410.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,735.06
|
| Rate for Payer: Cash Price |
$4,958.38
|
| Rate for Payer: Cigna Commercial |
$8,230.90
|
| Rate for Payer: First Health Commercial |
$9,420.91
|
| Rate for Payer: Humana Commercial |
$8,429.24
|
| Rate for Payer: Humana KY Medicaid |
$3,410.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3,445.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,131.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,318.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,478.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,726.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,437.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,627.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,842.56
|
| Rate for Payer: PHCS Commercial |
$9,520.08
|
| Rate for Payer: United Healthcare All Payer |
$8,726.74
|
|
|
ANCHORAGE CP LAP PLATE 1MM L
|
Facility
|
OP
|
$9,916.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,975.03 |
| Max. Negotiated Rate |
$9,520.08 |
| Rate for Payer: Aetna Commercial |
$7,635.90
|
| Rate for Payer: Anthem Medicaid |
$3,410.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,735.06
|
| Rate for Payer: Cash Price |
$4,958.38
|
| Rate for Payer: Cigna Commercial |
$8,230.90
|
| Rate for Payer: First Health Commercial |
$9,420.91
|
| Rate for Payer: Humana Commercial |
$8,429.24
|
| Rate for Payer: Humana KY Medicaid |
$3,410.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3,445.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,131.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,318.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,478.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,726.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,437.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,627.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,842.56
|
| Rate for Payer: PHCS Commercial |
$9,520.08
|
| Rate for Payer: United Healthcare All Payer |
$8,726.74
|
|
|
ANCHORAGE CP LAP PLATE 1MM L
|
Facility
|
IP
|
$9,916.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,975.03 |
| Max. Negotiated Rate |
$9,520.08 |
| Rate for Payer: Aetna Commercial |
$7,635.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,735.06
|
| Rate for Payer: Cash Price |
$4,958.38
|
| Rate for Payer: Cigna Commercial |
$8,230.90
|
| Rate for Payer: First Health Commercial |
$9,420.91
|
| Rate for Payer: Humana Commercial |
$8,429.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,131.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,318.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,726.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,437.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,627.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,842.56
|
| Rate for Payer: PHCS Commercial |
$9,520.08
|
| Rate for Payer: United Healthcare All Payer |
$8,726.74
|
|
|
ANCHORAGE CP LAP PLATE 1MM R
|
Facility
|
IP
|
$9,916.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,975.03 |
| Max. Negotiated Rate |
$9,520.08 |
| Rate for Payer: Aetna Commercial |
$7,635.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,735.06
|
| Rate for Payer: Cash Price |
$4,958.38
|
| Rate for Payer: Cigna Commercial |
$8,230.90
|
| Rate for Payer: First Health Commercial |
$9,420.91
|
| Rate for Payer: Humana Commercial |
$8,429.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,131.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,318.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,726.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,437.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,627.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,842.56
|
| Rate for Payer: PHCS Commercial |
$9,520.08
|
| Rate for Payer: United Healthcare All Payer |
$8,726.74
|
|
|
ANCHORAGE CP LAP PLATE 1MM R
|
Facility
|
OP
|
$9,916.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,975.03 |
| Max. Negotiated Rate |
$9,520.08 |
| Rate for Payer: Aetna Commercial |
$7,635.90
|
| Rate for Payer: Anthem Medicaid |
$3,410.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,735.06
|
| Rate for Payer: Cash Price |
$4,958.38
|
| Rate for Payer: Cigna Commercial |
$8,230.90
|
| Rate for Payer: First Health Commercial |
$9,420.91
|
| Rate for Payer: Humana Commercial |
$8,429.24
|
| Rate for Payer: Humana KY Medicaid |
$3,410.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3,445.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,131.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,318.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,478.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,726.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,437.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,627.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,842.56
|
| Rate for Payer: PHCS Commercial |
$9,520.08
|
| Rate for Payer: United Healthcare All Payer |
$8,726.74
|
|
|
ANCHORAGE CP LAP PLATE 2MM L
|
Facility
|
OP
|
$8,533.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,560.02 |
| Max. Negotiated Rate |
$8,192.06 |
| Rate for Payer: Aetna Commercial |
$6,570.72
|
| Rate for Payer: Anthem Medicaid |
$2,934.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,656.05
|
| Rate for Payer: Cash Price |
$4,266.70
|
| Rate for Payer: Cigna Commercial |
$7,082.72
|
| Rate for Payer: First Health Commercial |
$8,106.73
|
| Rate for Payer: Humana Commercial |
$7,253.39
|
| Rate for Payer: Humana KY Medicaid |
$2,934.64
|
| Rate for Payer: Kentucky WC Medicaid |
$2,964.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,997.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,297.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,560.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,993.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,509.39
|
| Rate for Payer: Ohio Health Group HMO |
$6,400.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,826.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,424.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,888.05
|
| Rate for Payer: PHCS Commercial |
$8,192.06
|
| Rate for Payer: United Healthcare All Payer |
$7,509.39
|
|
|
ANCHORAGE CP LAP PLATE 2MM L
|
Facility
|
IP
|
$8,533.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,560.02 |
| Max. Negotiated Rate |
$8,192.06 |
| Rate for Payer: Aetna Commercial |
$6,570.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,656.05
|
| Rate for Payer: Cash Price |
$4,266.70
|
| Rate for Payer: Cigna Commercial |
$7,082.72
|
| Rate for Payer: First Health Commercial |
$8,106.73
|
| Rate for Payer: Humana Commercial |
$7,253.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,997.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,297.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,560.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,509.39
|
| Rate for Payer: Ohio Health Group HMO |
$6,400.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,826.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,424.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,888.05
|
| Rate for Payer: PHCS Commercial |
$8,192.06
|
| Rate for Payer: United Healthcare All Payer |
$7,509.39
|
|
|
ANCHORAGE CP LAP PLATE 2MM R
|
Facility
|
OP
|
$9,916.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,975.03 |
| Max. Negotiated Rate |
$9,520.08 |
| Rate for Payer: Aetna Commercial |
$7,635.90
|
| Rate for Payer: Anthem Medicaid |
$3,410.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,735.06
|
| Rate for Payer: Cash Price |
$4,958.38
|
| Rate for Payer: Cigna Commercial |
$8,230.90
|
| Rate for Payer: First Health Commercial |
$9,420.91
|
| Rate for Payer: Humana Commercial |
$8,429.24
|
| Rate for Payer: Humana KY Medicaid |
$3,410.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3,445.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,131.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,318.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,478.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,726.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,437.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,627.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,842.56
|
| Rate for Payer: PHCS Commercial |
$9,520.08
|
| Rate for Payer: United Healthcare All Payer |
$8,726.74
|
|
|
ANCHORAGE CP LAP PLATE 2MM R
|
Facility
|
IP
|
$9,916.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,975.03 |
| Max. Negotiated Rate |
$9,520.08 |
| Rate for Payer: Aetna Commercial |
$7,635.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,735.06
|
| Rate for Payer: Cash Price |
$4,958.38
|
| Rate for Payer: Cigna Commercial |
$8,230.90
|
| Rate for Payer: First Health Commercial |
$9,420.91
|
| Rate for Payer: Humana Commercial |
$8,429.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,131.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,318.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,726.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,437.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,627.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,842.56
|
| Rate for Payer: PHCS Commercial |
$9,520.08
|
| Rate for Payer: United Healthcare All Payer |
$8,726.74
|
|
|
ANCHORAGE GUIDEWIRE 0.9*70MM
|
Facility
|
OP
|
$535.24
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$513.83 |
| Rate for Payer: Aetna Commercial |
$412.13
|
| Rate for Payer: Anthem Medicaid |
$184.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$417.49
|
| Rate for Payer: Cash Price |
$267.62
|
| Rate for Payer: Cigna Commercial |
$444.25
|
| Rate for Payer: First Health Commercial |
$508.48
|
| Rate for Payer: Humana Commercial |
$454.95
|
| Rate for Payer: Humana KY Medicaid |
$184.07
|
| Rate for Payer: Kentucky WC Medicaid |
$185.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$438.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$395.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$187.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$471.01
|
| Rate for Payer: Ohio Health Group HMO |
$401.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$428.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$369.32
|
| Rate for Payer: PHCS Commercial |
$513.83
|
| Rate for Payer: United Healthcare All Payer |
$471.01
|
|
|
ANCHORAGE GUIDEWIRE 0.9*70MM
|
Facility
|
IP
|
$535.24
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$513.83 |
| Rate for Payer: Aetna Commercial |
$412.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$417.49
|
| Rate for Payer: Cash Price |
$267.62
|
| Rate for Payer: Cigna Commercial |
$444.25
|
| Rate for Payer: First Health Commercial |
$508.48
|
| Rate for Payer: Humana Commercial |
$454.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$438.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$395.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$471.01
|
| Rate for Payer: Ohio Health Group HMO |
$401.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$428.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$369.32
|
| Rate for Payer: PHCS Commercial |
$513.83
|
| Rate for Payer: United Healthcare All Payer |
$471.01
|
|
|
ANCHORAGE GUIDEWIRE 1.0*100MM
|
Facility
|
OP
|
$835.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.50 |
| Max. Negotiated Rate |
$801.60 |
| Rate for Payer: Aetna Commercial |
$642.95
|
| Rate for Payer: Anthem Medicaid |
$287.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$651.30
|
| Rate for Payer: Cash Price |
$417.50
|
| Rate for Payer: Cigna Commercial |
$693.05
|
| Rate for Payer: First Health Commercial |
$793.25
|
| Rate for Payer: Humana Commercial |
$709.75
|
| Rate for Payer: Humana KY Medicaid |
$287.16
|
| Rate for Payer: Kentucky WC Medicaid |
$290.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$684.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$616.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$250.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$292.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$734.80
|
| Rate for Payer: Ohio Health Group HMO |
$626.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$668.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$726.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$576.15
|
| Rate for Payer: PHCS Commercial |
$801.60
|
| Rate for Payer: United Healthcare All Payer |
$734.80
|
|
|
ANCHORAGE GUIDEWIRE 1.0*100MM
|
Facility
|
IP
|
$835.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.50 |
| Max. Negotiated Rate |
$801.60 |
| Rate for Payer: Aetna Commercial |
$642.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$651.30
|
| Rate for Payer: Cash Price |
$417.50
|
| Rate for Payer: Cigna Commercial |
$693.05
|
| Rate for Payer: First Health Commercial |
$793.25
|
| Rate for Payer: Humana Commercial |
$709.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$684.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$616.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$250.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$734.80
|
| Rate for Payer: Ohio Health Group HMO |
$626.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$668.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$726.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$576.15
|
| Rate for Payer: PHCS Commercial |
$801.60
|
| Rate for Payer: United Healthcare All Payer |
$734.80
|
|
|
ANCHORAGE GUIDEWIRE 1.0*70MM
|
Facility
|
IP
|
$755.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$226.50 |
| Max. Negotiated Rate |
$724.80 |
| Rate for Payer: Aetna Commercial |
$581.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$588.90
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cigna Commercial |
$626.65
|
| Rate for Payer: First Health Commercial |
$717.25
|
| Rate for Payer: Humana Commercial |
$641.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$619.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$557.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$226.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$664.40
|
| Rate for Payer: Ohio Health Group HMO |
$566.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$604.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$656.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$520.95
|
| Rate for Payer: PHCS Commercial |
$724.80
|
| Rate for Payer: United Healthcare All Payer |
$664.40
|
|
|
ANCHORAGE GUIDEWIRE 1.0*70MM
|
Facility
|
OP
|
$755.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$226.50 |
| Max. Negotiated Rate |
$724.80 |
| Rate for Payer: Aetna Commercial |
$581.35
|
| Rate for Payer: Anthem Medicaid |
$259.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$588.90
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cigna Commercial |
$626.65
|
| Rate for Payer: First Health Commercial |
$717.25
|
| Rate for Payer: Humana Commercial |
$641.75
|
| Rate for Payer: Humana KY Medicaid |
$259.64
|
| Rate for Payer: Kentucky WC Medicaid |
$262.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$619.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$557.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$226.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$264.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$664.40
|
| Rate for Payer: Ohio Health Group HMO |
$566.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$604.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$656.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$520.95
|
| Rate for Payer: PHCS Commercial |
$724.80
|
| Rate for Payer: United Healthcare All Payer |
$664.40
|
|
|
ANCHORAGE GUIDEWIRE 1.2*70MM
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Aetna Commercial |
$646.80
|
| Rate for Payer: Anthem Medicaid |
$288.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$655.20
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$697.20
|
| Rate for Payer: First Health Commercial |
$798.00
|
| Rate for Payer: Humana Commercial |
$714.00
|
| Rate for Payer: Humana KY Medicaid |
$288.88
|
| Rate for Payer: Kentucky WC Medicaid |
$291.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$688.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$294.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$739.20
|
| Rate for Payer: Ohio Health Group HMO |
$630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$579.60
|
| Rate for Payer: PHCS Commercial |
$806.40
|
| Rate for Payer: United Healthcare All Payer |
$739.20
|
|
|
ANCHORAGE GUIDEWIRE 1.2*70MM
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Aetna Commercial |
$646.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$655.20
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$697.20
|
| Rate for Payer: First Health Commercial |
$798.00
|
| Rate for Payer: Humana Commercial |
$714.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$688.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$739.20
|
| Rate for Payer: Ohio Health Group HMO |
$630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$579.60
|
| Rate for Payer: PHCS Commercial |
$806.40
|
| Rate for Payer: United Healthcare All Payer |
$739.20
|
|
|
ANCHORAGE LAP PLATE 1MM L
|
Facility
|
IP
|
$9,880.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,964.07 |
| Max. Negotiated Rate |
$9,485.04 |
| Rate for Payer: Aetna Commercial |
$7,607.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,706.60
|
| Rate for Payer: Cash Price |
$4,940.12
|
| Rate for Payer: Cigna Commercial |
$8,200.61
|
| Rate for Payer: First Health Commercial |
$9,386.24
|
| Rate for Payer: Humana Commercial |
$8,398.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,101.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,291.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,964.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,694.62
|
| Rate for Payer: Ohio Health Group HMO |
$7,410.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,904.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,595.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,817.37
|
| Rate for Payer: PHCS Commercial |
$9,485.04
|
| Rate for Payer: United Healthcare All Payer |
$8,694.62
|
|
|
ANCHORAGE LAP PLATE 1MM L
|
Facility
|
OP
|
$9,880.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,964.07 |
| Max. Negotiated Rate |
$9,485.04 |
| Rate for Payer: Aetna Commercial |
$7,607.79
|
| Rate for Payer: Anthem Medicaid |
$3,397.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,706.60
|
| Rate for Payer: Cash Price |
$4,940.12
|
| Rate for Payer: Cigna Commercial |
$8,200.61
|
| Rate for Payer: First Health Commercial |
$9,386.24
|
| Rate for Payer: Humana Commercial |
$8,398.21
|
| Rate for Payer: Humana KY Medicaid |
$3,397.82
|
| Rate for Payer: Kentucky WC Medicaid |
$3,432.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,101.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,291.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,964.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,465.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,694.62
|
| Rate for Payer: Ohio Health Group HMO |
$7,410.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,904.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,595.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,817.37
|
| Rate for Payer: PHCS Commercial |
$9,485.04
|
| Rate for Payer: United Healthcare All Payer |
$8,694.62
|
|
|
ANCHORAGE MTP CP PLATE L
|
Facility
|
OP
|
$9,916.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,975.03 |
| Max. Negotiated Rate |
$9,520.08 |
| Rate for Payer: Aetna Commercial |
$7,635.90
|
| Rate for Payer: Anthem Medicaid |
$3,410.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,735.06
|
| Rate for Payer: Cash Price |
$4,958.38
|
| Rate for Payer: Cigna Commercial |
$8,230.90
|
| Rate for Payer: First Health Commercial |
$9,420.91
|
| Rate for Payer: Humana Commercial |
$8,429.24
|
| Rate for Payer: Humana KY Medicaid |
$3,410.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3,445.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,131.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,318.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,478.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,726.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,437.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,627.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,842.56
|
| Rate for Payer: PHCS Commercial |
$9,520.08
|
| Rate for Payer: United Healthcare All Payer |
$8,726.74
|
|
