|
ANCHORAGE MTP CP PLATE 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 MTP CP PLATE 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 MTP CP PLATE 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
|
|
|
ANCHOR FASTAK CORKSCREW 3.5MM
|
Facility
|
IP
|
$1,984.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$595.20 |
| Max. Negotiated Rate |
$1,904.64 |
| Rate for Payer: Aetna Commercial |
$1,527.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,547.52
|
| Rate for Payer: Cash Price |
$992.00
|
| Rate for Payer: Cigna Commercial |
$1,646.72
|
| Rate for Payer: First Health Commercial |
$1,884.80
|
| Rate for Payer: Humana Commercial |
$1,686.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,626.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,464.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$595.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,745.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,488.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,587.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,726.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,368.96
|
| Rate for Payer: PHCS Commercial |
$1,904.64
|
| Rate for Payer: United Healthcare All Payer |
$1,745.92
|
|
|
ANCHOR FASTAK CORKSCREW 3.5MM
|
Facility
|
OP
|
$1,984.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$595.20 |
| Max. Negotiated Rate |
$1,904.64 |
| Rate for Payer: Aetna Commercial |
$1,527.68
|
| Rate for Payer: Anthem Medicaid |
$682.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,547.52
|
| Rate for Payer: Cash Price |
$992.00
|
| Rate for Payer: Cigna Commercial |
$1,646.72
|
| Rate for Payer: First Health Commercial |
$1,884.80
|
| Rate for Payer: Humana Commercial |
$1,686.40
|
| Rate for Payer: Humana KY Medicaid |
$682.30
|
| Rate for Payer: Kentucky WC Medicaid |
$689.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,626.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,464.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$595.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$695.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,745.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,488.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,587.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,726.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,368.96
|
| Rate for Payer: PHCS Commercial |
$1,904.64
|
| Rate for Payer: United Healthcare All Payer |
$1,745.92
|
|
|
ANCHOR FASTAK CORKSCREW 6.5MM
|
Facility
|
IP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
ANCHOR FASTAK CORKSCREW 6.5MM
|
Facility
|
OP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem Medicaid |
$701.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Humana KY Medicaid |
$701.90
|
| Rate for Payer: Kentucky WC Medicaid |
$709.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$715.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
ANCHOR FASTAK SUTURE S BNE 0
|
Facility
|
OP
|
$1,813.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$543.90 |
| Max. Negotiated Rate |
$1,740.48 |
| Rate for Payer: Aetna Commercial |
$1,396.01
|
| Rate for Payer: Anthem Medicaid |
$623.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,414.14
|
| Rate for Payer: Cash Price |
$906.50
|
| Rate for Payer: Cigna Commercial |
$1,504.79
|
| Rate for Payer: First Health Commercial |
$1,722.35
|
| Rate for Payer: Humana Commercial |
$1,541.05
|
| Rate for Payer: Humana KY Medicaid |
$623.49
|
| Rate for Payer: Kentucky WC Medicaid |
$629.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,486.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,337.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$636.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,595.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,359.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,450.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,577.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,250.97
|
| Rate for Payer: PHCS Commercial |
$1,740.48
|
| Rate for Payer: United Healthcare All Payer |
$1,595.44
|
|
|
ANCHOR FASTAK SUTURE S BNE 0
|
Facility
|
IP
|
$1,813.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$543.90 |
| Max. Negotiated Rate |
$1,740.48 |
| Rate for Payer: Aetna Commercial |
$1,396.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,414.14
|
| Rate for Payer: Cash Price |
$906.50
|
| Rate for Payer: Cigna Commercial |
$1,504.79
|
| Rate for Payer: First Health Commercial |
$1,722.35
|
| Rate for Payer: Humana Commercial |
$1,541.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,486.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,337.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,595.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,359.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,450.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,577.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,250.97
|
| Rate for Payer: PHCS Commercial |
$1,740.48
|
| Rate for Payer: United Healthcare All Payer |
$1,595.44
|
|
|
ANCHOR FASTAK SUTURE S BNE 2-0
|
Facility
|
OP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem Medicaid |
$688.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Humana KY Medicaid |
$688.83
|
| Rate for Payer: Kentucky WC Medicaid |
$695.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$702.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
|
ANCHOR FASTAK SUTURE S BNE 2-0
|
Facility
|
IP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
|
ANCHOR FIBERTAK 1.8 KNOTLSS
|
Facility
|
OP
|
$3,575.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,072.50 |
| Max. Negotiated Rate |
$3,432.00 |
| Rate for Payer: Aetna Commercial |
$2,752.75
|
| Rate for Payer: Anthem Medicaid |
$1,229.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,788.50
|
| Rate for Payer: Cash Price |
$1,787.50
|
| Rate for Payer: Cigna Commercial |
$2,967.25
|
| Rate for Payer: First Health Commercial |
$3,396.25
|
| Rate for Payer: Humana Commercial |
$3,038.75
|
| Rate for Payer: Humana KY Medicaid |
$1,229.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,241.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,931.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,638.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,072.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,254.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,146.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,681.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,110.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,466.75
|
| Rate for Payer: PHCS Commercial |
$3,432.00
|
| Rate for Payer: United Healthcare All Payer |
$3,146.00
|
|
|
ANCHOR FIBERTAK 1.8 KNOTLSS
|
Facility
|
IP
|
$3,575.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,072.50 |
| Max. Negotiated Rate |
$3,432.00 |
| Rate for Payer: Aetna Commercial |
$2,752.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,788.50
|
| Rate for Payer: Cash Price |
$1,787.50
|
| Rate for Payer: Cigna Commercial |
$2,967.25
|
| Rate for Payer: First Health Commercial |
$3,396.25
|
| Rate for Payer: Humana Commercial |
$3,038.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,931.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,638.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,072.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,146.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,681.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,110.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,466.75
|
| Rate for Payer: PHCS Commercial |
$3,432.00
|
| Rate for Payer: United Healthcare All Payer |
$3,146.00
|
|
|
ANCHOR FIBER TAK KNOTLSS 2.6MM
|
Facility
|
OP
|
$3,771.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,131.56 |
| Max. Negotiated Rate |
$3,621.00 |
| Rate for Payer: Aetna Commercial |
$2,904.35
|
| Rate for Payer: Anthem Medicaid |
$1,297.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,942.07
|
| Rate for Payer: Cash Price |
$1,885.94
|
| Rate for Payer: Cigna Commercial |
$3,130.66
|
| Rate for Payer: First Health Commercial |
$3,583.29
|
| Rate for Payer: Humana Commercial |
$3,206.10
|
| Rate for Payer: Humana KY Medicaid |
$1,297.15
|
| Rate for Payer: Kentucky WC Medicaid |
$1,310.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,092.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,783.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,131.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,323.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,319.25
|
| Rate for Payer: Ohio Health Group HMO |
$2,828.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,017.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,281.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,602.60
|
| Rate for Payer: PHCS Commercial |
$3,621.00
|
| Rate for Payer: United Healthcare All Payer |
$3,319.25
|
|
|
ANCHOR FIBER TAK KNOTLSS 2.6MM
|
Facility
|
IP
|
$3,771.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,131.56 |
| Max. Negotiated Rate |
$3,621.00 |
| Rate for Payer: Aetna Commercial |
$2,904.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,942.07
|
| Rate for Payer: Cash Price |
$1,885.94
|
| Rate for Payer: Cigna Commercial |
$3,130.66
|
| Rate for Payer: First Health Commercial |
$3,583.29
|
| Rate for Payer: Humana Commercial |
$3,206.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,092.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,783.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,131.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,319.25
|
| Rate for Payer: Ohio Health Group HMO |
$2,828.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,017.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,281.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,602.60
|
| Rate for Payer: PHCS Commercial |
$3,621.00
|
| Rate for Payer: United Healthcare All Payer |
$3,319.25
|
|
|
ANCHOR FIBER TAK KNOTLSS 2.6SP
|
Facility
|
OP
|
$12,170.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,651.11 |
| Max. Negotiated Rate |
$11,683.56 |
| Rate for Payer: Aetna Commercial |
$9,371.19
|
| Rate for Payer: Anthem Medicaid |
$4,185.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,492.90
|
| Rate for Payer: Cash Price |
$6,085.19
|
| Rate for Payer: Cigna Commercial |
$10,101.42
|
| Rate for Payer: First Health Commercial |
$11,561.86
|
| Rate for Payer: Humana Commercial |
$10,344.82
|
| Rate for Payer: Humana KY Medicaid |
$4,185.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,227.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,979.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,981.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,651.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,269.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,709.93
|
| Rate for Payer: Ohio Health Group HMO |
$9,127.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,736.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,588.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,397.56
|
| Rate for Payer: PHCS Commercial |
$11,683.56
|
| Rate for Payer: United Healthcare All Payer |
$10,709.93
|
|
|
ANCHOR FIBER TAK KNOTLSS 2.6SP
|
Facility
|
IP
|
$12,170.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,651.11 |
| Max. Negotiated Rate |
$11,683.56 |
| Rate for Payer: Aetna Commercial |
$9,371.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,492.90
|
| Rate for Payer: Cash Price |
$6,085.19
|
| Rate for Payer: Cigna Commercial |
$10,101.42
|
| Rate for Payer: First Health Commercial |
$11,561.86
|
| Rate for Payer: Humana Commercial |
$10,344.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,979.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,981.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,651.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,709.93
|
| Rate for Payer: Ohio Health Group HMO |
$9,127.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,736.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,588.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,397.56
|
| Rate for Payer: PHCS Commercial |
$11,683.56
|
| Rate for Payer: United Healthcare All Payer |
$10,709.93
|
|
|
ANCHOR FIBERTAK SING LOAD
|
Facility
|
IP
|
$1,571.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$471.32 |
| Max. Negotiated Rate |
$1,508.23 |
| Rate for Payer: Aetna Commercial |
$1,209.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,225.43
|
| Rate for Payer: Cash Price |
$785.54
|
| Rate for Payer: Cigna Commercial |
$1,303.99
|
| Rate for Payer: First Health Commercial |
$1,492.52
|
| Rate for Payer: Humana Commercial |
$1,335.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,288.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,159.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$471.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,382.54
|
| Rate for Payer: Ohio Health Group HMO |
$1,178.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,256.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,366.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,084.04
|
| Rate for Payer: PHCS Commercial |
$1,508.23
|
| Rate for Payer: United Healthcare All Payer |
$1,382.54
|
|
|
ANCHOR FIBERTAK SING LOAD
|
Facility
|
OP
|
$1,571.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$471.32 |
| Max. Negotiated Rate |
$1,508.23 |
| Rate for Payer: Aetna Commercial |
$1,209.72
|
| Rate for Payer: Anthem Medicaid |
$540.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,225.43
|
| Rate for Payer: Cash Price |
$785.54
|
| Rate for Payer: Cigna Commercial |
$1,303.99
|
| Rate for Payer: First Health Commercial |
$1,492.52
|
| Rate for Payer: Humana Commercial |
$1,335.41
|
| Rate for Payer: Humana KY Medicaid |
$540.29
|
| Rate for Payer: Kentucky WC Medicaid |
$545.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,288.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,159.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$471.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$551.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,382.54
|
| Rate for Payer: Ohio Health Group HMO |
$1,178.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,256.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,366.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,084.04
|
| Rate for Payer: PHCS Commercial |
$1,508.23
|
| Rate for Payer: United Healthcare All Payer |
$1,382.54
|
|
|
ANCHOR FIBERTK RC DBL LD BL TP
|
Facility
|
OP
|
$3,456.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,037.06 |
| Max. Negotiated Rate |
$3,318.60 |
| Rate for Payer: Aetna Commercial |
$2,661.80
|
| Rate for Payer: Anthem Medicaid |
$1,188.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,696.37
|
| Rate for Payer: Cash Price |
$1,728.44
|
| Rate for Payer: Cigna Commercial |
$2,869.21
|
| Rate for Payer: First Health Commercial |
$3,284.04
|
| Rate for Payer: Humana Commercial |
$2,938.35
|
| Rate for Payer: Humana KY Medicaid |
$1,188.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,200.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,834.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,551.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,037.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,212.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,042.05
|
| Rate for Payer: Ohio Health Group HMO |
$2,592.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,765.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,007.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,385.25
|
| Rate for Payer: PHCS Commercial |
$3,318.60
|
| Rate for Payer: United Healthcare All Payer |
$3,042.05
|
|
|
ANCHOR FIBERTK RC DBL LD BL TP
|
Facility
|
IP
|
$3,456.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,037.06 |
| Max. Negotiated Rate |
$3,318.60 |
| Rate for Payer: Aetna Commercial |
$2,661.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,696.37
|
| Rate for Payer: Cash Price |
$1,728.44
|
| Rate for Payer: Cigna Commercial |
$2,869.21
|
| Rate for Payer: First Health Commercial |
$3,284.04
|
| Rate for Payer: Humana Commercial |
$2,938.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,834.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,551.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,037.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,042.05
|
| Rate for Payer: Ohio Health Group HMO |
$2,592.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,765.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,007.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,385.25
|
| Rate for Payer: PHCS Commercial |
$3,318.60
|
| Rate for Payer: United Healthcare All Payer |
$3,042.05
|
|
|
ANCHOR FIBERTK SP 1.3MM
|
Facility
|
OP
|
$11,110.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,333.20 |
| Max. Negotiated Rate |
$10,666.23 |
| Rate for Payer: Aetna Commercial |
$8,555.21
|
| Rate for Payer: Anthem Medicaid |
$3,820.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.31
|
| Rate for Payer: Cash Price |
$5,555.33
|
| Rate for Payer: Cigna Commercial |
$9,221.85
|
| Rate for Payer: First Health Commercial |
$10,555.13
|
| Rate for Payer: Humana Commercial |
$9,444.06
|
| Rate for Payer: Humana KY Medicaid |
$3,820.96
|
| Rate for Payer: Kentucky WC Medicaid |
$3,859.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,110.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,897.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.38
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,888.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,666.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,666.36
|
| Rate for Payer: PHCS Commercial |
$10,666.23
|
| Rate for Payer: United Healthcare All Payer |
$9,777.38
|
|
|
ANCHOR FIBERTK SP 1.3MM
|
Facility
|
IP
|
$11,110.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,333.20 |
| Max. Negotiated Rate |
$10,666.23 |
| Rate for Payer: Aetna Commercial |
$8,555.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,666.31
|
| Rate for Payer: Cash Price |
$5,555.33
|
| Rate for Payer: Cigna Commercial |
$9,221.85
|
| Rate for Payer: First Health Commercial |
$10,555.13
|
| Rate for Payer: Humana Commercial |
$9,444.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,110.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,199.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,333.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,777.38
|
| Rate for Payer: Ohio Health Group HMO |
$8,333.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,888.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,666.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,666.36
|
| Rate for Payer: PHCS Commercial |
$10,666.23
|
| Rate for Payer: United Healthcare All Payer |
$9,777.38
|
|
|
ANCHOR QUICK SUPER
|
Facility
|
IP
|
$3,046.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.88 |
| Max. Negotiated Rate |
$2,924.40 |
| Rate for Payer: Aetna Commercial |
$2,345.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,376.07
|
| Rate for Payer: Cash Price |
$1,523.12
|
| Rate for Payer: Cigna Commercial |
$2,528.39
|
| Rate for Payer: First Health Commercial |
$2,893.94
|
| Rate for Payer: Humana Commercial |
$2,589.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,497.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,248.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$913.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,680.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,284.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,437.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,650.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,101.91
|
| Rate for Payer: PHCS Commercial |
$2,924.40
|
| Rate for Payer: United Healthcare All Payer |
$2,680.70
|
|
|
ANCHOR QUICK SUPER
|
Facility
|
OP
|
$3,046.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.88 |
| Max. Negotiated Rate |
$2,924.40 |
| Rate for Payer: Aetna Commercial |
$2,345.61
|
| Rate for Payer: Anthem Medicaid |
$1,047.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,376.07
|
| Rate for Payer: Cash Price |
$1,523.12
|
| Rate for Payer: Cigna Commercial |
$2,528.39
|
| Rate for Payer: First Health Commercial |
$2,893.94
|
| Rate for Payer: Humana Commercial |
$2,589.31
|
| Rate for Payer: Humana KY Medicaid |
$1,047.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,058.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,497.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,248.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$913.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,068.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,680.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,284.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,437.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,650.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,101.91
|
| Rate for Payer: PHCS Commercial |
$2,924.40
|
| Rate for Payer: United Healthcare All Payer |
$2,680.70
|
|
