|
GMRS HEMI FLAT WDG RGT 5MM M 2
|
Facility
|
OP
|
$5,173.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.57 |
| Max. Negotiated Rate |
$4,966.66 |
| Rate for Payer: Aetna Commercial |
$3,983.67
|
| Rate for Payer: Anthem Medicaid |
$1,779.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,035.41
|
| Rate for Payer: Cash Price |
$2,586.80
|
| Rate for Payer: Cigna Commercial |
$4,294.09
|
| Rate for Payer: First Health Commercial |
$4,914.92
|
| Rate for Payer: Humana Commercial |
$4,397.56
|
| Rate for Payer: Humana KY Medicaid |
$1,779.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,797.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,242.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,814.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,552.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,880.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,034.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$672.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,603.82
|
| Rate for Payer: PHCS Commercial |
$4,966.66
|
| Rate for Payer: United Healthcare All Payer |
$4,552.77
|
|
|
GMRS HEMI FLAT WDG RT 10MM L 2
|
Facility
|
IP
|
$5,173.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.57 |
| Max. Negotiated Rate |
$4,966.66 |
| Rate for Payer: Aetna Commercial |
$3,983.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,035.41
|
| Rate for Payer: Cash Price |
$2,586.80
|
| Rate for Payer: Cigna Commercial |
$4,294.09
|
| Rate for Payer: First Health Commercial |
$4,914.92
|
| Rate for Payer: Humana Commercial |
$4,397.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,242.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,552.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,880.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,034.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$672.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,603.82
|
| Rate for Payer: PHCS Commercial |
$4,966.66
|
| Rate for Payer: United Healthcare All Payer |
$4,552.77
|
|
|
GMRS HEMI FLAT WDG RT 10MM L 2
|
Facility
|
OP
|
$5,173.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.57 |
| Max. Negotiated Rate |
$4,966.66 |
| Rate for Payer: Aetna Commercial |
$3,983.67
|
| Rate for Payer: Anthem Medicaid |
$1,779.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,035.41
|
| Rate for Payer: Cash Price |
$2,586.80
|
| Rate for Payer: Cigna Commercial |
$4,294.09
|
| Rate for Payer: First Health Commercial |
$4,914.92
|
| Rate for Payer: Humana Commercial |
$4,397.56
|
| Rate for Payer: Humana KY Medicaid |
$1,779.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,797.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,242.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,814.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,552.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,880.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,034.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$672.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,603.82
|
| Rate for Payer: PHCS Commercial |
$4,966.66
|
| Rate for Payer: United Healthcare All Payer |
$4,552.77
|
|
|
GMRS HEMI FLAT WDG RT 10MM M 2
|
Facility
|
IP
|
$5,173.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.57 |
| Max. Negotiated Rate |
$4,966.66 |
| Rate for Payer: Aetna Commercial |
$3,983.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,035.41
|
| Rate for Payer: Cash Price |
$2,586.80
|
| Rate for Payer: Cigna Commercial |
$4,294.09
|
| Rate for Payer: First Health Commercial |
$4,914.92
|
| Rate for Payer: Humana Commercial |
$4,397.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,242.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,552.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,880.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,034.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$672.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,603.82
|
| Rate for Payer: PHCS Commercial |
$4,966.66
|
| Rate for Payer: United Healthcare All Payer |
$4,552.77
|
|
|
GMRS HEMI FLAT WDG RT 10MM M 2
|
Facility
|
OP
|
$5,173.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.57 |
| Max. Negotiated Rate |
$4,966.66 |
| Rate for Payer: Aetna Commercial |
$3,983.67
|
| Rate for Payer: Anthem Medicaid |
$1,779.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,035.41
|
| Rate for Payer: Cash Price |
$2,586.80
|
| Rate for Payer: Cigna Commercial |
$4,294.09
|
| Rate for Payer: First Health Commercial |
$4,914.92
|
| Rate for Payer: Humana Commercial |
$4,397.56
|
| Rate for Payer: Humana KY Medicaid |
$1,779.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,797.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,242.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,814.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,552.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,880.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,034.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$672.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,603.82
|
| Rate for Payer: PHCS Commercial |
$4,966.66
|
| Rate for Payer: United Healthcare All Payer |
$4,552.77
|
|
|
GMRS HEMI FLAT WDG RT 10MM SM1
|
Facility
|
OP
|
$5,173.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.57 |
| Max. Negotiated Rate |
$4,966.66 |
| Rate for Payer: Aetna Commercial |
$3,983.67
|
| Rate for Payer: Anthem Medicaid |
$1,779.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,035.41
|
| Rate for Payer: Cash Price |
$2,586.80
|
| Rate for Payer: Cigna Commercial |
$4,294.09
|
| Rate for Payer: First Health Commercial |
$4,914.92
|
| Rate for Payer: Humana Commercial |
$4,397.56
|
| Rate for Payer: Humana KY Medicaid |
$1,779.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,797.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,242.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,814.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,552.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,880.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,034.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$672.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,603.82
|
| Rate for Payer: PHCS Commercial |
$4,966.66
|
| Rate for Payer: United Healthcare All Payer |
$4,552.77
|
|
|
GMRS HEMI FLAT WDG RT 10MM SM1
|
Facility
|
IP
|
$5,173.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.57 |
| Max. Negotiated Rate |
$4,966.66 |
| Rate for Payer: Aetna Commercial |
$3,983.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,035.41
|
| Rate for Payer: Cash Price |
$2,586.80
|
| Rate for Payer: Cigna Commercial |
$4,294.09
|
| Rate for Payer: First Health Commercial |
$4,914.92
|
| Rate for Payer: Humana Commercial |
$4,397.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,242.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,552.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,880.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,034.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$672.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,603.82
|
| Rate for Payer: PHCS Commercial |
$4,966.66
|
| Rate for Payer: United Healthcare All Payer |
$4,552.77
|
|
|
GMRS HEMI FLAT WDG RT 10MM SM2
|
Facility
|
OP
|
$5,173.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.57 |
| Max. Negotiated Rate |
$4,966.66 |
| Rate for Payer: Aetna Commercial |
$3,983.67
|
| Rate for Payer: Anthem Medicaid |
$1,779.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,035.41
|
| Rate for Payer: Cash Price |
$2,586.80
|
| Rate for Payer: Cigna Commercial |
$4,294.09
|
| Rate for Payer: First Health Commercial |
$4,914.92
|
| Rate for Payer: Humana Commercial |
$4,397.56
|
| Rate for Payer: Humana KY Medicaid |
$1,779.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,797.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,242.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,814.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,552.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,880.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,034.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$672.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,603.82
|
| Rate for Payer: PHCS Commercial |
$4,966.66
|
| Rate for Payer: United Healthcare All Payer |
$4,552.77
|
|
|
GMRS HEMI FLAT WDG RT 10MM SM2
|
Facility
|
IP
|
$5,173.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.57 |
| Max. Negotiated Rate |
$4,966.66 |
| Rate for Payer: Aetna Commercial |
$3,983.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,035.41
|
| Rate for Payer: Cash Price |
$2,586.80
|
| Rate for Payer: Cigna Commercial |
$4,294.09
|
| Rate for Payer: First Health Commercial |
$4,914.92
|
| Rate for Payer: Humana Commercial |
$4,397.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,242.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,552.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,880.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,034.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$672.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,603.82
|
| Rate for Payer: PHCS Commercial |
$4,966.66
|
| Rate for Payer: United Healthcare All Payer |
$4,552.77
|
|
|
GMRS HEMI FLAT WDG RT 5MM SM 2
|
Facility
|
IP
|
$5,173.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.57 |
| Max. Negotiated Rate |
$4,966.66 |
| Rate for Payer: Aetna Commercial |
$3,983.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,035.41
|
| Rate for Payer: Cash Price |
$2,586.80
|
| Rate for Payer: Cigna Commercial |
$4,294.09
|
| Rate for Payer: First Health Commercial |
$4,914.92
|
| Rate for Payer: Humana Commercial |
$4,397.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,242.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,552.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,880.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,034.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$672.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,603.82
|
| Rate for Payer: PHCS Commercial |
$4,966.66
|
| Rate for Payer: United Healthcare All Payer |
$4,552.77
|
|
|
GMRS HEMI FLAT WDG RT 5MM SM 2
|
Facility
|
OP
|
$5,173.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.57 |
| Max. Negotiated Rate |
$4,966.66 |
| Rate for Payer: Aetna Commercial |
$3,983.67
|
| Rate for Payer: Anthem Medicaid |
$1,779.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,035.41
|
| Rate for Payer: Cash Price |
$2,586.80
|
| Rate for Payer: Cigna Commercial |
$4,294.09
|
| Rate for Payer: First Health Commercial |
$4,914.92
|
| Rate for Payer: Humana Commercial |
$4,397.56
|
| Rate for Payer: Humana KY Medicaid |
$1,779.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,797.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,242.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,814.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,552.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,880.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,034.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$672.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,603.82
|
| Rate for Payer: PHCS Commercial |
$4,966.66
|
| Rate for Payer: United Healthcare All Payer |
$4,552.77
|
|
|
GMRS INSRT SMPROX TIB COMP 10M
|
Facility
|
OP
|
$2,083.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.87 |
| Max. Negotiated Rate |
$2,000.26 |
| Rate for Payer: Aetna Commercial |
$1,604.37
|
| Rate for Payer: Anthem Medicaid |
$716.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,625.21
|
| Rate for Payer: Cash Price |
$1,041.80
|
| Rate for Payer: Cigna Commercial |
$1,729.39
|
| Rate for Payer: First Health Commercial |
$1,979.42
|
| Rate for Payer: Humana Commercial |
$1,771.06
|
| Rate for Payer: Humana KY Medicaid |
$716.55
|
| Rate for Payer: Kentucky WC Medicaid |
$723.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,708.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,537.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$625.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$730.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,833.57
|
| Rate for Payer: Ohio Health Group HMO |
$1,562.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$416.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$270.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$645.92
|
| Rate for Payer: PHCS Commercial |
$2,000.26
|
| Rate for Payer: United Healthcare All Payer |
$1,833.57
|
|
|
GMRS INSRT SMPROX TIB COMP 10M
|
Facility
|
IP
|
$2,083.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.87 |
| Max. Negotiated Rate |
$2,000.26 |
| Rate for Payer: Aetna Commercial |
$1,604.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,625.21
|
| Rate for Payer: Cash Price |
$1,041.80
|
| Rate for Payer: Cigna Commercial |
$1,729.39
|
| Rate for Payer: First Health Commercial |
$1,979.42
|
| Rate for Payer: Humana Commercial |
$1,771.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,708.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,537.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$625.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,833.57
|
| Rate for Payer: Ohio Health Group HMO |
$1,562.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$416.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$270.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$645.92
|
| Rate for Payer: PHCS Commercial |
$2,000.26
|
| Rate for Payer: United Healthcare All Payer |
$1,833.57
|
|
|
GMRS MRH KEEL TIB BASEPLAT L 2
|
Facility
|
IP
|
$13,006.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,690.79 |
| Max. Negotiated Rate |
$12,485.84 |
| Rate for Payer: Aetna Commercial |
$10,014.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,144.74
|
| Rate for Payer: Cash Price |
$6,503.04
|
| Rate for Payer: Cigna Commercial |
$10,795.05
|
| Rate for Payer: First Health Commercial |
$12,355.78
|
| Rate for Payer: Humana Commercial |
$11,055.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,664.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,598.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,901.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,445.35
|
| Rate for Payer: Ohio Health Group HMO |
$9,754.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,601.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,690.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,031.88
|
| Rate for Payer: PHCS Commercial |
$12,485.84
|
| Rate for Payer: United Healthcare All Payer |
$11,445.35
|
|
|
GMRS MRH KEEL TIB BASEPLAT L 2
|
Facility
|
OP
|
$13,006.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,690.79 |
| Max. Negotiated Rate |
$12,485.84 |
| Rate for Payer: Aetna Commercial |
$10,014.68
|
| Rate for Payer: Anthem Medicaid |
$4,472.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,144.74
|
| Rate for Payer: Cash Price |
$6,503.04
|
| Rate for Payer: Cigna Commercial |
$10,795.05
|
| Rate for Payer: First Health Commercial |
$12,355.78
|
| Rate for Payer: Humana Commercial |
$11,055.17
|
| Rate for Payer: Humana KY Medicaid |
$4,472.79
|
| Rate for Payer: Kentucky WC Medicaid |
$4,518.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,664.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,598.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,901.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,562.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,445.35
|
| Rate for Payer: Ohio Health Group HMO |
$9,754.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,601.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,690.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,031.88
|
| Rate for Payer: PHCS Commercial |
$12,485.84
|
| Rate for Payer: United Healthcare All Payer |
$11,445.35
|
|
|
GMRS MRH KEEL TIB BASEPLAT M 2
|
Facility
|
OP
|
$15,279.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,986.32 |
| Max. Negotiated Rate |
$14,668.19 |
| Rate for Payer: Aetna Commercial |
$11,765.11
|
| Rate for Payer: Anthem Medicaid |
$5,254.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,917.90
|
| Rate for Payer: Cash Price |
$7,639.68
|
| Rate for Payer: Cigna Commercial |
$12,681.87
|
| Rate for Payer: First Health Commercial |
$14,515.39
|
| Rate for Payer: Humana Commercial |
$12,987.46
|
| Rate for Payer: Humana KY Medicaid |
$5,254.57
|
| Rate for Payer: Kentucky WC Medicaid |
$5,308.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,529.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,276.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,583.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,445.84
|
| Rate for Payer: Ohio Health Group HMO |
$11,459.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,055.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,986.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,736.60
|
| Rate for Payer: PHCS Commercial |
$14,668.19
|
| Rate for Payer: United Healthcare All Payer |
$13,445.84
|
|
|
GMRS MRH KEEL TIB BASEPLAT M 2
|
Facility
|
IP
|
$15,279.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,986.32 |
| Max. Negotiated Rate |
$14,668.19 |
| Rate for Payer: Aetna Commercial |
$11,765.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,917.90
|
| Rate for Payer: Cash Price |
$7,639.68
|
| Rate for Payer: Cigna Commercial |
$12,681.87
|
| Rate for Payer: First Health Commercial |
$14,515.39
|
| Rate for Payer: Humana Commercial |
$12,987.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,529.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,276.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,583.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,445.84
|
| Rate for Payer: Ohio Health Group HMO |
$11,459.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,055.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,986.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,736.60
|
| Rate for Payer: PHCS Commercial |
$14,668.19
|
| Rate for Payer: United Healthcare All Payer |
$13,445.84
|
|
|
GMRS MRH KEEL TIB BASEPLT SM 1
|
Facility
|
OP
|
$14,101.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,833.14 |
| Max. Negotiated Rate |
$13,537.04 |
| Rate for Payer: Aetna Commercial |
$10,857.83
|
| Rate for Payer: Anthem Medicaid |
$4,849.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,998.84
|
| Rate for Payer: Cash Price |
$7,050.54
|
| Rate for Payer: Cigna Commercial |
$11,703.90
|
| Rate for Payer: First Health Commercial |
$13,396.03
|
| Rate for Payer: Humana Commercial |
$11,985.92
|
| Rate for Payer: Humana KY Medicaid |
$4,849.36
|
| Rate for Payer: Kentucky WC Medicaid |
$4,898.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,562.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,406.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,230.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,946.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,408.95
|
| Rate for Payer: Ohio Health Group HMO |
$10,575.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,820.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,833.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,371.33
|
| Rate for Payer: PHCS Commercial |
$13,537.04
|
| Rate for Payer: United Healthcare All Payer |
$12,408.95
|
|
|
GMRS MRH KEEL TIB BASEPLT SM 1
|
Facility
|
IP
|
$14,101.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,833.14 |
| Max. Negotiated Rate |
$13,537.04 |
| Rate for Payer: Aetna Commercial |
$10,857.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,998.84
|
| Rate for Payer: Cash Price |
$7,050.54
|
| Rate for Payer: Cigna Commercial |
$11,703.90
|
| Rate for Payer: First Health Commercial |
$13,396.03
|
| Rate for Payer: Humana Commercial |
$11,985.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,562.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,406.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,230.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,408.95
|
| Rate for Payer: Ohio Health Group HMO |
$10,575.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,820.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,833.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,371.33
|
| Rate for Payer: PHCS Commercial |
$13,537.04
|
| Rate for Payer: United Healthcare All Payer |
$12,408.95
|
|
|
GMRS MRH KEEL TIB BASEPLT SM 2
|
Facility
|
OP
|
$16,787.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,182.36 |
| Max. Negotiated Rate |
$16,115.90 |
| Rate for Payer: Aetna Commercial |
$12,926.30
|
| Rate for Payer: Anthem Medicaid |
$5,773.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,094.17
|
| Rate for Payer: Cash Price |
$8,393.70
|
| Rate for Payer: Cigna Commercial |
$13,933.54
|
| Rate for Payer: First Health Commercial |
$15,948.03
|
| Rate for Payer: Humana Commercial |
$14,269.29
|
| Rate for Payer: Humana KY Medicaid |
$5,773.19
|
| Rate for Payer: Kentucky WC Medicaid |
$5,831.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,765.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,389.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,036.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,889.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,772.91
|
| Rate for Payer: Ohio Health Group HMO |
$12,590.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,357.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,182.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,204.09
|
| Rate for Payer: PHCS Commercial |
$16,115.90
|
| Rate for Payer: United Healthcare All Payer |
$14,772.91
|
|
|
GMRS MRH KEEL TIB BASEPLT SM 2
|
Facility
|
IP
|
$16,787.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,182.36 |
| Max. Negotiated Rate |
$16,115.90 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,765.67
|
| Rate for Payer: Aetna Commercial |
$12,926.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,094.17
|
| Rate for Payer: Cash Price |
$8,393.70
|
| Rate for Payer: Cigna Commercial |
$13,933.54
|
| Rate for Payer: First Health Commercial |
$15,948.03
|
| Rate for Payer: Humana Commercial |
$14,269.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,389.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,036.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,772.91
|
| Rate for Payer: Ohio Health Group HMO |
$12,590.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,357.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,182.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,204.09
|
| Rate for Payer: PHCS Commercial |
$16,115.90
|
| Rate for Payer: United Healthcare All Payer |
$14,772.91
|
|
|
GMRS MRH TIB INSERT 10MM M2/L2
|
Facility
|
IP
|
$6,505.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.71 |
| Max. Negotiated Rate |
$6,245.26 |
| Rate for Payer: Aetna Commercial |
$5,009.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,074.27
|
| Rate for Payer: Cash Price |
$3,252.74
|
| Rate for Payer: Cigna Commercial |
$5,399.55
|
| Rate for Payer: First Health Commercial |
$6,180.21
|
| Rate for Payer: Humana Commercial |
$5,529.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,334.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,801.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.82
|
| Rate for Payer: Ohio Health Group HMO |
$4,879.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,301.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.70
|
| Rate for Payer: PHCS Commercial |
$6,245.26
|
| Rate for Payer: United Healthcare All Payer |
$5,724.82
|
|
|
GMRS MRH TIB INSERT 10MM M2/L2
|
Facility
|
OP
|
$6,505.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.71 |
| Max. Negotiated Rate |
$6,245.26 |
| Rate for Payer: Aetna Commercial |
$5,009.22
|
| Rate for Payer: Anthem Medicaid |
$2,237.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,074.27
|
| Rate for Payer: Cash Price |
$3,252.74
|
| Rate for Payer: Cigna Commercial |
$5,399.55
|
| Rate for Payer: First Health Commercial |
$6,180.21
|
| Rate for Payer: Humana Commercial |
$5,529.66
|
| Rate for Payer: Humana KY Medicaid |
$2,237.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,260.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,334.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,801.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,282.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.82
|
| Rate for Payer: Ohio Health Group HMO |
$4,879.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,301.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.70
|
| Rate for Payer: PHCS Commercial |
$6,245.26
|
| Rate for Payer: United Healthcare All Payer |
$5,724.82
|
|
|
GMRS MRH TIB INSERT 10MM S1/S2
|
Facility
|
IP
|
$7,388.78
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$960.54 |
| Max. Negotiated Rate |
$7,093.23 |
| Rate for Payer: Aetna Commercial |
$5,689.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,763.25
|
| Rate for Payer: Cash Price |
$3,694.39
|
| Rate for Payer: Cigna Commercial |
$6,132.69
|
| Rate for Payer: First Health Commercial |
$7,019.34
|
| Rate for Payer: Humana Commercial |
$6,280.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,058.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,452.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,216.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,502.13
|
| Rate for Payer: Ohio Health Group HMO |
$5,541.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,477.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$960.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,290.52
|
| Rate for Payer: PHCS Commercial |
$7,093.23
|
| Rate for Payer: United Healthcare All Payer |
$6,502.13
|
|
|
GMRS MRH TIB INSERT 10MM S1/S2
|
Facility
|
OP
|
$7,388.78
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$960.54 |
| Max. Negotiated Rate |
$7,093.23 |
| Rate for Payer: Aetna Commercial |
$5,689.36
|
| Rate for Payer: Anthem Medicaid |
$2,541.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,763.25
|
| Rate for Payer: Cash Price |
$3,694.39
|
| Rate for Payer: Cigna Commercial |
$6,132.69
|
| Rate for Payer: First Health Commercial |
$7,019.34
|
| Rate for Payer: Humana Commercial |
$6,280.46
|
| Rate for Payer: Humana KY Medicaid |
$2,541.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,566.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,058.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,452.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,216.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,591.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,502.13
|
| Rate for Payer: Ohio Health Group HMO |
$5,541.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,477.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$960.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,290.52
|
| Rate for Payer: PHCS Commercial |
$7,093.23
|
| Rate for Payer: United Healthcare All Payer |
$6,502.13
|
|
