|
42/28 TI GLENOSPHERE
|
Facility
IP
|
$13,520.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$10,410.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,545.60
|
| Rate for Payer: Cash Price |
$6,760.00
|
| Rate for Payer: Cigna Commercial |
$11,221.60
|
| Rate for Payer: First Health Commercial |
$12,844.00
|
| Rate for Payer: Humana Commercial |
$11,492.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,086.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,977.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,056.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,897.60
|
| Rate for Payer: Ohio Health Group HMO |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,704.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,757.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,191.20
|
| Rate for Payer: PHCS Commercial |
$12,979.20
|
|
|
42/28 TI GLENOSPHERE
|
Facility
OP
|
$13,520.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$10,410.40
|
| Rate for Payer: Anthem Medicaid |
$4,649.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,545.60
|
| Rate for Payer: Cash Price |
$6,760.00
|
| Rate for Payer: Cigna Commercial |
$11,221.60
|
| Rate for Payer: First Health Commercial |
$12,844.00
|
| Rate for Payer: Humana Commercial |
$11,492.00
|
| Rate for Payer: Humana KY Medicaid |
$4,649.53
|
| Rate for Payer: Kentucky WC Medicaid |
$4,696.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,086.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,977.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,056.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,742.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,897.60
|
| Rate for Payer: Ohio Health Group HMO |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,704.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,757.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,191.20
|
| Rate for Payer: PHCS Commercial |
$12,979.20
|
| Rate for Payer: United Healthcare All Payer |
$11,897.60
|
|
|
42 +4 LAT/24 TI GLENOSPHERE
|
Facility
IP
|
$13,520.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$10,410.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,545.60
|
| Rate for Payer: Cash Price |
$6,760.00
|
| Rate for Payer: Cigna Commercial |
$11,221.60
|
| Rate for Payer: First Health Commercial |
$12,844.00
|
| Rate for Payer: Humana Commercial |
$11,492.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,086.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,977.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,056.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,897.60
|
| Rate for Payer: Ohio Health Group HMO |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,704.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,757.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,191.20
|
| Rate for Payer: PHCS Commercial |
$12,979.20
|
|
|
42 +4 LAT/24 TI GLENOSPHERE
|
Facility
OP
|
$13,520.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$10,410.40
|
| Rate for Payer: Anthem Medicaid |
$4,649.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,545.60
|
| Rate for Payer: Cash Price |
$6,760.00
|
| Rate for Payer: Cigna Commercial |
$11,221.60
|
| Rate for Payer: First Health Commercial |
$12,844.00
|
| Rate for Payer: Humana Commercial |
$11,492.00
|
| Rate for Payer: Humana KY Medicaid |
$4,649.53
|
| Rate for Payer: Kentucky WC Medicaid |
$4,696.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,086.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,977.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,056.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,742.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,897.60
|
| Rate for Payer: Ohio Health Group HMO |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,704.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,757.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,191.20
|
| Rate for Payer: PHCS Commercial |
$12,979.20
|
| Rate for Payer: United Healthcare All Payer |
$11,897.60
|
|
|
42 +4 LAT/28 TI GLENOSPHERE
|
Facility
IP
|
$13,520.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$10,410.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,545.60
|
| Rate for Payer: Cash Price |
$6,760.00
|
| Rate for Payer: Cigna Commercial |
$11,221.60
|
| Rate for Payer: First Health Commercial |
$12,844.00
|
| Rate for Payer: Humana Commercial |
$11,492.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,086.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,977.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,056.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,897.60
|
| Rate for Payer: Ohio Health Group HMO |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,704.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,757.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,191.20
|
| Rate for Payer: PHCS Commercial |
$12,979.20
|
|
|
42 +4 LAT/28 TI GLENOSPHERE
|
Facility
OP
|
$13,520.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$10,410.40
|
| Rate for Payer: Anthem Medicaid |
$4,649.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,545.60
|
| Rate for Payer: Cash Price |
$6,760.00
|
| Rate for Payer: Cigna Commercial |
$11,221.60
|
| Rate for Payer: First Health Commercial |
$12,844.00
|
| Rate for Payer: Humana Commercial |
$11,492.00
|
| Rate for Payer: Humana KY Medicaid |
$4,649.53
|
| Rate for Payer: Kentucky WC Medicaid |
$4,696.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,086.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,977.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,056.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,742.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,897.60
|
| Rate for Payer: Ohio Health Group HMO |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,704.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,757.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,191.20
|
| Rate for Payer: PHCS Commercial |
$12,979.20
|
| Rate for Payer: United Healthcare All Payer |
$11,897.60
|
|
|
46MM GLENOID W/40MM SURFCE PEG
|
Facility
OP
|
$9,092.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$7,001.30
|
| Rate for Payer: Anthem Medicaid |
$3,126.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,092.23
|
| Rate for Payer: Cash Price |
$4,546.30
|
| Rate for Payer: Cigna Commercial |
$7,546.86
|
| Rate for Payer: First Health Commercial |
$8,637.97
|
| Rate for Payer: Humana Commercial |
$7,728.71
|
| Rate for Payer: Humana KY Medicaid |
$3,126.95
|
| Rate for Payer: Kentucky WC Medicaid |
$3,158.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,455.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,710.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,727.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,189.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,001.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,819.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,818.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,182.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,818.71
|
| Rate for Payer: PHCS Commercial |
$8,728.90
|
| Rate for Payer: United Healthcare All Payer |
$8,001.49
|
|
|
46MM GLENOID W/40MM SURFCE PEG
|
Facility
IP
|
$9,092.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$7,001.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,092.23
|
| Rate for Payer: Cash Price |
$4,546.30
|
| Rate for Payer: Cigna Commercial |
$7,546.86
|
| Rate for Payer: First Health Commercial |
$8,637.97
|
| Rate for Payer: Humana Commercial |
$7,728.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,455.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,710.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,727.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,001.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,819.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,818.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,182.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,818.71
|
| Rate for Payer: PHCS Commercial |
$8,728.90
|
|
|
46MM GLENOID W/52MM SURFCE PEG
|
Facility
OP
|
$9,092.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$7,001.30
|
| Rate for Payer: Anthem Medicaid |
$3,126.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,092.23
|
| Rate for Payer: Cash Price |
$4,546.30
|
| Rate for Payer: Cigna Commercial |
$7,546.86
|
| Rate for Payer: First Health Commercial |
$8,637.97
|
| Rate for Payer: Humana Commercial |
$7,728.71
|
| Rate for Payer: Humana KY Medicaid |
$3,126.95
|
| Rate for Payer: Kentucky WC Medicaid |
$3,158.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,455.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,710.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,727.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,189.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,001.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,819.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,818.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,182.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,818.71
|
| Rate for Payer: PHCS Commercial |
$8,728.90
|
| Rate for Payer: United Healthcare All Payer |
$8,001.49
|
|
|
46MM GLENOID W/52MM SURFCE PEG
|
Facility
IP
|
$9,092.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$7,001.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,092.23
|
| Rate for Payer: Cash Price |
$4,546.30
|
| Rate for Payer: Cigna Commercial |
$7,546.86
|
| Rate for Payer: First Health Commercial |
$8,637.97
|
| Rate for Payer: Humana Commercial |
$7,728.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,455.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,710.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,727.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,001.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,819.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,818.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,182.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,818.71
|
| Rate for Payer: PHCS Commercial |
$8,728.90
|
|
|
46MM GLNOD 4/40MM SRFC KEEL
|
Facility
OP
|
$8,607.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$6,627.51
|
| Rate for Payer: Anthem Medicaid |
$2,960.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,713.58
|
| Rate for Payer: Cash Price |
$4,303.58
|
| Rate for Payer: Cigna Commercial |
$7,143.93
|
| Rate for Payer: First Health Commercial |
$8,176.79
|
| Rate for Payer: Humana Commercial |
$7,316.08
|
| Rate for Payer: Humana KY Medicaid |
$2,960.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,990.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,057.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,352.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,582.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,019.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,574.29
|
| Rate for Payer: Ohio Health Group HMO |
$6,455.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,721.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,118.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,668.22
|
| Rate for Payer: PHCS Commercial |
$8,262.86
|
| Rate for Payer: United Healthcare All Payer |
$7,574.29
|
|
|
46MM GLNOD 4/40MM SRFC KEEL
|
Facility
IP
|
$8,607.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$6,627.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,713.58
|
| Rate for Payer: Cash Price |
$4,303.58
|
| Rate for Payer: Cigna Commercial |
$7,143.93
|
| Rate for Payer: First Health Commercial |
$8,176.79
|
| Rate for Payer: Humana Commercial |
$7,316.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,057.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,352.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,582.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,574.29
|
| Rate for Payer: Ohio Health Group HMO |
$6,455.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,721.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,118.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,668.22
|
| Rate for Payer: PHCS Commercial |
$8,262.86
|
|
|
46MM GLNOD W/52MM SUFC KEEL
|
Facility
IP
|
$8,607.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$6,627.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,713.58
|
| Rate for Payer: Cash Price |
$4,303.58
|
| Rate for Payer: Cigna Commercial |
$7,143.93
|
| Rate for Payer: First Health Commercial |
$8,176.79
|
| Rate for Payer: Humana Commercial |
$7,316.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,057.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,352.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,582.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,574.29
|
| Rate for Payer: Ohio Health Group HMO |
$6,455.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,721.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,118.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,668.22
|
| Rate for Payer: PHCS Commercial |
$8,262.86
|
|
|
46MM GLNOD W/52MM SUFC KEEL
|
Facility
OP
|
$8,607.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$6,627.51
|
| Rate for Payer: Anthem Medicaid |
$2,960.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,713.58
|
| Rate for Payer: Cash Price |
$4,303.58
|
| Rate for Payer: Cigna Commercial |
$7,143.93
|
| Rate for Payer: First Health Commercial |
$8,176.79
|
| Rate for Payer: Humana Commercial |
$7,316.08
|
| Rate for Payer: Humana KY Medicaid |
$2,960.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,990.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,057.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,352.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,582.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,019.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,574.29
|
| Rate for Payer: Ohio Health Group HMO |
$6,455.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,721.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,118.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,668.22
|
| Rate for Payer: PHCS Commercial |
$8,262.86
|
| Rate for Payer: United Healthcare All Payer |
$7,574.29
|
|
|
4FR. PIGTAIL 65CM
|
Facility
IP
|
$484.17
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$12,611.28 |
| Rate for Payer: Aetna Commercial |
$372.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$377.65
|
| Rate for Payer: Cash Price |
$242.08
|
| Rate for Payer: Cigna Commercial |
$401.86
|
| Rate for Payer: First Health Commercial |
$459.96
|
| Rate for Payer: Humana Commercial |
$411.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$397.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$357.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$145.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$426.07
|
| Rate for Payer: Ohio Health Group HMO |
$363.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$150.09
|
| Rate for Payer: PHCS Commercial |
$464.80
|
|
|
4FR. PIGTAIL 65CM
|
Facility
OP
|
$484.17
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$12,611.28 |
| Rate for Payer: Aetna Commercial |
$372.81
|
| Rate for Payer: Anthem Medicaid |
$166.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$377.65
|
| Rate for Payer: Cash Price |
$242.08
|
| Rate for Payer: Cigna Commercial |
$401.86
|
| Rate for Payer: First Health Commercial |
$459.96
|
| Rate for Payer: Humana Commercial |
$411.54
|
| Rate for Payer: Humana KY Medicaid |
$166.51
|
| Rate for Payer: Kentucky WC Medicaid |
$168.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$397.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$357.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$145.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$169.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$426.07
|
| Rate for Payer: Ohio Health Group HMO |
$363.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$150.09
|
| Rate for Payer: PHCS Commercial |
$464.80
|
| Rate for Payer: United Healthcare All Payer |
$426.07
|
|
|
4FR. PIGTAIL 90CM
|
Facility
OP
|
$807.75
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$12,611.28 |
| Rate for Payer: Aetna Commercial |
$621.97
|
| Rate for Payer: Anthem Medicaid |
$277.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$630.04
|
| Rate for Payer: Cash Price |
$403.88
|
| Rate for Payer: Cigna Commercial |
$670.43
|
| Rate for Payer: First Health Commercial |
$767.36
|
| Rate for Payer: Humana Commercial |
$686.59
|
| Rate for Payer: Humana KY Medicaid |
$277.79
|
| Rate for Payer: Kentucky WC Medicaid |
$280.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$662.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$596.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$242.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$283.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$710.82
|
| Rate for Payer: Ohio Health Group HMO |
$605.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$161.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$250.40
|
| Rate for Payer: PHCS Commercial |
$775.44
|
| Rate for Payer: United Healthcare All Payer |
$710.82
|
|
|
4FR. PIGTAIL 90CM
|
Facility
IP
|
$807.75
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$12,611.28 |
| Rate for Payer: Aetna Commercial |
$621.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$630.04
|
| Rate for Payer: Cash Price |
$403.88
|
| Rate for Payer: Cigna Commercial |
$670.43
|
| Rate for Payer: First Health Commercial |
$767.36
|
| Rate for Payer: Humana Commercial |
$686.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$662.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$596.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$242.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$710.82
|
| Rate for Payer: Ohio Health Group HMO |
$605.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$161.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$250.40
|
| Rate for Payer: PHCS Commercial |
$775.44
|
|
|
4FR SINGLE BIOFLO PICC
|
Facility
OP
|
$1,704.20
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$12,611.28 |
| Rate for Payer: Aetna Commercial |
$1,312.23
|
| Rate for Payer: Anthem Medicaid |
$586.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,329.28
|
| Rate for Payer: Cash Price |
$852.10
|
| Rate for Payer: Cigna Commercial |
$1,414.49
|
| Rate for Payer: First Health Commercial |
$1,618.99
|
| Rate for Payer: Humana Commercial |
$1,448.57
|
| Rate for Payer: Humana KY Medicaid |
$586.07
|
| Rate for Payer: Kentucky WC Medicaid |
$592.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,397.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,257.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$511.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$597.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,499.70
|
| Rate for Payer: Ohio Health Group HMO |
$1,278.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$528.30
|
| Rate for Payer: PHCS Commercial |
$1,636.03
|
| Rate for Payer: United Healthcare All Payer |
$1,499.70
|
|
|
4FR SINGLE BIOFLO PICC
|
Facility
IP
|
$1,704.20
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$12,611.28 |
| Rate for Payer: Aetna Commercial |
$1,312.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,329.28
|
| Rate for Payer: Cash Price |
$852.10
|
| Rate for Payer: Cigna Commercial |
$1,414.49
|
| Rate for Payer: First Health Commercial |
$1,618.99
|
| Rate for Payer: Humana Commercial |
$1,448.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,397.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,257.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$511.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,499.70
|
| Rate for Payer: Ohio Health Group HMO |
$1,278.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$528.30
|
| Rate for Payer: PHCS Commercial |
$1,636.03
|
|
|
5.0M SCREW
|
Facility
IP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$36,566.41 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
|
|
5.0M SCREW
|
Facility
OP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$36,566.41 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem Medicaid |
$686.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Humana KY Medicaid |
$686.94
|
| Rate for Payer: Kentucky WC Medicaid |
$693.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
52MM GLNOD W/46MM SUFC KEEL
|
Facility
OP
|
$8,607.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$6,627.51
|
| Rate for Payer: Anthem Medicaid |
$2,960.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,713.58
|
| Rate for Payer: Cash Price |
$4,303.58
|
| Rate for Payer: Cigna Commercial |
$7,143.93
|
| Rate for Payer: First Health Commercial |
$8,176.79
|
| Rate for Payer: Humana Commercial |
$7,316.08
|
| Rate for Payer: Humana KY Medicaid |
$2,960.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,990.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,057.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,352.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,582.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,019.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,574.29
|
| Rate for Payer: Ohio Health Group HMO |
$6,455.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,721.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,118.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,668.22
|
| Rate for Payer: PHCS Commercial |
$8,262.86
|
| Rate for Payer: United Healthcare All Payer |
$7,574.29
|
|
|
52MM GLNOD W/46MM SUFC KEEL
|
Facility
IP
|
$8,607.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$6,627.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,713.58
|
| Rate for Payer: Cash Price |
$4,303.58
|
| Rate for Payer: Cigna Commercial |
$7,143.93
|
| Rate for Payer: First Health Commercial |
$8,176.79
|
| Rate for Payer: Humana Commercial |
$7,316.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,057.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,352.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,582.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,574.29
|
| Rate for Payer: Ohio Health Group HMO |
$6,455.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,721.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,118.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,668.22
|
| Rate for Payer: PHCS Commercial |
$8,262.86
|
|
|
52MM GLNOD W/56MM SUFC KEEL
|
Facility
OP
|
$8,607.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$6,627.51
|
| Rate for Payer: Anthem Medicaid |
$2,960.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,713.58
|
| Rate for Payer: Cash Price |
$4,303.58
|
| Rate for Payer: Cigna Commercial |
$7,143.93
|
| Rate for Payer: First Health Commercial |
$8,176.79
|
| Rate for Payer: Humana Commercial |
$7,316.08
|
| Rate for Payer: Humana KY Medicaid |
$2,960.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,990.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,057.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,352.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,582.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,019.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,574.29
|
| Rate for Payer: Ohio Health Group HMO |
$6,455.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,721.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,118.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,668.22
|
| Rate for Payer: PHCS Commercial |
$8,262.86
|
| Rate for Payer: United Healthcare All Payer |
$7,574.29
|
|
