|
HED BIOLOX DLTACER 28MM -3.5MM
|
Facility
|
OP
|
$7,481.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$972.55 |
| Max. Negotiated Rate |
$7,181.88 |
| Rate for Payer: Aetna Commercial |
$5,760.46
|
| Rate for Payer: Anthem Medicaid |
$2,572.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,835.27
|
| Rate for Payer: Cash Price |
$3,740.56
|
| Rate for Payer: Cigna Commercial |
$6,209.33
|
| Rate for Payer: First Health Commercial |
$7,107.06
|
| Rate for Payer: Humana Commercial |
$6,358.95
|
| Rate for Payer: Humana KY Medicaid |
$2,572.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,598.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,134.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,521.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,244.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,624.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,583.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,610.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$972.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,319.15
|
| Rate for Payer: PHCS Commercial |
$7,181.88
|
| Rate for Payer: United Healthcare All Payer |
$6,583.39
|
|
|
HED BIOLOX DLTACER 28MM -3.5MM
|
Facility
|
IP
|
$7,481.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$972.55 |
| Max. Negotiated Rate |
$7,181.88 |
| Rate for Payer: Aetna Commercial |
$5,760.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,835.27
|
| Rate for Payer: Cash Price |
$3,740.56
|
| Rate for Payer: Cigna Commercial |
$6,209.33
|
| Rate for Payer: First Health Commercial |
$7,107.06
|
| Rate for Payer: Humana Commercial |
$6,358.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,134.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,521.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,244.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,583.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,610.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$972.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,319.15
|
| Rate for Payer: PHCS Commercial |
$7,181.88
|
| Rate for Payer: United Healthcare All Payer |
$6,583.39
|
|
|
HED BIOLOX DLTA CER 32MM+3.5MM
|
Facility
|
IP
|
$7,481.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$972.55 |
| Max. Negotiated Rate |
$7,181.88 |
| Rate for Payer: Aetna Commercial |
$5,760.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,835.27
|
| Rate for Payer: Cash Price |
$3,740.56
|
| Rate for Payer: Cigna Commercial |
$6,209.33
|
| Rate for Payer: First Health Commercial |
$7,107.06
|
| Rate for Payer: Humana Commercial |
$6,358.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,134.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,521.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,244.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,583.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,610.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$972.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,319.15
|
| Rate for Payer: PHCS Commercial |
$7,181.88
|
| Rate for Payer: United Healthcare All Payer |
$6,583.39
|
|
|
HED BIOLOX DLTA CER 32MM+3.5MM
|
Facility
|
OP
|
$7,481.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$972.55 |
| Max. Negotiated Rate |
$7,181.88 |
| Rate for Payer: Aetna Commercial |
$5,760.46
|
| Rate for Payer: Anthem Medicaid |
$2,572.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,835.27
|
| Rate for Payer: Cash Price |
$3,740.56
|
| Rate for Payer: Cigna Commercial |
$6,209.33
|
| Rate for Payer: First Health Commercial |
$7,107.06
|
| Rate for Payer: Humana Commercial |
$6,358.95
|
| Rate for Payer: Humana KY Medicaid |
$2,572.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,598.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,134.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,521.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,244.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,624.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,583.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,610.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$972.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,319.15
|
| Rate for Payer: PHCS Commercial |
$7,181.88
|
| Rate for Payer: United Healthcare All Payer |
$6,583.39
|
|
|
HED BIOLOX DLTACER 32MM -3.5MM
|
Facility
|
OP
|
$7,481.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$972.55 |
| Max. Negotiated Rate |
$7,181.88 |
| Rate for Payer: Aetna Commercial |
$5,760.46
|
| Rate for Payer: Anthem Medicaid |
$2,572.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,835.27
|
| Rate for Payer: Cash Price |
$3,740.56
|
| Rate for Payer: Cigna Commercial |
$6,209.33
|
| Rate for Payer: First Health Commercial |
$7,107.06
|
| Rate for Payer: Humana Commercial |
$6,358.95
|
| Rate for Payer: Humana KY Medicaid |
$2,572.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,598.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,134.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,521.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,244.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,624.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,583.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,610.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$972.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,319.15
|
| Rate for Payer: PHCS Commercial |
$7,181.88
|
| Rate for Payer: United Healthcare All Payer |
$6,583.39
|
|
|
HED BIOLOX DLTACER 32MM -3.5MM
|
Facility
|
IP
|
$7,481.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$972.55 |
| Max. Negotiated Rate |
$7,181.88 |
| Rate for Payer: Aetna Commercial |
$5,760.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,835.27
|
| Rate for Payer: Cash Price |
$3,740.56
|
| Rate for Payer: Cigna Commercial |
$6,209.33
|
| Rate for Payer: First Health Commercial |
$7,107.06
|
| Rate for Payer: Humana Commercial |
$6,358.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,134.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,521.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,244.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,583.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,610.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$972.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,319.15
|
| Rate for Payer: PHCS Commercial |
$7,181.88
|
| Rate for Payer: United Healthcare All Payer |
$6,583.39
|
|
|
HED BIOLOX DLTA CER 36MM+3.5MM
|
Facility
|
IP
|
$8,001.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,040.16 |
| Max. Negotiated Rate |
$7,681.20 |
| Rate for Payer: Aetna Commercial |
$6,160.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,240.98
|
| Rate for Payer: Cash Price |
$4,000.62
|
| Rate for Payer: Cigna Commercial |
$6,641.04
|
| Rate for Payer: First Health Commercial |
$7,601.19
|
| Rate for Payer: Humana Commercial |
$6,801.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,561.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,904.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,400.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,041.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,000.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,040.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,480.39
|
| Rate for Payer: PHCS Commercial |
$7,681.20
|
| Rate for Payer: United Healthcare All Payer |
$7,041.10
|
|
|
HED BIOLOX DLTA CER 36MM+3.5MM
|
Facility
|
OP
|
$8,001.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,040.16 |
| Max. Negotiated Rate |
$7,681.20 |
| Rate for Payer: Aetna Commercial |
$6,160.96
|
| Rate for Payer: Anthem Medicaid |
$2,751.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,240.98
|
| Rate for Payer: Cash Price |
$4,000.62
|
| Rate for Payer: Cigna Commercial |
$6,641.04
|
| Rate for Payer: First Health Commercial |
$7,601.19
|
| Rate for Payer: Humana Commercial |
$6,801.06
|
| Rate for Payer: Humana KY Medicaid |
$2,751.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,779.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,561.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,904.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,400.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,806.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,041.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,000.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,040.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,480.39
|
| Rate for Payer: PHCS Commercial |
$7,681.20
|
| Rate for Payer: United Healthcare All Payer |
$7,041.10
|
|
|
HED BIOLOX DLTACER 36MM -3.5MM
|
Facility
|
IP
|
$8,001.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,040.16 |
| Max. Negotiated Rate |
$7,681.20 |
| Rate for Payer: Aetna Commercial |
$6,160.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,240.98
|
| Rate for Payer: Cash Price |
$4,000.62
|
| Rate for Payer: Cigna Commercial |
$6,641.04
|
| Rate for Payer: First Health Commercial |
$7,601.19
|
| Rate for Payer: Humana Commercial |
$6,801.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,561.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,904.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,400.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,041.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,000.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,040.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,480.39
|
| Rate for Payer: PHCS Commercial |
$7,681.20
|
| Rate for Payer: United Healthcare All Payer |
$7,041.10
|
|
|
HED BIOLOX DLTACER 36MM -3.5MM
|
Facility
|
OP
|
$8,001.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,040.16 |
| Max. Negotiated Rate |
$7,681.20 |
| Rate for Payer: Aetna Commercial |
$6,160.96
|
| Rate for Payer: Anthem Medicaid |
$2,751.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,240.98
|
| Rate for Payer: Cash Price |
$4,000.62
|
| Rate for Payer: Cigna Commercial |
$6,641.04
|
| Rate for Payer: First Health Commercial |
$7,601.19
|
| Rate for Payer: Humana Commercial |
$6,801.06
|
| Rate for Payer: Humana KY Medicaid |
$2,751.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,779.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,561.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,904.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,400.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,806.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,041.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,000.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,040.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,480.39
|
| Rate for Payer: PHCS Commercial |
$7,681.20
|
| Rate for Payer: United Healthcare All Payer |
$7,041.10
|
|
|
HED BIOLOX DLTA CER 40MM+3.5MM
|
Facility
|
OP
|
$8,001.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,040.16 |
| Max. Negotiated Rate |
$7,681.20 |
| Rate for Payer: Aetna Commercial |
$6,160.96
|
| Rate for Payer: Anthem Medicaid |
$2,751.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,240.98
|
| Rate for Payer: Cash Price |
$4,000.62
|
| Rate for Payer: Cigna Commercial |
$6,641.04
|
| Rate for Payer: First Health Commercial |
$7,601.19
|
| Rate for Payer: Humana Commercial |
$6,801.06
|
| Rate for Payer: Humana KY Medicaid |
$2,751.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,779.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,561.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,904.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,400.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,806.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,041.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,000.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,040.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,480.39
|
| Rate for Payer: PHCS Commercial |
$7,681.20
|
| Rate for Payer: United Healthcare All Payer |
$7,041.10
|
|
|
HED BIOLOX DLTA CER 40MM+3.5MM
|
Facility
|
IP
|
$8,001.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,040.16 |
| Max. Negotiated Rate |
$7,681.20 |
| Rate for Payer: Aetna Commercial |
$6,160.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,240.98
|
| Rate for Payer: Cash Price |
$4,000.62
|
| Rate for Payer: Cigna Commercial |
$6,641.04
|
| Rate for Payer: First Health Commercial |
$7,601.19
|
| Rate for Payer: Humana Commercial |
$6,801.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,561.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,904.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,400.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,041.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,000.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,040.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,480.39
|
| Rate for Payer: PHCS Commercial |
$7,681.20
|
| Rate for Payer: United Healthcare All Payer |
$7,041.10
|
|
|
HED BIOLOX DLTACER 40MM -3.5MM
|
Facility
|
OP
|
$8,001.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,040.16 |
| Max. Negotiated Rate |
$7,681.20 |
| Rate for Payer: Aetna Commercial |
$6,160.96
|
| Rate for Payer: Anthem Medicaid |
$2,751.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,240.98
|
| Rate for Payer: Cash Price |
$4,000.62
|
| Rate for Payer: Cigna Commercial |
$6,641.04
|
| Rate for Payer: First Health Commercial |
$7,601.19
|
| Rate for Payer: Humana Commercial |
$6,801.06
|
| Rate for Payer: Humana KY Medicaid |
$2,751.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,779.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,561.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,904.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,400.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,806.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,041.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,000.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,040.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,480.39
|
| Rate for Payer: PHCS Commercial |
$7,681.20
|
| Rate for Payer: United Healthcare All Payer |
$7,041.10
|
|
|
HED BIOLOX DLTACER 40MM -3.5MM
|
Facility
|
IP
|
$8,001.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,040.16 |
| Max. Negotiated Rate |
$7,681.20 |
| Rate for Payer: Aetna Commercial |
$6,160.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,240.98
|
| Rate for Payer: Cash Price |
$4,000.62
|
| Rate for Payer: Cigna Commercial |
$6,641.04
|
| Rate for Payer: First Health Commercial |
$7,601.19
|
| Rate for Payer: Humana Commercial |
$6,801.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,561.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,904.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,400.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,041.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,000.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,040.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,480.39
|
| Rate for Payer: PHCS Commercial |
$7,681.20
|
| Rate for Payer: United Healthcare All Payer |
$7,041.10
|
|
|
HED BIOLOX DLTAOPT 28MM -3.0MM
|
Facility
|
IP
|
$10,678.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,388.25 |
| Max. Negotiated Rate |
$10,251.69 |
| Rate for Payer: Aetna Commercial |
$8,222.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,329.50
|
| Rate for Payer: Cash Price |
$5,339.42
|
| Rate for Payer: Cigna Commercial |
$8,863.44
|
| Rate for Payer: First Health Commercial |
$10,144.90
|
| Rate for Payer: Humana Commercial |
$9,077.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,756.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,880.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,203.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,397.38
|
| Rate for Payer: Ohio Health Group HMO |
$8,009.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,135.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,388.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,310.44
|
| Rate for Payer: PHCS Commercial |
$10,251.69
|
| Rate for Payer: United Healthcare All Payer |
$9,397.38
|
|
|
HED BIOLOX DLTAOPT 28MM -3.0MM
|
Facility
|
OP
|
$10,678.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,388.25 |
| Max. Negotiated Rate |
$10,251.69 |
| Rate for Payer: Aetna Commercial |
$8,222.71
|
| Rate for Payer: Anthem Medicaid |
$3,672.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,329.50
|
| Rate for Payer: Cash Price |
$5,339.42
|
| Rate for Payer: Cigna Commercial |
$8,863.44
|
| Rate for Payer: First Health Commercial |
$10,144.90
|
| Rate for Payer: Humana Commercial |
$9,077.01
|
| Rate for Payer: Humana KY Medicaid |
$3,672.45
|
| Rate for Payer: Kentucky WC Medicaid |
$3,709.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,756.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,880.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,203.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,746.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,397.38
|
| Rate for Payer: Ohio Health Group HMO |
$8,009.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,135.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,388.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,310.44
|
| Rate for Payer: PHCS Commercial |
$10,251.69
|
| Rate for Payer: United Healthcare All Payer |
$9,397.38
|
|
|
HED BIOLOX DLTA OPT 28MM+3.5MM
|
Facility
|
IP
|
$10,678.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,388.25 |
| Max. Negotiated Rate |
$10,251.69 |
| Rate for Payer: Aetna Commercial |
$8,222.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,329.50
|
| Rate for Payer: Cash Price |
$5,339.42
|
| Rate for Payer: Cigna Commercial |
$8,863.44
|
| Rate for Payer: First Health Commercial |
$10,144.90
|
| Rate for Payer: Humana Commercial |
$9,077.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,756.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,880.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,203.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,397.38
|
| Rate for Payer: Ohio Health Group HMO |
$8,009.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,135.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,388.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,310.44
|
| Rate for Payer: PHCS Commercial |
$10,251.69
|
| Rate for Payer: United Healthcare All Payer |
$9,397.38
|
|
|
HED BIOLOX DLTA OPT 28MM+3.5MM
|
Facility
|
OP
|
$10,678.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,388.25 |
| Max. Negotiated Rate |
$10,251.69 |
| Rate for Payer: Aetna Commercial |
$8,222.71
|
| Rate for Payer: Anthem Medicaid |
$3,672.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,329.50
|
| Rate for Payer: Cash Price |
$5,339.42
|
| Rate for Payer: Cigna Commercial |
$8,863.44
|
| Rate for Payer: First Health Commercial |
$10,144.90
|
| Rate for Payer: Humana Commercial |
$9,077.01
|
| Rate for Payer: Humana KY Medicaid |
$3,672.45
|
| Rate for Payer: Kentucky WC Medicaid |
$3,709.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,756.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,880.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,203.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,746.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,397.38
|
| Rate for Payer: Ohio Health Group HMO |
$8,009.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,135.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,388.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,310.44
|
| Rate for Payer: PHCS Commercial |
$10,251.69
|
| Rate for Payer: United Healthcare All Payer |
$9,397.38
|
|
|
HED BIOLOX DLTAOPT 32MM -3.0MM
|
Facility
|
IP
|
$10,678.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,388.25 |
| Max. Negotiated Rate |
$10,251.69 |
| Rate for Payer: Aetna Commercial |
$8,222.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,329.50
|
| Rate for Payer: Cash Price |
$5,339.42
|
| Rate for Payer: Cigna Commercial |
$8,863.44
|
| Rate for Payer: First Health Commercial |
$10,144.90
|
| Rate for Payer: Humana Commercial |
$9,077.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,756.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,880.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,203.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,397.38
|
| Rate for Payer: Ohio Health Group HMO |
$8,009.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,135.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,388.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,310.44
|
| Rate for Payer: PHCS Commercial |
$10,251.69
|
| Rate for Payer: United Healthcare All Payer |
$9,397.38
|
|
|
HED BIOLOX DLTAOPT 32MM -3.0MM
|
Facility
|
OP
|
$10,678.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,388.25 |
| Max. Negotiated Rate |
$10,251.69 |
| Rate for Payer: Aetna Commercial |
$8,222.71
|
| Rate for Payer: Anthem Medicaid |
$3,672.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,329.50
|
| Rate for Payer: Cash Price |
$5,339.42
|
| Rate for Payer: Cigna Commercial |
$8,863.44
|
| Rate for Payer: First Health Commercial |
$10,144.90
|
| Rate for Payer: Humana Commercial |
$9,077.01
|
| Rate for Payer: Humana KY Medicaid |
$3,672.45
|
| Rate for Payer: Kentucky WC Medicaid |
$3,709.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,756.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,880.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,203.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,746.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,397.38
|
| Rate for Payer: Ohio Health Group HMO |
$8,009.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,135.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,388.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,310.44
|
| Rate for Payer: PHCS Commercial |
$10,251.69
|
| Rate for Payer: United Healthcare All Payer |
$9,397.38
|
|
|
HED BIOLOX DLTA OPT 32MM+3.5MM
|
Facility
|
OP
|
$10,678.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,388.25 |
| Max. Negotiated Rate |
$10,251.69 |
| Rate for Payer: Aetna Commercial |
$8,222.71
|
| Rate for Payer: Anthem Medicaid |
$3,672.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,329.50
|
| Rate for Payer: Cash Price |
$5,339.42
|
| Rate for Payer: Cigna Commercial |
$8,863.44
|
| Rate for Payer: First Health Commercial |
$10,144.90
|
| Rate for Payer: Humana Commercial |
$9,077.01
|
| Rate for Payer: Humana KY Medicaid |
$3,672.45
|
| Rate for Payer: Kentucky WC Medicaid |
$3,709.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,756.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,880.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,203.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,746.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,397.38
|
| Rate for Payer: Ohio Health Group HMO |
$8,009.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,135.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,388.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,310.44
|
| Rate for Payer: PHCS Commercial |
$10,251.69
|
| Rate for Payer: United Healthcare All Payer |
$9,397.38
|
|
|
HED BIOLOX DLTA OPT 32MM+3.5MM
|
Facility
|
IP
|
$10,678.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,388.25 |
| Max. Negotiated Rate |
$10,251.69 |
| Rate for Payer: Aetna Commercial |
$8,222.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,329.50
|
| Rate for Payer: Cash Price |
$5,339.42
|
| Rate for Payer: Cigna Commercial |
$8,863.44
|
| Rate for Payer: First Health Commercial |
$10,144.90
|
| Rate for Payer: Humana Commercial |
$9,077.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,756.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,880.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,203.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,397.38
|
| Rate for Payer: Ohio Health Group HMO |
$8,009.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,135.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,388.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,310.44
|
| Rate for Payer: PHCS Commercial |
$10,251.69
|
| Rate for Payer: United Healthcare All Payer |
$9,397.38
|
|
|
HED BIOLOX DLTAOPT 36MM -3.0MM
|
Facility
|
OP
|
$11,717.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,523.30 |
| Max. Negotiated Rate |
$11,248.99 |
| Rate for Payer: Aetna Commercial |
$9,022.63
|
| Rate for Payer: Anthem Medicaid |
$4,029.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,139.81
|
| Rate for Payer: Cash Price |
$5,858.85
|
| Rate for Payer: Cigna Commercial |
$9,725.69
|
| Rate for Payer: First Health Commercial |
$11,131.82
|
| Rate for Payer: Humana Commercial |
$9,960.04
|
| Rate for Payer: Humana KY Medicaid |
$4,029.72
|
| Rate for Payer: Kentucky WC Medicaid |
$4,070.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,608.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,647.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,515.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,110.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,311.58
|
| Rate for Payer: Ohio Health Group HMO |
$8,788.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,343.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,523.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,632.49
|
| Rate for Payer: PHCS Commercial |
$11,248.99
|
| Rate for Payer: United Healthcare All Payer |
$10,311.58
|
|
|
HED BIOLOX DLTAOPT 36MM -3.0MM
|
Facility
|
IP
|
$11,717.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,523.30 |
| Max. Negotiated Rate |
$11,248.99 |
| Rate for Payer: Aetna Commercial |
$9,022.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,139.81
|
| Rate for Payer: Cash Price |
$5,858.85
|
| Rate for Payer: Cigna Commercial |
$9,725.69
|
| Rate for Payer: First Health Commercial |
$11,131.82
|
| Rate for Payer: Humana Commercial |
$9,960.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,608.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,647.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,515.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,311.58
|
| Rate for Payer: Ohio Health Group HMO |
$8,788.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,343.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,523.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,632.49
|
| Rate for Payer: PHCS Commercial |
$11,248.99
|
| Rate for Payer: United Healthcare All Payer |
$10,311.58
|
|
|
HED BIOLOX DLTA OPT 36MM+3.5MM
|
Facility
|
IP
|
$11,717.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,523.30 |
| Max. Negotiated Rate |
$11,248.99 |
| Rate for Payer: Aetna Commercial |
$9,022.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,139.81
|
| Rate for Payer: Cash Price |
$5,858.85
|
| Rate for Payer: Cigna Commercial |
$9,725.69
|
| Rate for Payer: First Health Commercial |
$11,131.82
|
| Rate for Payer: Humana Commercial |
$9,960.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,608.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,647.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,515.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,311.58
|
| Rate for Payer: Ohio Health Group HMO |
$8,788.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,343.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,523.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,632.49
|
| Rate for Payer: PHCS Commercial |
$11,248.99
|
| Rate for Payer: United Healthcare All Payer |
$10,311.58
|
|
