|
HED BIOLOX DLTA OPT 36MM+3.5MM
|
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 40MM -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 40MM -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 40MM+3.5MM
|
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 DLTA OPT 40MM+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
|
|
|
HED COCR DIA MOD 22.2MM-3MM NK
|
Facility
|
OP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem Medicaid |
$1,478.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Humana KY Medicaid |
$1,478.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,493.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,508.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
HED COCR DIA MOD 22.2MM-3MM NK
|
Facility
|
IP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
HED COCR DIA MOD 22.2MM-5MM NK
|
Facility
|
IP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
HED COCR DIA MOD 22.2MM-5MM NK
|
Facility
|
OP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem Medicaid |
$1,478.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Humana KY Medicaid |
$1,478.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,493.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,508.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
HED COCR DIA MOD 22.2MM STD NK
|
Facility
|
OP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem Medicaid |
$1,478.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Humana KY Medicaid |
$1,478.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,493.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,508.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
HED COCR DIA MOD 22.2MM STD NK
|
Facility
|
IP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
HED COCR DIA MOD 26MM +12MM NK
|
Facility
|
OP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem Medicaid |
$1,478.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Humana KY Medicaid |
$1,478.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,493.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,508.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
HED COCR DIA MOD 26MM +12MM NK
|
Facility
|
IP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
HED COCR FEM 44MM TYPE 1 +12MM
|
Facility
|
OP
|
$4,930.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.90 |
| Max. Negotiated Rate |
$4,732.80 |
| Rate for Payer: Aetna Commercial |
$3,796.10
|
| Rate for Payer: Anthem Medicaid |
$1,695.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,845.40
|
| Rate for Payer: Cash Price |
$2,465.00
|
| Rate for Payer: Cigna Commercial |
$4,091.90
|
| Rate for Payer: First Health Commercial |
$4,683.50
|
| Rate for Payer: Humana Commercial |
$4,190.50
|
| Rate for Payer: Humana KY Medicaid |
$1,695.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,712.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,042.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,638.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,479.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,729.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,338.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$640.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.30
|
| Rate for Payer: PHCS Commercial |
$4,732.80
|
| Rate for Payer: United Healthcare All Payer |
$4,338.40
|
|
|
HED COCR FEM 44MM TYPE 1 +12MM
|
Facility
|
IP
|
$4,930.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.90 |
| Max. Negotiated Rate |
$4,732.80 |
| Rate for Payer: Aetna Commercial |
$3,796.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,845.40
|
| Rate for Payer: Cash Price |
$2,465.00
|
| Rate for Payer: Cigna Commercial |
$4,091.90
|
| Rate for Payer: First Health Commercial |
$4,683.50
|
| Rate for Payer: Humana Commercial |
$4,190.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,042.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,638.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,479.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,338.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$640.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.30
|
| Rate for Payer: PHCS Commercial |
$4,732.80
|
| Rate for Payer: United Healthcare All Payer |
$4,338.40
|
|
|
HED COCR MOD 26MM +6MM NO SKRT
|
Facility
|
IP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
HED COCR MOD 26MM +6MM NO SKRT
|
Facility
|
OP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem Medicaid |
$1,478.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Humana KY Medicaid |
$1,478.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,493.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,508.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
HED COCR MOD 28MM +6MM NO SKRT
|
Facility
|
IP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
HED COCR MOD 28MM +6MM NO SKRT
|
Facility
|
OP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem Medicaid |
$1,478.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Humana KY Medicaid |
$1,478.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,493.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,508.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
HED COCR MOD 32MM +6MM N0 SKRT
|
Facility
|
OP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem Medicaid |
$1,478.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Humana KY Medicaid |
$1,478.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,493.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,508.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
HED COCR MOD 32MM +6MM N0 SKRT
|
Facility
|
IP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
HED FRACTURE MOD CATHCART 45MM
|
Facility
|
IP
|
$5,448.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$708.24 |
| Max. Negotiated Rate |
$5,230.08 |
| Rate for Payer: Aetna Commercial |
$4,194.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,249.44
|
| Rate for Payer: Cash Price |
$2,724.00
|
| Rate for Payer: Cigna Commercial |
$4,521.84
|
| Rate for Payer: First Health Commercial |
$5,175.60
|
| Rate for Payer: Humana Commercial |
$4,630.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,467.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,020.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,634.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,794.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,086.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,089.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$708.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,688.88
|
| Rate for Payer: PHCS Commercial |
$5,230.08
|
| Rate for Payer: United Healthcare All Payer |
$4,794.24
|
|
|
HED FRACTURE MOD CATHCART 45MM
|
Facility
|
OP
|
$5,448.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$708.24 |
| Max. Negotiated Rate |
$5,230.08 |
| Rate for Payer: Aetna Commercial |
$4,194.96
|
| Rate for Payer: Anthem Medicaid |
$1,873.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,249.44
|
| Rate for Payer: Cash Price |
$2,724.00
|
| Rate for Payer: Cigna Commercial |
$4,521.84
|
| Rate for Payer: First Health Commercial |
$5,175.60
|
| Rate for Payer: Humana Commercial |
$4,630.80
|
| Rate for Payer: Humana KY Medicaid |
$1,873.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,892.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,467.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,020.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,634.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,911.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,794.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,086.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,089.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$708.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,688.88
|
| Rate for Payer: PHCS Commercial |
$5,230.08
|
| Rate for Payer: United Healthcare All Payer |
$4,794.24
|
|
|
HED FRACTURE MOD CATHCART 46MM
|
Facility
|
IP
|
$5,448.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$708.24 |
| Max. Negotiated Rate |
$5,230.08 |
| Rate for Payer: Aetna Commercial |
$4,194.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,249.44
|
| Rate for Payer: Cash Price |
$2,724.00
|
| Rate for Payer: Cigna Commercial |
$4,521.84
|
| Rate for Payer: First Health Commercial |
$5,175.60
|
| Rate for Payer: Humana Commercial |
$4,630.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,467.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,020.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,634.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,794.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,086.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,089.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$708.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,688.88
|
| Rate for Payer: PHCS Commercial |
$5,230.08
|
| Rate for Payer: United Healthcare All Payer |
$4,794.24
|
|
|
HED FRACTURE MOD CATHCART 46MM
|
Facility
|
OP
|
$5,448.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$708.24 |
| Max. Negotiated Rate |
$5,230.08 |
| Rate for Payer: Aetna Commercial |
$4,194.96
|
| Rate for Payer: Anthem Medicaid |
$1,873.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,249.44
|
| Rate for Payer: Cash Price |
$2,724.00
|
| Rate for Payer: Cigna Commercial |
$4,521.84
|
| Rate for Payer: First Health Commercial |
$5,175.60
|
| Rate for Payer: Humana Commercial |
$4,630.80
|
| Rate for Payer: Humana KY Medicaid |
$1,873.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,892.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,467.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,020.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,634.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,911.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,794.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,086.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,089.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$708.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,688.88
|
| Rate for Payer: PHCS Commercial |
$5,230.08
|
| Rate for Payer: United Healthcare All Payer |
$4,794.24
|
|
