|
IMPLANT OSS RESURFACING 5CM R
|
Facility
|
IP
|
$69,390.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,020.81 |
| Max. Negotiated Rate |
$66,615.18 |
| Rate for Payer: Aetna Commercial |
$53,430.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54,124.83
|
| Rate for Payer: Cash Price |
$34,695.40
|
| Rate for Payer: Cigna Commercial |
$57,594.37
|
| Rate for Payer: First Health Commercial |
$65,921.27
|
| Rate for Payer: Humana Commercial |
$58,982.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,900.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51,210.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,817.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$61,063.91
|
| Rate for Payer: Ohio Health Group HMO |
$52,043.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,878.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,020.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,511.15
|
| Rate for Payer: PHCS Commercial |
$66,615.18
|
| Rate for Payer: United Healthcare All Payer |
$61,063.91
|
|
|
IMPLANT OSS RESURFACING 5CM R
|
Facility
|
OP
|
$69,390.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,020.81 |
| Max. Negotiated Rate |
$66,615.18 |
| Rate for Payer: Aetna Commercial |
$53,430.92
|
| Rate for Payer: Anthem Medicaid |
$23,863.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54,124.83
|
| Rate for Payer: Cash Price |
$34,695.40
|
| Rate for Payer: Cigna Commercial |
$57,594.37
|
| Rate for Payer: First Health Commercial |
$65,921.27
|
| Rate for Payer: Humana Commercial |
$58,982.19
|
| Rate for Payer: Humana KY Medicaid |
$23,863.50
|
| Rate for Payer: Kentucky WC Medicaid |
$24,106.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,900.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51,210.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,817.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,342.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$61,063.91
|
| Rate for Payer: Ohio Health Group HMO |
$52,043.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,878.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,020.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,511.15
|
| Rate for Payer: PHCS Commercial |
$66,615.18
|
| Rate for Payer: United Healthcare All Payer |
$61,063.91
|
|
|
IMPLANT OSS RESURF FEM 5CM L
|
Facility
|
IP
|
$71,650.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,314.53 |
| Max. Negotiated Rate |
$68,784.23 |
| Rate for Payer: Aetna Commercial |
$55,170.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,887.19
|
| Rate for Payer: Cash Price |
$35,825.12
|
| Rate for Payer: Cigna Commercial |
$59,469.70
|
| Rate for Payer: First Health Commercial |
$68,067.73
|
| Rate for Payer: Humana Commercial |
$60,902.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,753.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,877.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,495.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,052.21
|
| Rate for Payer: Ohio Health Group HMO |
$53,737.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,330.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,314.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,211.57
|
| Rate for Payer: PHCS Commercial |
$68,784.23
|
| Rate for Payer: United Healthcare All Payer |
$63,052.21
|
|
|
IMPLANT OSS RESURF FEM 5CM L
|
Facility
|
OP
|
$71,650.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,314.53 |
| Max. Negotiated Rate |
$68,784.23 |
| Rate for Payer: Aetna Commercial |
$55,170.68
|
| Rate for Payer: Anthem Medicaid |
$24,640.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,887.19
|
| Rate for Payer: Cash Price |
$35,825.12
|
| Rate for Payer: Cigna Commercial |
$59,469.70
|
| Rate for Payer: First Health Commercial |
$68,067.73
|
| Rate for Payer: Humana Commercial |
$60,902.70
|
| Rate for Payer: Humana KY Medicaid |
$24,640.52
|
| Rate for Payer: Kentucky WC Medicaid |
$24,891.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,753.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,877.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,495.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,134.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,052.21
|
| Rate for Payer: Ohio Health Group HMO |
$53,737.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,330.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,314.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,211.57
|
| Rate for Payer: PHCS Commercial |
$68,784.23
|
| Rate for Payer: United Healthcare All Payer |
$63,052.21
|
|
|
IMPLANT OSS RESURF FEM 5CM R
|
Facility
|
OP
|
$71,648.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,314.34 |
| Max. Negotiated Rate |
$68,782.85 |
| Rate for Payer: Aetna Commercial |
$55,169.58
|
| Rate for Payer: Anthem Medicaid |
$24,640.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,886.06
|
| Rate for Payer: Cash Price |
$35,824.40
|
| Rate for Payer: Cigna Commercial |
$59,468.50
|
| Rate for Payer: First Health Commercial |
$68,066.36
|
| Rate for Payer: Humana Commercial |
$60,901.48
|
| Rate for Payer: Humana KY Medicaid |
$24,640.02
|
| Rate for Payer: Kentucky WC Medicaid |
$24,890.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,752.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,876.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,494.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,134.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,050.94
|
| Rate for Payer: Ohio Health Group HMO |
$53,736.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,329.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,314.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,211.13
|
| Rate for Payer: PHCS Commercial |
$68,782.85
|
| Rate for Payer: United Healthcare All Payer |
$63,050.94
|
|
|
IMPLANT OSS RESURF FEM 5CM R
|
Facility
|
IP
|
$71,648.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,314.34 |
| Max. Negotiated Rate |
$68,782.85 |
| Rate for Payer: Aetna Commercial |
$55,169.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,886.06
|
| Rate for Payer: Cash Price |
$35,824.40
|
| Rate for Payer: Cigna Commercial |
$59,468.50
|
| Rate for Payer: First Health Commercial |
$68,066.36
|
| Rate for Payer: Humana Commercial |
$60,901.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58,752.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,876.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,494.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,050.94
|
| Rate for Payer: Ohio Health Group HMO |
$53,736.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,329.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,314.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,211.13
|
| Rate for Payer: PHCS Commercial |
$68,782.85
|
| Rate for Payer: United Healthcare All Payer |
$63,050.94
|
|
|
IMPLANT OSS RESURF FEM SLEVE L
|
Facility
|
OP
|
$8,283.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,076.89 |
| Max. Negotiated Rate |
$7,952.41 |
| Rate for Payer: Aetna Commercial |
$6,378.50
|
| Rate for Payer: Anthem Medicaid |
$2,848.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,461.33
|
| Rate for Payer: Cash Price |
$4,141.88
|
| Rate for Payer: Cigna Commercial |
$6,875.52
|
| Rate for Payer: First Health Commercial |
$7,869.57
|
| Rate for Payer: Humana Commercial |
$7,041.20
|
| Rate for Payer: Humana KY Medicaid |
$2,848.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,877.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,792.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,113.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,485.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,905.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,289.71
|
| Rate for Payer: Ohio Health Group HMO |
$6,212.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,656.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,076.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,567.97
|
| Rate for Payer: PHCS Commercial |
$7,952.41
|
| Rate for Payer: United Healthcare All Payer |
$7,289.71
|
|
|
IMPLANT OSS RESURF FEM SLEVE L
|
Facility
|
IP
|
$8,283.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,076.89 |
| Max. Negotiated Rate |
$7,952.41 |
| Rate for Payer: Aetna Commercial |
$6,378.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,461.33
|
| Rate for Payer: Cash Price |
$4,141.88
|
| Rate for Payer: Cigna Commercial |
$6,875.52
|
| Rate for Payer: First Health Commercial |
$7,869.57
|
| Rate for Payer: Humana Commercial |
$7,041.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,792.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,113.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,485.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,289.71
|
| Rate for Payer: Ohio Health Group HMO |
$6,212.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,656.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,076.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,567.97
|
| Rate for Payer: PHCS Commercial |
$7,952.41
|
| Rate for Payer: United Healthcare All Payer |
$7,289.71
|
|
|
IMPLANT OSS RESURF FEM SLEVE R
|
Facility
|
OP
|
$8,283.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,076.89 |
| Max. Negotiated Rate |
$7,952.41 |
| Rate for Payer: Aetna Commercial |
$6,378.50
|
| Rate for Payer: Anthem Medicaid |
$2,848.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,461.33
|
| Rate for Payer: Cash Price |
$4,141.88
|
| Rate for Payer: Cigna Commercial |
$6,875.52
|
| Rate for Payer: First Health Commercial |
$7,869.57
|
| Rate for Payer: Humana Commercial |
$7,041.20
|
| Rate for Payer: Humana KY Medicaid |
$2,848.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,877.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,792.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,113.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,485.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,905.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,289.71
|
| Rate for Payer: Ohio Health Group HMO |
$6,212.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,656.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,076.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,567.97
|
| Rate for Payer: PHCS Commercial |
$7,952.41
|
| Rate for Payer: United Healthcare All Payer |
$7,289.71
|
|
|
IMPLANT OSS RESURF FEM SLEVE R
|
Facility
|
IP
|
$8,283.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,076.89 |
| Max. Negotiated Rate |
$7,952.41 |
| Rate for Payer: Aetna Commercial |
$6,378.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,461.33
|
| Rate for Payer: Cash Price |
$4,141.88
|
| Rate for Payer: Cigna Commercial |
$6,875.52
|
| Rate for Payer: First Health Commercial |
$7,869.57
|
| Rate for Payer: Humana Commercial |
$7,041.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,792.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,113.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,485.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,289.71
|
| Rate for Payer: Ohio Health Group HMO |
$6,212.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,656.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,076.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,567.97
|
| Rate for Payer: PHCS Commercial |
$7,952.41
|
| Rate for Payer: United Healthcare All Payer |
$7,289.71
|
|
|
IMPLANT OSS SEG ELLIPT 7CM L
|
Facility
|
OP
|
$72,599.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,437.91 |
| Max. Negotiated Rate |
$69,695.37 |
| Rate for Payer: Aetna Commercial |
$55,901.49
|
| Rate for Payer: Anthem Medicaid |
$24,966.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,627.49
|
| Rate for Payer: Cash Price |
$36,299.67
|
| Rate for Payer: Cigna Commercial |
$60,257.45
|
| Rate for Payer: First Health Commercial |
$68,969.37
|
| Rate for Payer: Humana Commercial |
$61,709.44
|
| Rate for Payer: Humana KY Medicaid |
$24,966.91
|
| Rate for Payer: Kentucky WC Medicaid |
$25,221.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,531.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,578.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,779.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,467.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,887.42
|
| Rate for Payer: Ohio Health Group HMO |
$54,449.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,519.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,437.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,505.80
|
| Rate for Payer: PHCS Commercial |
$69,695.37
|
| Rate for Payer: United Healthcare All Payer |
$63,887.42
|
|
|
IMPLANT OSS SEG ELLIPT 7CM L
|
Facility
|
IP
|
$72,599.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,437.91 |
| Max. Negotiated Rate |
$69,695.37 |
| Rate for Payer: Aetna Commercial |
$55,901.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,627.49
|
| Rate for Payer: Cash Price |
$36,299.67
|
| Rate for Payer: Cigna Commercial |
$60,257.45
|
| Rate for Payer: First Health Commercial |
$68,969.37
|
| Rate for Payer: Humana Commercial |
$61,709.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,531.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,578.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,779.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,887.42
|
| Rate for Payer: Ohio Health Group HMO |
$54,449.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,519.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,437.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,505.80
|
| Rate for Payer: PHCS Commercial |
$69,695.37
|
| Rate for Payer: United Healthcare All Payer |
$63,887.42
|
|
|
IMPLANT OSS SEG ELLIPT 7CM R
|
Facility
|
OP
|
$72,599.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,437.91 |
| Max. Negotiated Rate |
$69,695.37 |
| Rate for Payer: Aetna Commercial |
$55,901.49
|
| Rate for Payer: Anthem Medicaid |
$24,966.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,627.49
|
| Rate for Payer: Cash Price |
$36,299.67
|
| Rate for Payer: Cigna Commercial |
$60,257.45
|
| Rate for Payer: First Health Commercial |
$68,969.37
|
| Rate for Payer: Humana Commercial |
$61,709.44
|
| Rate for Payer: Humana KY Medicaid |
$24,966.91
|
| Rate for Payer: Kentucky WC Medicaid |
$25,221.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,531.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,578.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,779.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,467.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,887.42
|
| Rate for Payer: Ohio Health Group HMO |
$54,449.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,519.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,437.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,505.80
|
| Rate for Payer: PHCS Commercial |
$69,695.37
|
| Rate for Payer: United Healthcare All Payer |
$63,887.42
|
|
|
IMPLANT OSS SEG ELLIPT 7CM R
|
Facility
|
IP
|
$72,599.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,437.91 |
| Max. Negotiated Rate |
$69,695.37 |
| Rate for Payer: Aetna Commercial |
$55,901.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,627.49
|
| Rate for Payer: Cash Price |
$36,299.67
|
| Rate for Payer: Cigna Commercial |
$60,257.45
|
| Rate for Payer: First Health Commercial |
$68,969.37
|
| Rate for Payer: Humana Commercial |
$61,709.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,531.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,578.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,779.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,887.42
|
| Rate for Payer: Ohio Health Group HMO |
$54,449.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,519.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,437.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,505.80
|
| Rate for Payer: PHCS Commercial |
$69,695.37
|
| Rate for Payer: United Healthcare All Payer |
$63,887.42
|
|
|
IMPLANT OSS SEG FEM 7CM L
|
Facility
|
IP
|
$73,723.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,584.10 |
| Max. Negotiated Rate |
$70,774.89 |
| Rate for Payer: Aetna Commercial |
$56,767.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,504.60
|
| Rate for Payer: Cash Price |
$36,861.92
|
| Rate for Payer: Cigna Commercial |
$61,190.79
|
| Rate for Payer: First Health Commercial |
$70,037.65
|
| Rate for Payer: Humana Commercial |
$62,665.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,453.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,408.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,117.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,876.98
|
| Rate for Payer: Ohio Health Group HMO |
$55,292.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,744.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,584.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,854.39
|
| Rate for Payer: PHCS Commercial |
$70,774.89
|
| Rate for Payer: United Healthcare All Payer |
$64,876.98
|
|
|
IMPLANT OSS SEG FEM 7CM L
|
Facility
|
OP
|
$73,723.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,584.10 |
| Max. Negotiated Rate |
$70,774.89 |
| Rate for Payer: Aetna Commercial |
$56,767.36
|
| Rate for Payer: Anthem Medicaid |
$25,353.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,504.60
|
| Rate for Payer: Cash Price |
$36,861.92
|
| Rate for Payer: Cigna Commercial |
$61,190.79
|
| Rate for Payer: First Health Commercial |
$70,037.65
|
| Rate for Payer: Humana Commercial |
$62,665.26
|
| Rate for Payer: Humana KY Medicaid |
$25,353.63
|
| Rate for Payer: Kentucky WC Medicaid |
$25,611.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,453.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,408.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,117.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,862.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,876.98
|
| Rate for Payer: Ohio Health Group HMO |
$55,292.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,744.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,584.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,854.39
|
| Rate for Payer: PHCS Commercial |
$70,774.89
|
| Rate for Payer: United Healthcare All Payer |
$64,876.98
|
|
|
IMPLANT OSS SEG FEM 7CM R
|
Facility
|
OP
|
$70,183.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,123.85 |
| Max. Negotiated Rate |
$67,376.12 |
| Rate for Payer: Aetna Commercial |
$54,041.26
|
| Rate for Payer: Anthem Medicaid |
$24,136.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54,743.10
|
| Rate for Payer: Cash Price |
$35,091.73
|
| Rate for Payer: Cigna Commercial |
$58,252.27
|
| Rate for Payer: First Health Commercial |
$66,674.29
|
| Rate for Payer: Humana Commercial |
$59,655.94
|
| Rate for Payer: Humana KY Medicaid |
$24,136.09
|
| Rate for Payer: Kentucky WC Medicaid |
$24,381.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,550.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51,795.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,055.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,620.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$61,761.44
|
| Rate for Payer: Ohio Health Group HMO |
$52,637.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,036.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,123.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,756.87
|
| Rate for Payer: PHCS Commercial |
$67,376.12
|
| Rate for Payer: United Healthcare All Payer |
$61,761.44
|
|
|
IMPLANT OSS SEG FEM 7CM R
|
Facility
|
IP
|
$70,183.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,123.85 |
| Max. Negotiated Rate |
$67,376.12 |
| Rate for Payer: Aetna Commercial |
$54,041.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54,743.10
|
| Rate for Payer: Cash Price |
$35,091.73
|
| Rate for Payer: Cigna Commercial |
$58,252.27
|
| Rate for Payer: First Health Commercial |
$66,674.29
|
| Rate for Payer: Humana Commercial |
$59,655.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,550.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51,795.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,055.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$61,761.44
|
| Rate for Payer: Ohio Health Group HMO |
$52,637.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,036.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,123.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,756.87
|
| Rate for Payer: PHCS Commercial |
$67,376.12
|
| Rate for Payer: United Healthcare All Payer |
$61,761.44
|
|
|
IMPLANT RESTORE
|
Facility
|
OP
|
$11,585.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,506.12 |
| Max. Negotiated Rate |
$11,122.08 |
| Rate for Payer: Aetna Commercial |
$8,920.84
|
| Rate for Payer: Anthem Medicaid |
$3,984.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,036.69
|
| Rate for Payer: Cash Price |
$5,792.75
|
| Rate for Payer: Cigna Commercial |
$9,615.96
|
| Rate for Payer: First Health Commercial |
$11,006.22
|
| Rate for Payer: Humana Commercial |
$9,847.68
|
| Rate for Payer: Humana KY Medicaid |
$3,984.25
|
| Rate for Payer: Kentucky WC Medicaid |
$4,024.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,500.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,550.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,475.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,064.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,195.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,689.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,317.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,506.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,591.50
|
| Rate for Payer: PHCS Commercial |
$11,122.08
|
| Rate for Payer: United Healthcare All Payer |
$10,195.24
|
|
|
IMPLANT RESTORE
|
Facility
|
IP
|
$11,585.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,506.12 |
| Max. Negotiated Rate |
$11,122.08 |
| Rate for Payer: Aetna Commercial |
$8,920.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,036.69
|
| Rate for Payer: Cash Price |
$5,792.75
|
| Rate for Payer: Cigna Commercial |
$9,615.96
|
| Rate for Payer: First Health Commercial |
$11,006.22
|
| Rate for Payer: Humana Commercial |
$9,847.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,500.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,550.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,475.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,195.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,689.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,317.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,506.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,591.50
|
| Rate for Payer: PHCS Commercial |
$11,122.08
|
| Rate for Payer: United Healthcare All Payer |
$10,195.24
|
|
|
IMPLANT SYSTEM CPR MINI SCORP
|
Facility
|
OP
|
$6,796.75
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$883.58 |
| Max. Negotiated Rate |
$6,524.88 |
| Rate for Payer: Aetna Commercial |
$5,233.50
|
| Rate for Payer: Anthem Medicaid |
$2,337.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,301.46
|
| Rate for Payer: Cash Price |
$3,398.38
|
| Rate for Payer: Cigna Commercial |
$5,641.30
|
| Rate for Payer: First Health Commercial |
$6,456.91
|
| Rate for Payer: Humana Commercial |
$5,777.24
|
| Rate for Payer: Humana KY Medicaid |
$2,337.40
|
| Rate for Payer: Kentucky WC Medicaid |
$2,361.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,573.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,016.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,039.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,384.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,981.14
|
| Rate for Payer: Ohio Health Group HMO |
$5,097.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,359.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$883.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,106.99
|
| Rate for Payer: PHCS Commercial |
$6,524.88
|
| Rate for Payer: United Healthcare All Payer |
$5,981.14
|
|
|
IMPLANT SYSTEM CPR MINI SCORP
|
Facility
|
IP
|
$6,796.75
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$883.58 |
| Max. Negotiated Rate |
$6,524.88 |
| Rate for Payer: Aetna Commercial |
$5,233.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,301.46
|
| Rate for Payer: Cash Price |
$3,398.38
|
| Rate for Payer: Cigna Commercial |
$5,641.30
|
| Rate for Payer: First Health Commercial |
$6,456.91
|
| Rate for Payer: Humana Commercial |
$5,777.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,573.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,016.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,039.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,981.14
|
| Rate for Payer: Ohio Health Group HMO |
$5,097.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,359.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$883.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,106.99
|
| Rate for Payer: PHCS Commercial |
$6,524.88
|
| Rate for Payer: United Healthcare All Payer |
$5,981.14
|
|
|
IMPLANT SYSTEM CPR VIPER
|
Facility
|
IP
|
$6,796.75
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$883.58 |
| Max. Negotiated Rate |
$6,524.88 |
| Rate for Payer: Aetna Commercial |
$5,233.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,301.46
|
| Rate for Payer: Cash Price |
$3,398.38
|
| Rate for Payer: Cigna Commercial |
$5,641.30
|
| Rate for Payer: First Health Commercial |
$6,456.91
|
| Rate for Payer: Humana Commercial |
$5,777.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,573.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,016.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,039.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,981.14
|
| Rate for Payer: Ohio Health Group HMO |
$5,097.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,359.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$883.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,106.99
|
| Rate for Payer: PHCS Commercial |
$6,524.88
|
| Rate for Payer: United Healthcare All Payer |
$5,981.14
|
|
|
IMPLANT SYSTEM CPR VIPER
|
Facility
|
OP
|
$6,796.75
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$883.58 |
| Max. Negotiated Rate |
$6,524.88 |
| Rate for Payer: Aetna Commercial |
$5,233.50
|
| Rate for Payer: Anthem Medicaid |
$2,337.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,301.46
|
| Rate for Payer: Cash Price |
$3,398.38
|
| Rate for Payer: Cigna Commercial |
$5,641.30
|
| Rate for Payer: First Health Commercial |
$6,456.91
|
| Rate for Payer: Humana Commercial |
$5,777.24
|
| Rate for Payer: Humana KY Medicaid |
$2,337.40
|
| Rate for Payer: Kentucky WC Medicaid |
$2,361.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,573.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,016.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,039.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,384.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,981.14
|
| Rate for Payer: Ohio Health Group HMO |
$5,097.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,359.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$883.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,106.99
|
| Rate for Payer: PHCS Commercial |
$6,524.88
|
| Rate for Payer: United Healthcare All Payer |
$5,981.14
|
|
|
IMPLANT VENTRICULAR DEVICE
|
Professional
|
Both
|
$3,384.00
|
|
|
Service Code
|
HCPCS 33975
|
| Hospital Charge Code |
76101329
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,020.70 |
| Max. Negotiated Rate |
$3,384.00 |
| Rate for Payer: Aetna Commercial |
$1,939.00
|
| Rate for Payer: Anthem Medicaid |
$1,020.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,384.00
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cigna Commercial |
$1,781.24
|
| Rate for Payer: Healthspan PPO |
$1,906.41
|
| Rate for Payer: Humana Medicaid |
$1,020.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,558.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,041.11
|
| Rate for Payer: Molina Healthcare Passport |
$1,020.70
|
| Rate for Payer: Multiplan PHCS |
$2,030.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,368.80
|
| Rate for Payer: UHCCP Medicaid |
$1,184.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,030.91
|
|
