|
HED BIOLOX DELTA CER 36MM +0MM
|
Facility
|
IP
|
$8,201.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,460.38 |
| Max. Negotiated Rate |
$7,873.20 |
| Rate for Payer: Aetna Commercial |
$6,314.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,396.98
|
| Rate for Payer: Cash Price |
$4,100.62
|
| Rate for Payer: Cigna Commercial |
$6,807.04
|
| Rate for Payer: First Health Commercial |
$7,791.19
|
| Rate for Payer: Humana Commercial |
$6,971.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,725.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,052.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,460.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,217.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,561.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,135.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,658.86
|
| Rate for Payer: PHCS Commercial |
$7,873.20
|
| Rate for Payer: United Healthcare All Payer |
$7,217.10
|
|
|
HED BIOLOX DELTA CER 36MM +0MM
|
Facility
|
OP
|
$8,201.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,460.38 |
| Max. Negotiated Rate |
$7,873.20 |
| Rate for Payer: Aetna Commercial |
$6,314.96
|
| Rate for Payer: Anthem Medicaid |
$2,820.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,396.98
|
| Rate for Payer: Cash Price |
$4,100.62
|
| Rate for Payer: Cigna Commercial |
$6,807.04
|
| Rate for Payer: First Health Commercial |
$7,791.19
|
| Rate for Payer: Humana Commercial |
$6,971.06
|
| Rate for Payer: Humana KY Medicaid |
$2,820.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,849.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,725.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,052.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,460.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,877.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,217.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,561.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,135.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,658.86
|
| Rate for Payer: PHCS Commercial |
$7,873.20
|
| Rate for Payer: United Healthcare All Payer |
$7,217.10
|
|
|
HED BIOLOX DELTA CER 36MM +7MM
|
Facility
|
IP
|
$8,201.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,460.38 |
| Max. Negotiated Rate |
$7,873.20 |
| Rate for Payer: Aetna Commercial |
$6,314.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,396.98
|
| Rate for Payer: Cash Price |
$4,100.62
|
| Rate for Payer: Cigna Commercial |
$6,807.04
|
| Rate for Payer: First Health Commercial |
$7,791.19
|
| Rate for Payer: Humana Commercial |
$6,971.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,725.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,052.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,460.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,217.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,561.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,135.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,658.86
|
| Rate for Payer: PHCS Commercial |
$7,873.20
|
| Rate for Payer: United Healthcare All Payer |
$7,217.10
|
|
|
HED BIOLOX DELTA CER 36MM +7MM
|
Facility
|
OP
|
$8,201.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,460.38 |
| Max. Negotiated Rate |
$7,873.20 |
| Rate for Payer: Aetna Commercial |
$6,314.96
|
| Rate for Payer: Anthem Medicaid |
$2,820.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,396.98
|
| Rate for Payer: Cash Price |
$4,100.62
|
| Rate for Payer: Cigna Commercial |
$6,807.04
|
| Rate for Payer: First Health Commercial |
$7,791.19
|
| Rate for Payer: Humana Commercial |
$6,971.06
|
| Rate for Payer: Humana KY Medicaid |
$2,820.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,849.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,725.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,052.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,460.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,877.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,217.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,561.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,135.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,658.86
|
| Rate for Payer: PHCS Commercial |
$7,873.20
|
| Rate for Payer: United Healthcare All Payer |
$7,217.10
|
|
|
HED BIOLOX DELTA CER 40MM +0MM
|
Facility
|
IP
|
$8,201.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,460.38 |
| Max. Negotiated Rate |
$7,873.20 |
| Rate for Payer: Aetna Commercial |
$6,314.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,396.98
|
| Rate for Payer: Cash Price |
$4,100.62
|
| Rate for Payer: Cigna Commercial |
$6,807.04
|
| Rate for Payer: First Health Commercial |
$7,791.19
|
| Rate for Payer: Humana Commercial |
$6,971.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,725.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,052.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,460.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,217.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,561.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,135.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,658.86
|
| Rate for Payer: PHCS Commercial |
$7,873.20
|
| Rate for Payer: United Healthcare All Payer |
$7,217.10
|
|
|
HED BIOLOX DELTA CER 40MM +0MM
|
Facility
|
OP
|
$8,201.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,460.38 |
| Max. Negotiated Rate |
$7,873.20 |
| Rate for Payer: Aetna Commercial |
$6,314.96
|
| Rate for Payer: Anthem Medicaid |
$2,820.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,396.98
|
| Rate for Payer: Cash Price |
$4,100.62
|
| Rate for Payer: Cigna Commercial |
$6,807.04
|
| Rate for Payer: First Health Commercial |
$7,791.19
|
| Rate for Payer: Humana Commercial |
$6,971.06
|
| Rate for Payer: Humana KY Medicaid |
$2,820.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,849.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,725.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,052.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,460.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,877.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,217.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,561.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,135.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,658.86
|
| Rate for Payer: PHCS Commercial |
$7,873.20
|
| Rate for Payer: United Healthcare All Payer |
$7,217.10
|
|
|
HED BIOLOX DELTA CER 40MM +7MM
|
Facility
|
IP
|
$8,201.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,460.38 |
| Max. Negotiated Rate |
$7,873.20 |
| Rate for Payer: Aetna Commercial |
$6,314.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,396.98
|
| Rate for Payer: Cash Price |
$4,100.62
|
| Rate for Payer: Cigna Commercial |
$6,807.04
|
| Rate for Payer: First Health Commercial |
$7,791.19
|
| Rate for Payer: Humana Commercial |
$6,971.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,725.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,052.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,460.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,217.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,561.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,135.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,658.86
|
| Rate for Payer: PHCS Commercial |
$7,873.20
|
| Rate for Payer: United Healthcare All Payer |
$7,217.10
|
|
|
HED BIOLOX DELTA CER 40MM +7MM
|
Facility
|
OP
|
$8,201.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,460.38 |
| Max. Negotiated Rate |
$7,873.20 |
| Rate for Payer: Aetna Commercial |
$6,314.96
|
| Rate for Payer: Anthem Medicaid |
$2,820.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,396.98
|
| Rate for Payer: Cash Price |
$4,100.62
|
| Rate for Payer: Cigna Commercial |
$6,807.04
|
| Rate for Payer: First Health Commercial |
$7,791.19
|
| Rate for Payer: Humana Commercial |
$6,971.06
|
| Rate for Payer: Humana KY Medicaid |
$2,820.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,849.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,725.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,052.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,460.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,877.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,217.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,561.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,135.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,658.86
|
| Rate for Payer: PHCS Commercial |
$7,873.20
|
| Rate for Payer: United Healthcare All Payer |
$7,217.10
|
|
|
HED BIOLOX DELTA OPT 28MM +0MM
|
Facility
|
OP
|
$10,919.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,275.78 |
| Max. Negotiated Rate |
$10,482.50 |
| Rate for Payer: Aetna Commercial |
$8,407.84
|
| Rate for Payer: Anthem Medicaid |
$3,755.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,517.03
|
| Rate for Payer: Cash Price |
$5,459.64
|
| Rate for Payer: Cigna Commercial |
$9,062.99
|
| Rate for Payer: First Health Commercial |
$10,373.31
|
| Rate for Payer: Humana Commercial |
$9,281.38
|
| Rate for Payer: Humana KY Medicaid |
$3,755.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,793.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,953.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,058.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,275.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,830.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,608.96
|
| Rate for Payer: Ohio Health Group HMO |
$8,189.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,735.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,499.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,534.30
|
| Rate for Payer: PHCS Commercial |
$10,482.50
|
| Rate for Payer: United Healthcare All Payer |
$9,608.96
|
|
|
HED BIOLOX DELTA OPT 28MM +0MM
|
Facility
|
IP
|
$10,919.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,275.78 |
| Max. Negotiated Rate |
$10,482.50 |
| Rate for Payer: Aetna Commercial |
$8,407.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,517.03
|
| Rate for Payer: Cash Price |
$5,459.64
|
| Rate for Payer: Cigna Commercial |
$9,062.99
|
| Rate for Payer: First Health Commercial |
$10,373.31
|
| Rate for Payer: Humana Commercial |
$9,281.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,953.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,058.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,275.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,608.96
|
| Rate for Payer: Ohio Health Group HMO |
$8,189.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,735.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,499.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,534.30
|
| Rate for Payer: PHCS Commercial |
$10,482.50
|
| Rate for Payer: United Healthcare All Payer |
$9,608.96
|
|
|
HED BIOLOX DELTA OPT 28MM +7MM
|
Facility
|
IP
|
$10,919.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,275.78 |
| Max. Negotiated Rate |
$10,482.50 |
| Rate for Payer: Aetna Commercial |
$8,407.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,517.03
|
| Rate for Payer: Cash Price |
$5,459.64
|
| Rate for Payer: Cigna Commercial |
$9,062.99
|
| Rate for Payer: First Health Commercial |
$10,373.31
|
| Rate for Payer: Humana Commercial |
$9,281.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,953.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,058.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,275.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,608.96
|
| Rate for Payer: Ohio Health Group HMO |
$8,189.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,735.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,499.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,534.30
|
| Rate for Payer: PHCS Commercial |
$10,482.50
|
| Rate for Payer: United Healthcare All Payer |
$9,608.96
|
|
|
HED BIOLOX DELTA OPT 28MM +7MM
|
Facility
|
OP
|
$10,919.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,275.78 |
| Max. Negotiated Rate |
$10,482.50 |
| Rate for Payer: Aetna Commercial |
$8,407.84
|
| Rate for Payer: Anthem Medicaid |
$3,755.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,517.03
|
| Rate for Payer: Cash Price |
$5,459.64
|
| Rate for Payer: Cigna Commercial |
$9,062.99
|
| Rate for Payer: First Health Commercial |
$10,373.31
|
| Rate for Payer: Humana Commercial |
$9,281.38
|
| Rate for Payer: Humana KY Medicaid |
$3,755.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,793.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,953.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,058.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,275.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,830.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,608.96
|
| Rate for Payer: Ohio Health Group HMO |
$8,189.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,735.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,499.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,534.30
|
| Rate for Payer: PHCS Commercial |
$10,482.50
|
| Rate for Payer: United Healthcare All Payer |
$9,608.96
|
|
|
HED BIOLOX DELTA OPT 32MM +0MM
|
Facility
|
OP
|
$10,919.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,275.78 |
| Max. Negotiated Rate |
$10,482.50 |
| Rate for Payer: Aetna Commercial |
$8,407.84
|
| Rate for Payer: Anthem Medicaid |
$3,755.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,517.03
|
| Rate for Payer: Cash Price |
$5,459.64
|
| Rate for Payer: Cigna Commercial |
$9,062.99
|
| Rate for Payer: First Health Commercial |
$10,373.31
|
| Rate for Payer: Humana Commercial |
$9,281.38
|
| Rate for Payer: Humana KY Medicaid |
$3,755.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,793.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,953.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,058.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,275.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,830.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,608.96
|
| Rate for Payer: Ohio Health Group HMO |
$8,189.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,735.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,499.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,534.30
|
| Rate for Payer: PHCS Commercial |
$10,482.50
|
| Rate for Payer: United Healthcare All Payer |
$9,608.96
|
|
|
HED BIOLOX DELTA OPT 32MM +0MM
|
Facility
|
IP
|
$10,919.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,275.78 |
| Max. Negotiated Rate |
$10,482.50 |
| Rate for Payer: Aetna Commercial |
$8,407.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,517.03
|
| Rate for Payer: Cash Price |
$5,459.64
|
| Rate for Payer: Cigna Commercial |
$9,062.99
|
| Rate for Payer: First Health Commercial |
$10,373.31
|
| Rate for Payer: Humana Commercial |
$9,281.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,953.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,058.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,275.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,608.96
|
| Rate for Payer: Ohio Health Group HMO |
$8,189.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,735.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,499.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,534.30
|
| Rate for Payer: PHCS Commercial |
$10,482.50
|
| Rate for Payer: United Healthcare All Payer |
$9,608.96
|
|
|
HED BIOLOX DELTA OPT 32MM +7MM
|
Facility
|
OP
|
$10,919.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,275.78 |
| Max. Negotiated Rate |
$10,482.50 |
| Rate for Payer: Aetna Commercial |
$8,407.84
|
| Rate for Payer: Anthem Medicaid |
$3,755.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,517.03
|
| Rate for Payer: Cash Price |
$5,459.64
|
| Rate for Payer: Cigna Commercial |
$9,062.99
|
| Rate for Payer: First Health Commercial |
$10,373.31
|
| Rate for Payer: Humana Commercial |
$9,281.38
|
| Rate for Payer: Humana KY Medicaid |
$3,755.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,793.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,953.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,058.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,275.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,830.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,608.96
|
| Rate for Payer: Ohio Health Group HMO |
$8,189.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,735.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,499.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,534.30
|
| Rate for Payer: PHCS Commercial |
$10,482.50
|
| Rate for Payer: United Healthcare All Payer |
$9,608.96
|
|
|
HED BIOLOX DELTA OPT 32MM +7MM
|
Facility
|
IP
|
$10,919.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,275.78 |
| Max. Negotiated Rate |
$10,482.50 |
| Rate for Payer: Aetna Commercial |
$8,407.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,517.03
|
| Rate for Payer: Cash Price |
$5,459.64
|
| Rate for Payer: Cigna Commercial |
$9,062.99
|
| Rate for Payer: First Health Commercial |
$10,373.31
|
| Rate for Payer: Humana Commercial |
$9,281.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,953.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,058.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,275.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,608.96
|
| Rate for Payer: Ohio Health Group HMO |
$8,189.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,735.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,499.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,534.30
|
| Rate for Payer: PHCS Commercial |
$10,482.50
|
| Rate for Payer: United Healthcare All Payer |
$9,608.96
|
|
|
HED BIOLOX DELTA OPT 36MM +0MM
|
Facility
|
OP
|
$11,963.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,589.15 |
| Max. Negotiated Rate |
$11,485.28 |
| Rate for Payer: Aetna Commercial |
$9,212.15
|
| Rate for Payer: Anthem Medicaid |
$4,114.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,331.79
|
| Rate for Payer: Cash Price |
$5,981.91
|
| Rate for Payer: Cigna Commercial |
$9,929.98
|
| Rate for Payer: First Health Commercial |
$11,365.64
|
| Rate for Payer: Humana Commercial |
$10,169.26
|
| Rate for Payer: Humana KY Medicaid |
$4,114.36
|
| Rate for Payer: Kentucky WC Medicaid |
$4,156.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,810.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,829.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,589.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,196.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,528.17
|
| Rate for Payer: Ohio Health Group HMO |
$8,972.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,571.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,408.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,255.04
|
| Rate for Payer: PHCS Commercial |
$11,485.28
|
| Rate for Payer: United Healthcare All Payer |
$10,528.17
|
|
|
HED BIOLOX DELTA OPT 36MM +0MM
|
Facility
|
IP
|
$11,963.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,589.15 |
| Max. Negotiated Rate |
$11,485.28 |
| Rate for Payer: Aetna Commercial |
$9,212.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,331.79
|
| Rate for Payer: Cash Price |
$5,981.91
|
| Rate for Payer: Cigna Commercial |
$9,929.98
|
| Rate for Payer: First Health Commercial |
$11,365.64
|
| Rate for Payer: Humana Commercial |
$10,169.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,810.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,829.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,589.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,528.17
|
| Rate for Payer: Ohio Health Group HMO |
$8,972.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,571.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,408.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,255.04
|
| Rate for Payer: PHCS Commercial |
$11,485.28
|
| Rate for Payer: United Healthcare All Payer |
$10,528.17
|
|
|
HED BIOLOX DELTA OPT 36MM +7MM
|
Facility
|
OP
|
$11,963.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,589.15 |
| Max. Negotiated Rate |
$11,485.28 |
| Rate for Payer: Aetna Commercial |
$9,212.15
|
| Rate for Payer: Anthem Medicaid |
$4,114.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,331.79
|
| Rate for Payer: Cash Price |
$5,981.91
|
| Rate for Payer: Cigna Commercial |
$9,929.98
|
| Rate for Payer: First Health Commercial |
$11,365.64
|
| Rate for Payer: Humana Commercial |
$10,169.26
|
| Rate for Payer: Humana KY Medicaid |
$4,114.36
|
| Rate for Payer: Kentucky WC Medicaid |
$4,156.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,810.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,829.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,589.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,196.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,528.17
|
| Rate for Payer: Ohio Health Group HMO |
$8,972.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,571.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,408.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,255.04
|
| Rate for Payer: PHCS Commercial |
$11,485.28
|
| Rate for Payer: United Healthcare All Payer |
$10,528.17
|
|
|
HED BIOLOX DELTA OPT 36MM +7MM
|
Facility
|
IP
|
$11,963.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,589.15 |
| Max. Negotiated Rate |
$11,485.28 |
| Rate for Payer: Aetna Commercial |
$9,212.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,331.79
|
| Rate for Payer: Cash Price |
$5,981.91
|
| Rate for Payer: Cigna Commercial |
$9,929.98
|
| Rate for Payer: First Health Commercial |
$11,365.64
|
| Rate for Payer: Humana Commercial |
$10,169.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,810.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,829.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,589.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,528.17
|
| Rate for Payer: Ohio Health Group HMO |
$8,972.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,571.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,408.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,255.04
|
| Rate for Payer: PHCS Commercial |
$11,485.28
|
| Rate for Payer: United Healthcare All Payer |
$10,528.17
|
|
|
HED BIOLOX DELTA OPT 40MM +0MM
|
Facility
|
OP
|
$11,963.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,589.15 |
| Max. Negotiated Rate |
$11,485.28 |
| Rate for Payer: Aetna Commercial |
$9,212.15
|
| Rate for Payer: Anthem Medicaid |
$4,114.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,331.79
|
| Rate for Payer: Cash Price |
$5,981.91
|
| Rate for Payer: Cigna Commercial |
$9,929.98
|
| Rate for Payer: First Health Commercial |
$11,365.64
|
| Rate for Payer: Humana Commercial |
$10,169.26
|
| Rate for Payer: Humana KY Medicaid |
$4,114.36
|
| Rate for Payer: Kentucky WC Medicaid |
$4,156.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,810.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,829.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,589.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,196.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,528.17
|
| Rate for Payer: Ohio Health Group HMO |
$8,972.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,571.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,408.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,255.04
|
| Rate for Payer: PHCS Commercial |
$11,485.28
|
| Rate for Payer: United Healthcare All Payer |
$10,528.17
|
|
|
HED BIOLOX DELTA OPT 40MM +0MM
|
Facility
|
IP
|
$11,963.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,589.15 |
| Max. Negotiated Rate |
$11,485.28 |
| Rate for Payer: Aetna Commercial |
$9,212.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,331.79
|
| Rate for Payer: Cash Price |
$5,981.91
|
| Rate for Payer: Cigna Commercial |
$9,929.98
|
| Rate for Payer: First Health Commercial |
$11,365.64
|
| Rate for Payer: Humana Commercial |
$10,169.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,810.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,829.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,589.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,528.17
|
| Rate for Payer: Ohio Health Group HMO |
$8,972.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,571.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,408.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,255.04
|
| Rate for Payer: PHCS Commercial |
$11,485.28
|
| Rate for Payer: United Healthcare All Payer |
$10,528.17
|
|
|
HED BIOLOX DELTA OPT 40MM +7MM
|
Facility
|
IP
|
$11,963.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,589.15 |
| Max. Negotiated Rate |
$11,485.28 |
| Rate for Payer: Aetna Commercial |
$9,212.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,331.79
|
| Rate for Payer: Cash Price |
$5,981.91
|
| Rate for Payer: Cigna Commercial |
$9,929.98
|
| Rate for Payer: First Health Commercial |
$11,365.64
|
| Rate for Payer: Humana Commercial |
$10,169.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,810.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,829.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,589.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,528.17
|
| Rate for Payer: Ohio Health Group HMO |
$8,972.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,571.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,408.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,255.04
|
| Rate for Payer: PHCS Commercial |
$11,485.28
|
| Rate for Payer: United Healthcare All Payer |
$10,528.17
|
|
|
HED BIOLOX DELTA OPT 40MM +7MM
|
Facility
|
OP
|
$11,963.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,589.15 |
| Max. Negotiated Rate |
$11,485.28 |
| Rate for Payer: Aetna Commercial |
$9,212.15
|
| Rate for Payer: Anthem Medicaid |
$4,114.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,331.79
|
| Rate for Payer: Cash Price |
$5,981.91
|
| Rate for Payer: Cigna Commercial |
$9,929.98
|
| Rate for Payer: First Health Commercial |
$11,365.64
|
| Rate for Payer: Humana Commercial |
$10,169.26
|
| Rate for Payer: Humana KY Medicaid |
$4,114.36
|
| Rate for Payer: Kentucky WC Medicaid |
$4,156.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,810.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,829.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,589.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,196.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,528.17
|
| Rate for Payer: Ohio Health Group HMO |
$8,972.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,571.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,408.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,255.04
|
| Rate for Payer: PHCS Commercial |
$11,485.28
|
| Rate for Payer: United Healthcare All Payer |
$10,528.17
|
|
|
HED BIOLOX DLTA CER 28MM+3.5MM
|
Facility
|
OP
|
$7,681.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,304.34 |
| Max. Negotiated Rate |
$7,373.88 |
| Rate for Payer: Aetna Commercial |
$5,914.46
|
| Rate for Payer: Anthem Medicaid |
$2,641.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,991.27
|
| Rate for Payer: Cash Price |
$3,840.56
|
| Rate for Payer: Cigna Commercial |
$6,375.33
|
| Rate for Payer: First Health Commercial |
$7,297.06
|
| Rate for Payer: Humana Commercial |
$6,528.95
|
| Rate for Payer: Humana KY Medicaid |
$2,641.54
|
| Rate for Payer: Kentucky WC Medicaid |
$2,668.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,298.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,668.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,304.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,694.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,759.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,760.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,144.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,682.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,299.97
|
| Rate for Payer: PHCS Commercial |
$7,373.88
|
| Rate for Payer: United Healthcare All Payer |
$6,759.39
|
|
