|
HED BIOLOX DLTA OPT 36MM+3.5MM
|
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 OPT 36MM+3.5MM
|
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 DLTAOPT 40MM -3.0MM
|
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 DLTAOPT 40MM -3.0MM
|
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 DLTA OPT 40MM+3.5MM
|
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 DLTA OPT 40MM+3.5MM
|
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 COCR DIA MOD 22.2MM-3MM NK
|
Facility
|
IP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$3,272.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,315.00
|
| Rate for Payer: Cash Price |
$2,125.00
|
| Rate for Payer: Cigna Commercial |
$3,527.50
|
| Rate for Payer: First Health Commercial |
$4,037.50
|
| Rate for Payer: Humana Commercial |
$3,612.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,136.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,740.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,932.50
|
| Rate for Payer: PHCS Commercial |
$4,080.00
|
| Rate for Payer: United Healthcare All Payer |
$3,740.00
|
|
|
HED COCR DIA MOD 22.2MM-3MM NK
|
Facility
|
OP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$3,272.50
|
| Rate for Payer: Anthem Medicaid |
$1,461.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,315.00
|
| Rate for Payer: Cash Price |
$2,125.00
|
| Rate for Payer: Cigna Commercial |
$3,527.50
|
| Rate for Payer: First Health Commercial |
$4,037.50
|
| Rate for Payer: Humana Commercial |
$3,612.50
|
| Rate for Payer: Humana KY Medicaid |
$1,461.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,476.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,136.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,490.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,740.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,932.50
|
| Rate for Payer: PHCS Commercial |
$4,080.00
|
| Rate for Payer: United Healthcare All Payer |
$3,740.00
|
|
|
HED COCR DIA MOD 22.2MM-5MM NK
|
Facility
|
OP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$3,272.50
|
| Rate for Payer: Anthem Medicaid |
$1,461.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,315.00
|
| Rate for Payer: Cash Price |
$2,125.00
|
| Rate for Payer: Cigna Commercial |
$3,527.50
|
| Rate for Payer: First Health Commercial |
$4,037.50
|
| Rate for Payer: Humana Commercial |
$3,612.50
|
| Rate for Payer: Humana KY Medicaid |
$1,461.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,476.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,136.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,490.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,740.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,932.50
|
| Rate for Payer: PHCS Commercial |
$4,080.00
|
| Rate for Payer: United Healthcare All Payer |
$3,740.00
|
|
|
HED COCR DIA MOD 22.2MM-5MM NK
|
Facility
|
IP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$3,272.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,315.00
|
| Rate for Payer: Cash Price |
$2,125.00
|
| Rate for Payer: Cigna Commercial |
$3,527.50
|
| Rate for Payer: First Health Commercial |
$4,037.50
|
| Rate for Payer: Humana Commercial |
$3,612.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,136.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,740.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,932.50
|
| Rate for Payer: PHCS Commercial |
$4,080.00
|
| Rate for Payer: United Healthcare All Payer |
$3,740.00
|
|
|
HED COCR DIA MOD 22.2MM STD NK
|
Facility
|
IP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$3,272.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,315.00
|
| Rate for Payer: Cash Price |
$2,125.00
|
| Rate for Payer: Cigna Commercial |
$3,527.50
|
| Rate for Payer: First Health Commercial |
$4,037.50
|
| Rate for Payer: Humana Commercial |
$3,612.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,136.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,740.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,932.50
|
| Rate for Payer: PHCS Commercial |
$4,080.00
|
| Rate for Payer: United Healthcare All Payer |
$3,740.00
|
|
|
HED COCR DIA MOD 22.2MM STD NK
|
Facility
|
OP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$3,272.50
|
| Rate for Payer: Anthem Medicaid |
$1,461.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,315.00
|
| Rate for Payer: Cash Price |
$2,125.00
|
| Rate for Payer: Cigna Commercial |
$3,527.50
|
| Rate for Payer: First Health Commercial |
$4,037.50
|
| Rate for Payer: Humana Commercial |
$3,612.50
|
| Rate for Payer: Humana KY Medicaid |
$1,461.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,476.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,136.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,490.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,740.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,932.50
|
| Rate for Payer: PHCS Commercial |
$4,080.00
|
| Rate for Payer: United Healthcare All Payer |
$3,740.00
|
|
|
HED COCR DIA MOD 26MM +12MM NK
|
Facility
|
OP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$3,272.50
|
| Rate for Payer: Anthem Medicaid |
$1,461.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,315.00
|
| Rate for Payer: Cash Price |
$2,125.00
|
| Rate for Payer: Cigna Commercial |
$3,527.50
|
| Rate for Payer: First Health Commercial |
$4,037.50
|
| Rate for Payer: Humana Commercial |
$3,612.50
|
| Rate for Payer: Humana KY Medicaid |
$1,461.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,476.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,136.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,490.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,740.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,932.50
|
| Rate for Payer: PHCS Commercial |
$4,080.00
|
| Rate for Payer: United Healthcare All Payer |
$3,740.00
|
|
|
HED COCR DIA MOD 26MM +12MM NK
|
Facility
|
IP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$3,272.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,315.00
|
| Rate for Payer: Cash Price |
$2,125.00
|
| Rate for Payer: Cigna Commercial |
$3,527.50
|
| Rate for Payer: First Health Commercial |
$4,037.50
|
| Rate for Payer: Humana Commercial |
$3,612.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,136.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,740.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,932.50
|
| Rate for Payer: PHCS Commercial |
$4,080.00
|
| Rate for Payer: United Healthcare All Payer |
$3,740.00
|
|
|
HED COCR FEM 44MM TYPE 1 +12MM
|
Facility
|
IP
|
$4,925.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.50 |
| Max. Negotiated Rate |
$4,728.00 |
| Rate for Payer: Aetna Commercial |
$3,792.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,841.50
|
| Rate for Payer: Cash Price |
$2,462.50
|
| Rate for Payer: Cigna Commercial |
$4,087.75
|
| Rate for Payer: First Health Commercial |
$4,678.75
|
| Rate for Payer: Humana Commercial |
$4,186.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,038.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,634.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,477.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,334.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,693.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,284.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,398.25
|
| Rate for Payer: PHCS Commercial |
$4,728.00
|
| Rate for Payer: United Healthcare All Payer |
$4,334.00
|
|
|
HED COCR FEM 44MM TYPE 1 +12MM
|
Facility
|
OP
|
$4,925.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.50 |
| Max. Negotiated Rate |
$4,728.00 |
| Rate for Payer: Aetna Commercial |
$3,792.25
|
| Rate for Payer: Anthem Medicaid |
$1,693.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,841.50
|
| Rate for Payer: Cash Price |
$2,462.50
|
| Rate for Payer: Cigna Commercial |
$4,087.75
|
| Rate for Payer: First Health Commercial |
$4,678.75
|
| Rate for Payer: Humana Commercial |
$4,186.25
|
| Rate for Payer: Humana KY Medicaid |
$1,693.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,710.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,038.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,634.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,477.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,727.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,334.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,693.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,284.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,398.25
|
| Rate for Payer: PHCS Commercial |
$4,728.00
|
| Rate for Payer: United Healthcare All Payer |
$4,334.00
|
|
|
HED COCR MOD 26MM +6MM NO SKRT
|
Facility
|
OP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$3,272.50
|
| Rate for Payer: Anthem Medicaid |
$1,461.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,315.00
|
| Rate for Payer: Cash Price |
$2,125.00
|
| Rate for Payer: Cigna Commercial |
$3,527.50
|
| Rate for Payer: First Health Commercial |
$4,037.50
|
| Rate for Payer: Humana Commercial |
$3,612.50
|
| Rate for Payer: Humana KY Medicaid |
$1,461.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,476.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,136.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,490.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,740.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,932.50
|
| Rate for Payer: PHCS Commercial |
$4,080.00
|
| Rate for Payer: United Healthcare All Payer |
$3,740.00
|
|
|
HED COCR MOD 26MM +6MM NO SKRT
|
Facility
|
IP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$3,272.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,315.00
|
| Rate for Payer: Cash Price |
$2,125.00
|
| Rate for Payer: Cigna Commercial |
$3,527.50
|
| Rate for Payer: First Health Commercial |
$4,037.50
|
| Rate for Payer: Humana Commercial |
$3,612.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,136.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,740.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,932.50
|
| Rate for Payer: PHCS Commercial |
$4,080.00
|
| Rate for Payer: United Healthcare All Payer |
$3,740.00
|
|
|
HED COCR MOD 28MM +6MM NO SKRT
|
Facility
|
IP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$3,272.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,315.00
|
| Rate for Payer: Cash Price |
$2,125.00
|
| Rate for Payer: Cigna Commercial |
$3,527.50
|
| Rate for Payer: First Health Commercial |
$4,037.50
|
| Rate for Payer: Humana Commercial |
$3,612.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,136.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,740.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,932.50
|
| Rate for Payer: PHCS Commercial |
$4,080.00
|
| Rate for Payer: United Healthcare All Payer |
$3,740.00
|
|
|
HED COCR MOD 28MM +6MM NO SKRT
|
Facility
|
OP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$3,272.50
|
| Rate for Payer: Anthem Medicaid |
$1,461.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,315.00
|
| Rate for Payer: Cash Price |
$2,125.00
|
| Rate for Payer: Cigna Commercial |
$3,527.50
|
| Rate for Payer: First Health Commercial |
$4,037.50
|
| Rate for Payer: Humana Commercial |
$3,612.50
|
| Rate for Payer: Humana KY Medicaid |
$1,461.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,476.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,136.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,490.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,740.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,932.50
|
| Rate for Payer: PHCS Commercial |
$4,080.00
|
| Rate for Payer: United Healthcare All Payer |
$3,740.00
|
|
|
HED COCR MOD 32MM +6MM N0 SKRT
|
Facility
|
OP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$3,272.50
|
| Rate for Payer: Anthem Medicaid |
$1,461.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,315.00
|
| Rate for Payer: Cash Price |
$2,125.00
|
| Rate for Payer: Cigna Commercial |
$3,527.50
|
| Rate for Payer: First Health Commercial |
$4,037.50
|
| Rate for Payer: Humana Commercial |
$3,612.50
|
| Rate for Payer: Humana KY Medicaid |
$1,461.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,476.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,136.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,490.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,740.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,932.50
|
| Rate for Payer: PHCS Commercial |
$4,080.00
|
| Rate for Payer: United Healthcare All Payer |
$3,740.00
|
|
|
HED COCR MOD 32MM +6MM N0 SKRT
|
Facility
|
IP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$3,272.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,315.00
|
| Rate for Payer: Cash Price |
$2,125.00
|
| Rate for Payer: Cigna Commercial |
$3,527.50
|
| Rate for Payer: First Health Commercial |
$4,037.50
|
| Rate for Payer: Humana Commercial |
$3,612.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,136.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,740.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,932.50
|
| Rate for Payer: PHCS Commercial |
$4,080.00
|
| Rate for Payer: United Healthcare All Payer |
$3,740.00
|
|
|
HED FRACTURE MOD CATHCART 45MM
|
Facility
|
OP
|
$5,480.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,644.00 |
| Max. Negotiated Rate |
$5,260.80 |
| Rate for Payer: Aetna Commercial |
$4,219.60
|
| Rate for Payer: Anthem Medicaid |
$1,884.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,274.40
|
| Rate for Payer: Cash Price |
$2,740.00
|
| Rate for Payer: Cigna Commercial |
$4,548.40
|
| Rate for Payer: First Health Commercial |
$5,206.00
|
| Rate for Payer: Humana Commercial |
$4,658.00
|
| Rate for Payer: Humana KY Medicaid |
$1,884.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,903.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,493.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,044.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,644.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,922.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,822.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,110.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,384.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,767.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,781.20
|
| Rate for Payer: PHCS Commercial |
$5,260.80
|
| Rate for Payer: United Healthcare All Payer |
$4,822.40
|
|
|
HED FRACTURE MOD CATHCART 45MM
|
Facility
|
IP
|
$5,480.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,644.00 |
| Max. Negotiated Rate |
$5,260.80 |
| Rate for Payer: Aetna Commercial |
$4,219.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,274.40
|
| Rate for Payer: Cash Price |
$2,740.00
|
| Rate for Payer: Cigna Commercial |
$4,548.40
|
| Rate for Payer: First Health Commercial |
$5,206.00
|
| Rate for Payer: Humana Commercial |
$4,658.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,493.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,044.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,644.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,822.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,110.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,384.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,767.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,781.20
|
| Rate for Payer: PHCS Commercial |
$5,260.80
|
| Rate for Payer: United Healthcare All Payer |
$4,822.40
|
|
|
HED FRACTURE MOD CATHCART 46MM
|
Facility
|
IP
|
$5,480.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,644.00 |
| Max. Negotiated Rate |
$5,260.80 |
| Rate for Payer: Aetna Commercial |
$4,219.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,274.40
|
| Rate for Payer: Cash Price |
$2,740.00
|
| Rate for Payer: Cigna Commercial |
$4,548.40
|
| Rate for Payer: First Health Commercial |
$5,206.00
|
| Rate for Payer: Humana Commercial |
$4,658.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,493.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,044.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,644.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,822.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,110.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,384.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,767.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,781.20
|
| Rate for Payer: PHCS Commercial |
$5,260.80
|
| Rate for Payer: United Healthcare All Payer |
$4,822.40
|
|
