|
IMPLANT OSS RESURF FEM SLEVE R
|
Facility
|
IP
|
$8,483.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,545.13 |
| Max. Negotiated Rate |
$8,144.41 |
| Rate for Payer: Aetna Commercial |
$6,532.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,617.33
|
| Rate for Payer: Cash Price |
$4,241.88
|
| Rate for Payer: Cigna Commercial |
$7,041.52
|
| Rate for Payer: First Health Commercial |
$8,059.57
|
| Rate for Payer: Humana Commercial |
$7,211.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,956.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,261.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,545.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,465.71
|
| Rate for Payer: Ohio Health Group HMO |
$6,362.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,787.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,380.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,853.79
|
| Rate for Payer: PHCS Commercial |
$8,144.41
|
| Rate for Payer: United Healthcare All Payer |
$7,465.71
|
|
|
IMPLANT OSS RESURF FEM SLEVE R
|
Facility
|
OP
|
$8,483.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,545.13 |
| Max. Negotiated Rate |
$8,144.41 |
| Rate for Payer: Aetna Commercial |
$6,532.50
|
| Rate for Payer: Anthem Medicaid |
$2,917.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,617.33
|
| Rate for Payer: Cash Price |
$4,241.88
|
| Rate for Payer: Cigna Commercial |
$7,041.52
|
| Rate for Payer: First Health Commercial |
$8,059.57
|
| Rate for Payer: Humana Commercial |
$7,211.20
|
| Rate for Payer: Humana KY Medicaid |
$2,917.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,947.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,956.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,261.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,545.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,976.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,465.71
|
| Rate for Payer: Ohio Health Group HMO |
$6,362.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,787.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,380.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,853.79
|
| Rate for Payer: PHCS Commercial |
$8,144.41
|
| Rate for Payer: United Healthcare All Payer |
$7,465.71
|
|
|
IMPLANT OSS SEG ELLIPT 7CM L
|
Facility
|
IP
|
$74,993.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,498.12 |
| Max. Negotiated Rate |
$71,994.00 |
| Rate for Payer: Aetna Commercial |
$57,745.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,495.12
|
| Rate for Payer: Cash Price |
$37,496.88
|
| Rate for Payer: Cigna Commercial |
$62,244.81
|
| Rate for Payer: First Health Commercial |
$71,244.06
|
| Rate for Payer: Humana Commercial |
$63,744.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,494.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,345.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,498.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,994.50
|
| Rate for Payer: Ohio Health Group HMO |
$56,245.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59,995.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,244.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,745.69
|
| Rate for Payer: PHCS Commercial |
$71,994.00
|
| Rate for Payer: United Healthcare All Payer |
$65,994.50
|
|
|
IMPLANT OSS SEG ELLIPT 7CM L
|
Facility
|
OP
|
$74,993.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,498.12 |
| Max. Negotiated Rate |
$71,994.00 |
| Rate for Payer: Aetna Commercial |
$57,745.19
|
| Rate for Payer: Anthem Medicaid |
$25,790.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,495.12
|
| Rate for Payer: Cash Price |
$37,496.88
|
| Rate for Payer: Cigna Commercial |
$62,244.81
|
| Rate for Payer: First Health Commercial |
$71,244.06
|
| Rate for Payer: Humana Commercial |
$63,744.69
|
| Rate for Payer: Humana KY Medicaid |
$25,790.35
|
| Rate for Payer: Kentucky WC Medicaid |
$26,052.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,494.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,345.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,498.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,307.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,994.50
|
| Rate for Payer: Ohio Health Group HMO |
$56,245.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59,995.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,244.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,745.69
|
| Rate for Payer: PHCS Commercial |
$71,994.00
|
| Rate for Payer: United Healthcare All Payer |
$65,994.50
|
|
|
IMPLANT OSS SEG ELLIPT 7CM R
|
Facility
|
IP
|
$74,993.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,498.12 |
| Max. Negotiated Rate |
$71,994.00 |
| Rate for Payer: Aetna Commercial |
$57,745.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,495.12
|
| Rate for Payer: Cash Price |
$37,496.88
|
| Rate for Payer: Cigna Commercial |
$62,244.81
|
| Rate for Payer: First Health Commercial |
$71,244.06
|
| Rate for Payer: Humana Commercial |
$63,744.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,494.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,345.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,498.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,994.50
|
| Rate for Payer: Ohio Health Group HMO |
$56,245.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59,995.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,244.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,745.69
|
| Rate for Payer: PHCS Commercial |
$71,994.00
|
| Rate for Payer: United Healthcare All Payer |
$65,994.50
|
|
|
IMPLANT OSS SEG ELLIPT 7CM R
|
Facility
|
OP
|
$74,993.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,498.12 |
| Max. Negotiated Rate |
$71,994.00 |
| Rate for Payer: Aetna Commercial |
$57,745.19
|
| Rate for Payer: Anthem Medicaid |
$25,790.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,495.12
|
| Rate for Payer: Cash Price |
$37,496.88
|
| Rate for Payer: Cigna Commercial |
$62,244.81
|
| Rate for Payer: First Health Commercial |
$71,244.06
|
| Rate for Payer: Humana Commercial |
$63,744.69
|
| Rate for Payer: Humana KY Medicaid |
$25,790.35
|
| Rate for Payer: Kentucky WC Medicaid |
$26,052.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,494.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,345.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,498.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,307.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$65,994.50
|
| Rate for Payer: Ohio Health Group HMO |
$56,245.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59,995.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65,244.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51,745.69
|
| Rate for Payer: PHCS Commercial |
$71,994.00
|
| Rate for Payer: United Healthcare All Payer |
$65,994.50
|
|
|
IMPLANT OSS SEG FEM 7CM L
|
Facility
|
IP
|
$76,180.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,854.22 |
| Max. Negotiated Rate |
$73,133.49 |
| Rate for Payer: Aetna Commercial |
$58,659.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,420.96
|
| Rate for Payer: Cash Price |
$38,090.36
|
| Rate for Payer: Cigna Commercial |
$63,230.00
|
| Rate for Payer: First Health Commercial |
$72,371.68
|
| Rate for Payer: Humana Commercial |
$64,753.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,468.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,221.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,854.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,039.03
|
| Rate for Payer: Ohio Health Group HMO |
$57,135.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,944.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66,277.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52,564.70
|
| Rate for Payer: PHCS Commercial |
$73,133.49
|
| Rate for Payer: United Healthcare All Payer |
$67,039.03
|
|
|
IMPLANT OSS SEG FEM 7CM L
|
Facility
|
OP
|
$76,180.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,854.22 |
| Max. Negotiated Rate |
$73,133.49 |
| Rate for Payer: Aetna Commercial |
$58,659.15
|
| Rate for Payer: Anthem Medicaid |
$26,198.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,420.96
|
| Rate for Payer: Cash Price |
$38,090.36
|
| Rate for Payer: Cigna Commercial |
$63,230.00
|
| Rate for Payer: First Health Commercial |
$72,371.68
|
| Rate for Payer: Humana Commercial |
$64,753.61
|
| Rate for Payer: Humana KY Medicaid |
$26,198.55
|
| Rate for Payer: Kentucky WC Medicaid |
$26,465.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,468.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,221.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,854.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,724.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,039.03
|
| Rate for Payer: Ohio Health Group HMO |
$57,135.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,944.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66,277.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52,564.70
|
| Rate for Payer: PHCS Commercial |
$73,133.49
|
| Rate for Payer: United Healthcare All Payer |
$67,039.03
|
|
|
IMPLANT OSS SEG FEM 7CM R
|
Facility
|
IP
|
$72,443.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,733.10 |
| Max. Negotiated Rate |
$69,545.90 |
| Rate for Payer: Aetna Commercial |
$55,781.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,506.05
|
| Rate for Payer: Cash Price |
$36,221.82
|
| Rate for Payer: Cigna Commercial |
$60,128.23
|
| Rate for Payer: First Health Commercial |
$68,821.47
|
| Rate for Payer: Humana Commercial |
$61,577.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,403.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,463.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,733.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,750.41
|
| Rate for Payer: Ohio Health Group HMO |
$54,332.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,954.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,025.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,986.12
|
| Rate for Payer: PHCS Commercial |
$69,545.90
|
| Rate for Payer: United Healthcare All Payer |
$63,750.41
|
|
|
IMPLANT OSS SEG FEM 7CM R
|
Facility
|
OP
|
$72,443.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,733.10 |
| Max. Negotiated Rate |
$69,545.90 |
| Rate for Payer: Aetna Commercial |
$55,781.61
|
| Rate for Payer: Anthem Medicaid |
$24,913.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,506.05
|
| Rate for Payer: Cash Price |
$36,221.82
|
| Rate for Payer: Cigna Commercial |
$60,128.23
|
| Rate for Payer: First Health Commercial |
$68,821.47
|
| Rate for Payer: Humana Commercial |
$61,577.10
|
| Rate for Payer: Humana KY Medicaid |
$24,913.37
|
| Rate for Payer: Kentucky WC Medicaid |
$25,166.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,403.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,463.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,733.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,413.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,750.41
|
| Rate for Payer: Ohio Health Group HMO |
$54,332.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57,954.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63,025.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49,986.12
|
| Rate for Payer: PHCS Commercial |
$69,545.90
|
| Rate for Payer: United Healthcare All Payer |
$63,750.41
|
|
|
IMPLANT RESTORE
|
Facility
|
IP
|
$11,830.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,549.27 |
| Max. Negotiated Rate |
$11,357.66 |
| Rate for Payer: Aetna Commercial |
$9,109.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,228.10
|
| Rate for Payer: Cash Price |
$5,915.45
|
| Rate for Payer: Cigna Commercial |
$9,819.65
|
| Rate for Payer: First Health Commercial |
$11,239.35
|
| Rate for Payer: Humana Commercial |
$10,056.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,701.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,731.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,549.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,411.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,873.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,464.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,292.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,163.32
|
| Rate for Payer: PHCS Commercial |
$11,357.66
|
| Rate for Payer: United Healthcare All Payer |
$10,411.19
|
|
|
IMPLANT RESTORE
|
Facility
|
OP
|
$11,830.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,549.27 |
| Max. Negotiated Rate |
$11,357.66 |
| Rate for Payer: Aetna Commercial |
$9,109.79
|
| Rate for Payer: Anthem Medicaid |
$4,068.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,228.10
|
| Rate for Payer: Cash Price |
$5,915.45
|
| Rate for Payer: Cigna Commercial |
$9,819.65
|
| Rate for Payer: First Health Commercial |
$11,239.35
|
| Rate for Payer: Humana Commercial |
$10,056.26
|
| Rate for Payer: Humana KY Medicaid |
$4,068.65
|
| Rate for Payer: Kentucky WC Medicaid |
$4,110.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,701.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,731.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,549.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,150.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,411.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,873.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,464.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,292.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,163.32
|
| Rate for Payer: PHCS Commercial |
$11,357.66
|
| Rate for Payer: United Healthcare All Payer |
$10,411.19
|
|
|
IMPLANT SYSTEM CPR MINI SCORP
|
Facility
|
IP
|
$6,996.75
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,099.03 |
| Max. Negotiated Rate |
$6,716.88 |
| Rate for Payer: Aetna Commercial |
$5,387.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,457.47
|
| Rate for Payer: Cash Price |
$3,498.38
|
| Rate for Payer: Cigna Commercial |
$5,807.30
|
| Rate for Payer: First Health Commercial |
$6,646.91
|
| Rate for Payer: Humana Commercial |
$5,947.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,163.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.14
|
| Rate for Payer: Ohio Health Group HMO |
$5,247.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,597.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,087.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,827.76
|
| Rate for Payer: PHCS Commercial |
$6,716.88
|
| Rate for Payer: United Healthcare All Payer |
$6,157.14
|
|
|
IMPLANT SYSTEM CPR MINI SCORP
|
Facility
|
OP
|
$6,996.75
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,099.03 |
| Max. Negotiated Rate |
$6,716.88 |
| Rate for Payer: Aetna Commercial |
$5,387.50
|
| Rate for Payer: Anthem Medicaid |
$2,406.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,457.47
|
| Rate for Payer: Cash Price |
$3,498.38
|
| Rate for Payer: Cigna Commercial |
$5,807.30
|
| Rate for Payer: First Health Commercial |
$6,646.91
|
| Rate for Payer: Humana Commercial |
$5,947.24
|
| Rate for Payer: Humana KY Medicaid |
$2,406.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,430.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,163.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,454.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.14
|
| Rate for Payer: Ohio Health Group HMO |
$5,247.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,597.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,087.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,827.76
|
| Rate for Payer: PHCS Commercial |
$6,716.88
|
| Rate for Payer: United Healthcare All Payer |
$6,157.14
|
|
|
IMPLANT SYSTEM CPR VIPER
|
Facility
|
IP
|
$6,996.75
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,099.03 |
| Max. Negotiated Rate |
$6,716.88 |
| Rate for Payer: Aetna Commercial |
$5,387.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,457.47
|
| Rate for Payer: Cash Price |
$3,498.38
|
| Rate for Payer: Cigna Commercial |
$5,807.30
|
| Rate for Payer: First Health Commercial |
$6,646.91
|
| Rate for Payer: Humana Commercial |
$5,947.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,163.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.14
|
| Rate for Payer: Ohio Health Group HMO |
$5,247.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,597.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,087.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,827.76
|
| Rate for Payer: PHCS Commercial |
$6,716.88
|
| Rate for Payer: United Healthcare All Payer |
$6,157.14
|
|
|
IMPLANT SYSTEM CPR VIPER
|
Facility
|
OP
|
$6,996.75
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,099.03 |
| Max. Negotiated Rate |
$6,716.88 |
| Rate for Payer: Aetna Commercial |
$5,387.50
|
| Rate for Payer: Anthem Medicaid |
$2,406.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,457.47
|
| Rate for Payer: Cash Price |
$3,498.38
|
| Rate for Payer: Cigna Commercial |
$5,807.30
|
| Rate for Payer: First Health Commercial |
$6,646.91
|
| Rate for Payer: Humana Commercial |
$5,947.24
|
| Rate for Payer: Humana KY Medicaid |
$2,406.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,430.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,163.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,454.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.14
|
| Rate for Payer: Ohio Health Group HMO |
$5,247.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,597.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,087.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,827.76
|
| Rate for Payer: PHCS Commercial |
$6,716.88
|
| Rate for Payer: United Healthcare All Payer |
$6,157.14
|
|
|
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 |
$2,030.40 |
| Rate for Payer: Aetna Commercial |
$1,939.00
|
| Rate for Payer: Ambetter Exchange |
$1,225.10
|
| Rate for Payer: Anthem Medicaid |
$1,020.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,225.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,225.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,470.12
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,225.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,225.10
|
| 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 |
$1,592.63
|
| Rate for Payer: UHCCP Medicaid |
$1,184.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,030.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,225.10
|
|
|
IMPLANT VENTRICULAR DEVICE
|
Facility
|
IP
|
$3,384.00
|
|
|
Service Code
|
HCPCS 33975
|
| Hospital Charge Code |
76101329
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,015.20 |
| Max. Negotiated Rate |
$3,248.64 |
| Rate for Payer: Aetna Commercial |
$2,605.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,639.52
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cigna Commercial |
$2,808.72
|
| Rate for Payer: First Health Commercial |
$3,214.80
|
| Rate for Payer: Humana Commercial |
$2,876.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,774.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,497.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,015.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,977.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,538.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,707.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,944.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,334.96
|
| Rate for Payer: PHCS Commercial |
$3,248.64
|
| Rate for Payer: United Healthcare All Payer |
$2,977.92
|
|
|
IMPLANT VENTRICULAR DEVICE
|
Facility
|
OP
|
$3,384.00
|
|
|
Service Code
|
HCPCS 33975
|
| Hospital Charge Code |
76101329
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,015.20 |
| Max. Negotiated Rate |
$3,248.64 |
| Rate for Payer: Aetna Commercial |
$2,605.68
|
| Rate for Payer: Anthem Medicaid |
$1,163.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,639.52
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cigna Commercial |
$2,808.72
|
| Rate for Payer: First Health Commercial |
$3,214.80
|
| Rate for Payer: Humana Commercial |
$2,876.40
|
| Rate for Payer: Humana KY Medicaid |
$1,163.76
|
| Rate for Payer: Kentucky WC Medicaid |
$1,175.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,774.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,497.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,015.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,187.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,977.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,538.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,707.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,944.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,334.96
|
| Rate for Payer: PHCS Commercial |
$3,248.64
|
| Rate for Payer: United Healthcare All Payer |
$2,977.92
|
|
|
IMPLANT VENTRICULAR DEVICE(P
|
Professional
|
Both
|
$3,384.00
|
|
|
Service Code
|
HCPCS 33975
|
| Hospital Charge Code |
761P1329
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,020.70 |
| Max. Negotiated Rate |
$2,030.40 |
| Rate for Payer: Aetna Commercial |
$1,939.00
|
| Rate for Payer: Ambetter Exchange |
$1,225.10
|
| Rate for Payer: Anthem Medicaid |
$1,020.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,225.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,225.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,470.12
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,225.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,225.10
|
| 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 |
$1,592.63
|
| Rate for Payer: UHCCP Medicaid |
$1,184.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,030.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,225.10
|
|
|
IMPL DELIVERY SYS DIST BICEPS
|
Facility
|
OP
|
$7,015.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,104.50 |
| Max. Negotiated Rate |
$6,734.40 |
| Rate for Payer: Aetna Commercial |
$5,401.55
|
| Rate for Payer: Anthem Medicaid |
$2,412.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,471.70
|
| Rate for Payer: Cash Price |
$3,507.50
|
| Rate for Payer: Cigna Commercial |
$5,822.45
|
| Rate for Payer: First Health Commercial |
$6,664.25
|
| Rate for Payer: Humana Commercial |
$5,962.75
|
| Rate for Payer: Humana KY Medicaid |
$2,412.46
|
| Rate for Payer: Kentucky WC Medicaid |
$2,437.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,752.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,460.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,173.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,612.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,103.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,840.35
|
| Rate for Payer: PHCS Commercial |
$6,734.40
|
| Rate for Payer: United Healthcare All Payer |
$6,173.20
|
|
|
IMPL DELIVERY SYS DIST BICEPS
|
Facility
|
IP
|
$7,015.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,104.50 |
| Max. Negotiated Rate |
$6,734.40 |
| Rate for Payer: Aetna Commercial |
$5,401.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,471.70
|
| Rate for Payer: Cash Price |
$3,507.50
|
| Rate for Payer: Cigna Commercial |
$5,822.45
|
| Rate for Payer: First Health Commercial |
$6,664.25
|
| Rate for Payer: Humana Commercial |
$5,962.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,752.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,173.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,612.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,103.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,840.35
|
| Rate for Payer: PHCS Commercial |
$6,734.40
|
| Rate for Payer: United Healthcare All Payer |
$6,173.20
|
|
|
IMPLNT MAL 650 PENIL 16CM*13MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
IMPLNT MAL 650 PENIL 16CM*13MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
IMPLNT OS SEG DIST-FEM 8.5CM L
|
Facility
|
IP
|
$70,709.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,212.72 |
| Max. Negotiated Rate |
$67,880.70 |
| Rate for Payer: Aetna Commercial |
$54,445.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55,153.07
|
| Rate for Payer: Cash Price |
$35,354.53
|
| Rate for Payer: Cigna Commercial |
$58,688.52
|
| Rate for Payer: First Health Commercial |
$67,173.61
|
| Rate for Payer: Humana Commercial |
$60,102.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,981.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52,183.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,212.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$62,223.97
|
| Rate for Payer: Ohio Health Group HMO |
$53,031.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56,567.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61,516.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48,789.25
|
| Rate for Payer: PHCS Commercial |
$67,880.70
|
| Rate for Payer: United Healthcare All Payer |
$62,223.97
|
|
