|
INSERT FLX XLPE HI PS 7-8 12MM
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
INSERT FLX XLPE HI PS 7-8 12MM
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
INSERT FX BEAR STB SZ 2 22.5MM
|
Facility
|
OP
|
$12,019.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,562.58 |
| Max. Negotiated Rate |
$11,539.06 |
| Rate for Payer: Aetna Commercial |
$9,255.28
|
| Rate for Payer: Anthem Medicaid |
$4,133.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,375.48
|
| Rate for Payer: Cash Price |
$6,009.92
|
| Rate for Payer: Cigna Commercial |
$9,976.48
|
| Rate for Payer: First Health Commercial |
$11,418.86
|
| Rate for Payer: Humana Commercial |
$10,216.87
|
| Rate for Payer: Humana KY Medicaid |
$4,133.63
|
| Rate for Payer: Kentucky WC Medicaid |
$4,175.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,856.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,870.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,605.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,216.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,577.47
|
| Rate for Payer: Ohio Health Group HMO |
$9,014.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,403.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,562.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,726.15
|
| Rate for Payer: PHCS Commercial |
$11,539.06
|
| Rate for Payer: United Healthcare All Payer |
$10,577.47
|
|
|
INSERT FX BEAR STB SZ 2 22.5MM
|
Facility
|
IP
|
$12,019.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,562.58 |
| Max. Negotiated Rate |
$11,539.06 |
| Rate for Payer: Aetna Commercial |
$9,255.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,375.48
|
| Rate for Payer: Cash Price |
$6,009.92
|
| Rate for Payer: Cigna Commercial |
$9,976.48
|
| Rate for Payer: First Health Commercial |
$11,418.86
|
| Rate for Payer: Humana Commercial |
$10,216.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,856.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,870.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,605.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,577.47
|
| Rate for Payer: Ohio Health Group HMO |
$9,014.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,403.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,562.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,726.15
|
| Rate for Payer: PHCS Commercial |
$11,539.06
|
| Rate for Payer: United Healthcare All Payer |
$10,577.47
|
|
|
INSERT FX BEAR STB SZ 2.5 15MM
|
Facility
|
IP
|
$15,687.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,039.39 |
| Max. Negotiated Rate |
$15,060.10 |
| Rate for Payer: Aetna Commercial |
$12,079.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,236.33
|
| Rate for Payer: Cash Price |
$7,843.80
|
| Rate for Payer: Cigna Commercial |
$13,020.71
|
| Rate for Payer: First Health Commercial |
$14,903.22
|
| Rate for Payer: Humana Commercial |
$13,334.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,863.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,577.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,706.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,805.09
|
| Rate for Payer: Ohio Health Group HMO |
$11,765.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,137.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,039.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,863.16
|
| Rate for Payer: PHCS Commercial |
$15,060.10
|
| Rate for Payer: United Healthcare All Payer |
$13,805.09
|
|
|
INSERT FX BEAR STB SZ 2.5 15MM
|
Facility
|
OP
|
$15,687.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,039.39 |
| Max. Negotiated Rate |
$15,060.10 |
| Rate for Payer: Aetna Commercial |
$12,079.45
|
| Rate for Payer: Anthem Medicaid |
$5,394.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,236.33
|
| Rate for Payer: Cash Price |
$7,843.80
|
| Rate for Payer: Cigna Commercial |
$13,020.71
|
| Rate for Payer: First Health Commercial |
$14,903.22
|
| Rate for Payer: Humana Commercial |
$13,334.46
|
| Rate for Payer: Humana KY Medicaid |
$5,394.97
|
| Rate for Payer: Kentucky WC Medicaid |
$5,449.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,863.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,577.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,706.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,503.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,805.09
|
| Rate for Payer: Ohio Health Group HMO |
$11,765.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,137.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,039.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,863.16
|
| Rate for Payer: PHCS Commercial |
$15,060.10
|
| Rate for Payer: United Healthcare All Payer |
$13,805.09
|
|
|
INSERT FX BEAR STB SZ 3 12.5MM
|
Facility
|
OP
|
$15,352.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.86 |
| Max. Negotiated Rate |
$14,738.69 |
| Rate for Payer: Aetna Commercial |
$11,821.66
|
| Rate for Payer: Anthem Medicaid |
$5,279.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,975.18
|
| Rate for Payer: Cash Price |
$7,676.40
|
| Rate for Payer: Cigna Commercial |
$12,742.82
|
| Rate for Payer: First Health Commercial |
$14,585.16
|
| Rate for Payer: Humana Commercial |
$13,049.88
|
| Rate for Payer: Humana KY Medicaid |
$5,279.83
|
| Rate for Payer: Kentucky WC Medicaid |
$5,333.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,589.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,330.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,605.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,385.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,510.46
|
| Rate for Payer: Ohio Health Group HMO |
$11,514.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,070.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,995.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,759.37
|
| Rate for Payer: PHCS Commercial |
$14,738.69
|
| Rate for Payer: United Healthcare All Payer |
$13,510.46
|
|
|
INSERT FX BEAR STB SZ 3 12.5MM
|
Facility
|
IP
|
$15,352.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.86 |
| Max. Negotiated Rate |
$14,738.69 |
| Rate for Payer: Aetna Commercial |
$11,821.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,975.18
|
| Rate for Payer: Cash Price |
$7,676.40
|
| Rate for Payer: Cigna Commercial |
$12,742.82
|
| Rate for Payer: First Health Commercial |
$14,585.16
|
| Rate for Payer: Humana Commercial |
$13,049.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,589.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,330.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,605.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,510.46
|
| Rate for Payer: Ohio Health Group HMO |
$11,514.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,070.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,995.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,759.37
|
| Rate for Payer: PHCS Commercial |
$14,738.69
|
| Rate for Payer: United Healthcare All Payer |
$13,510.46
|
|
|
INSERT FX BEAR STB SZ 3 8MM
|
Facility
|
IP
|
$9,928.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,290.70 |
| Max. Negotiated Rate |
$9,531.31 |
| Rate for Payer: Aetna Commercial |
$7,644.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,744.19
|
| Rate for Payer: Cash Price |
$4,964.23
|
| Rate for Payer: Cigna Commercial |
$8,240.61
|
| Rate for Payer: First Health Commercial |
$9,432.03
|
| Rate for Payer: Humana Commercial |
$8,439.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,141.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,327.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,978.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,737.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,446.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,985.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,290.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,077.82
|
| Rate for Payer: PHCS Commercial |
$9,531.31
|
| Rate for Payer: United Healthcare All Payer |
$8,737.04
|
|
|
INSERT FX BEAR STB SZ 3 8MM
|
Facility
|
OP
|
$9,928.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,290.70 |
| Max. Negotiated Rate |
$9,531.31 |
| Rate for Payer: Aetna Commercial |
$7,644.91
|
| Rate for Payer: Anthem Medicaid |
$3,414.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,744.19
|
| Rate for Payer: Cash Price |
$4,964.23
|
| Rate for Payer: Cigna Commercial |
$8,240.61
|
| Rate for Payer: First Health Commercial |
$9,432.03
|
| Rate for Payer: Humana Commercial |
$8,439.18
|
| Rate for Payer: Humana KY Medicaid |
$3,414.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,449.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,141.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,327.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,978.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,482.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,737.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,446.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,985.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,290.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,077.82
|
| Rate for Payer: PHCS Commercial |
$9,531.31
|
| Rate for Payer: United Healthcare All Payer |
$8,737.04
|
|
|
INSERT FX BEAR STB SZ 4 10MM
|
Facility
|
OP
|
$15,352.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.86 |
| Max. Negotiated Rate |
$14,738.69 |
| Rate for Payer: Aetna Commercial |
$11,821.66
|
| Rate for Payer: Anthem Medicaid |
$5,279.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,975.18
|
| Rate for Payer: Cash Price |
$7,676.40
|
| Rate for Payer: Cigna Commercial |
$12,742.82
|
| Rate for Payer: First Health Commercial |
$14,585.16
|
| Rate for Payer: Humana Commercial |
$13,049.88
|
| Rate for Payer: Humana KY Medicaid |
$5,279.83
|
| Rate for Payer: Kentucky WC Medicaid |
$5,333.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,589.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,330.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,605.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,385.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,510.46
|
| Rate for Payer: Ohio Health Group HMO |
$11,514.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,070.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,995.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,759.37
|
| Rate for Payer: PHCS Commercial |
$14,738.69
|
| Rate for Payer: United Healthcare All Payer |
$13,510.46
|
|
|
INSERT FX BEAR STB SZ 4 10MM
|
Facility
|
IP
|
$15,352.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,995.86 |
| Max. Negotiated Rate |
$14,738.69 |
| Rate for Payer: Aetna Commercial |
$11,821.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,975.18
|
| Rate for Payer: Cash Price |
$7,676.40
|
| Rate for Payer: Cigna Commercial |
$12,742.82
|
| Rate for Payer: First Health Commercial |
$14,585.16
|
| Rate for Payer: Humana Commercial |
$13,049.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,589.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,330.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,605.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,510.46
|
| Rate for Payer: Ohio Health Group HMO |
$11,514.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,070.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,995.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,759.37
|
| Rate for Payer: PHCS Commercial |
$14,738.69
|
| Rate for Payer: United Healthcare All Payer |
$13,510.46
|
|
|
INSERT GEN II PS FLEX SZ 1-2
|
Facility
|
IP
|
$5,084.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$660.92 |
| Max. Negotiated Rate |
$4,880.64 |
| Rate for Payer: Aetna Commercial |
$3,914.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,965.52
|
| Rate for Payer: Cash Price |
$2,542.00
|
| Rate for Payer: Cigna Commercial |
$4,219.72
|
| Rate for Payer: First Health Commercial |
$4,829.80
|
| Rate for Payer: Humana Commercial |
$4,321.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,168.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,751.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,525.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,473.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,813.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,016.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$660.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,576.04
|
| Rate for Payer: PHCS Commercial |
$4,880.64
|
| Rate for Payer: United Healthcare All Payer |
$4,473.92
|
|
|
INSERT GEN II PS FLEX SZ 1-2
|
Facility
|
OP
|
$5,084.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$660.92 |
| Max. Negotiated Rate |
$4,880.64 |
| Rate for Payer: Aetna Commercial |
$3,914.68
|
| Rate for Payer: Anthem Medicaid |
$1,748.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,965.52
|
| Rate for Payer: Cash Price |
$2,542.00
|
| Rate for Payer: Cigna Commercial |
$4,219.72
|
| Rate for Payer: First Health Commercial |
$4,829.80
|
| Rate for Payer: Humana Commercial |
$4,321.40
|
| Rate for Payer: Humana KY Medicaid |
$1,748.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,766.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,168.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,751.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,525.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,783.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,473.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,813.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,016.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$660.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,576.04
|
| Rate for Payer: PHCS Commercial |
$4,880.64
|
| Rate for Payer: United Healthcare All Payer |
$4,473.92
|
|
|
INSERT GEN II PS FLEX SZ 5-6
|
Facility
|
OP
|
$5,084.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$660.92 |
| Max. Negotiated Rate |
$4,880.64 |
| Rate for Payer: Aetna Commercial |
$3,914.68
|
| Rate for Payer: Anthem Medicaid |
$1,748.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,965.52
|
| Rate for Payer: Cash Price |
$2,542.00
|
| Rate for Payer: Cigna Commercial |
$4,219.72
|
| Rate for Payer: First Health Commercial |
$4,829.80
|
| Rate for Payer: Humana Commercial |
$4,321.40
|
| Rate for Payer: Humana KY Medicaid |
$1,748.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,766.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,168.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,751.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,525.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,783.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,473.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,813.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,016.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$660.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,576.04
|
| Rate for Payer: PHCS Commercial |
$4,880.64
|
| Rate for Payer: United Healthcare All Payer |
$4,473.92
|
|
|
INSERT GEN II PS FLEX SZ 5-6
|
Facility
|
IP
|
$5,084.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$660.92 |
| Max. Negotiated Rate |
$4,880.64 |
| Rate for Payer: Aetna Commercial |
$3,914.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,965.52
|
| Rate for Payer: Cash Price |
$2,542.00
|
| Rate for Payer: Cigna Commercial |
$4,219.72
|
| Rate for Payer: First Health Commercial |
$4,829.80
|
| Rate for Payer: Humana Commercial |
$4,321.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,168.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,751.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,525.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,473.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,813.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,016.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$660.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,576.04
|
| Rate for Payer: PHCS Commercial |
$4,880.64
|
| Rate for Payer: United Healthcare All Payer |
$4,473.92
|
|
|
INSERT GII PS SZ 3-4 11MM
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
INSERT GII PS SZ 3-4 11MM
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
INSERT GII PS SZ 3-4 9MM
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
INSERT GII PS SZ 3-4 9MM
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
INSERT GII PS SZ 5-6 11MM
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
INSERT GII PS SZ 5-6 11MM
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
INSERT GII PS SZ 5-6 9MM
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
INSERT GII PS SZ 5-6 9MM
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
INSERT IABP PERCUTANEOUS
|
Facility
|
IP
|
$3,336.00
|
|
|
Service Code
|
HCPCS 33967
|
| Hospital Charge Code |
48100003
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$433.68 |
| Max. Negotiated Rate |
$3,202.56 |
| Rate for Payer: Aetna Commercial |
$2,568.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,602.08
|
| Rate for Payer: Cash Price |
$1,668.00
|
| Rate for Payer: Cigna Commercial |
$2,768.88
|
| Rate for Payer: First Health Commercial |
$3,169.20
|
| Rate for Payer: Humana Commercial |
$2,835.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,735.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,461.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,000.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,935.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,502.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$667.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$433.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,034.16
|
| Rate for Payer: PHCS Commercial |
$3,202.56
|
| Rate for Payer: United Healthcare All Payer |
$2,935.68
|
|
